Carvalho Tânia Antunes, Vasconcelos Mônica Maria de Almeida, Guimarães Isabela Cristina de Oliveira, Dutra Melissa Faria, Lima Eleonora Moreira, Bastos Netto José Murillo, de Bessa Junior José, Simões E Silva Ana Cristina, de Carvalho Mrad Flávia Cristina
Universidade Federal de Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil.
Federal University of Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil.
J Pediatr Urol. 2022 Oct;18(5):554-562. doi: 10.1016/j.jpurol.2022.07.033. Epub 2022 Aug 10.
Primary nocturnal enuresis (PNE) affects the quality of life of children and families and may lead to low self-esteem and social isolation. The pathophysiology of enuresis is multifactorial. This systematic review aimed to investigate the relationship between toilet training (TT) and PNE in children and adolescents.
We searched for articles about TT and PNE in MEDLINE (via PubMed), SCOPUS and WEB of SCIENCE databases. The Preferred Reporting Items for Systematic Reviews (PRISMA) statement was used to guide the systematic review. Prior to the study, the review protocol was registered and approved in PROSPERO under the protocol CRD42021270976. The Risk of Bias in Non-Randomized Studies of Exposures (ROBINS-E) was used to analyze the biases of the select studies.
A total of 570 studies were initially selected. Of these, eight articles were included in this systematic review, with a total number of 5990 participants aged between 5 and 18 years diagnosed with PNE. Seven of the eight articles reported that prolonged use of disposable diapers for more than one-year, late initiation of the TT process or non-acceptance of the Assisted Infant TT or Elimination Communication approach, use of coercive approaches, and complete of TT after 24 months of age increase the risk of enuresis. Only one of the selected studies did not find an association between the start of TT after 24 months of age and the presence of isolated PNE. Three studies did not mention the approach used in the TT process.
Most of the articles reviewed showed that prolonged diaper use, delay in the start or completion of the TT and use of coercive approaches increase the risk of enuresis. On the other hand, one study showed no relationship between the start of TT after 24 months of age and the presence of isolated enuresis.
原发性夜间遗尿症（PNE）会影响儿童及其家庭的生活质量，并可能导致自卑和社交孤立。遗尿症的病理生理学是多因素的。本系统评价旨在研究儿童和青少年的如厕训练（TT）与PNE之间的关系。
我们在MEDLINE（通过PubMed）、SCOPUS和科学网数据库中搜索关于TT和PNE的文章。系统评价采用系统评价的首选报告项目（PRISMA）声明进行指导。在研究之前，该评价方案已在PROSPERO上注册并获得批准，方案编号为CRD42021270976。暴露的非随机研究中的偏倚风险（ROBINS-E）用于分析所选研究的偏倚。
最初共筛选出570项研究。其中，8篇文章纳入本系统评价，共有5990名年龄在5至18岁之间被诊断为PNE的参与者。8篇文章中有7篇报告称，长期使用一次性尿布超过一年、TT过程开始较晚或不接受辅助婴儿TT或排泄沟通方法、使用强制方法以及在24个月龄后完成TT会增加遗尿风险。所选研究中只有1项未发现24个月龄后开始TT与孤立性PNE之间存在关联。3项研究未提及TT过程中使用的方法。
大多数综述文章表明，长期使用尿布、TT开始或完成延迟以及使用强制方法会增加遗尿风险。另一方面，1项研究表明24个月龄后开始TT与孤立性遗尿之间没有关系。
