Primary Nocturnal Enuresis

Nocturnal enuresis, commonly known as bedwetting, is a frequent condition that affects many children and can have a significant impact on their self-esteem, social life, and family stress. The causes of bedwetting can vary widely, ranging from deep sleep patterns and excess nighttime urine production to underlying medical conditions like constipation, urinary tract infections, or enlarged tonsils and adenoids (which can affect breathing during sleep).The main goal of this descriptive study is to understand the different types and the underlying causes of bedwetting among children attending the pediatric outpatient clinics at Assiut University Children's Hospital. By identifying these specific causes in the local population, healthcare providers can offer better, more targeted treatments and help reduce the stigma surrounding this condition. During a single clinic visit, researchers will collect information through a structured interview with the parents and the child. The study involves a routine physical examination, including checking weight, height, and looking for physical signs of constipation or enlarged tonsils. Participants will also undergo standard tests to help pinpoint any medical causes, such as a urine test (urinalysis and culture), a basic ultrasound of the abdomen and pelvis, and potentially plain X-rays if issues like severe constipation or airway blockages are suspected. The study aims to include at least 80 male and female children aged 5 years and older who have been experiencing bedwetting at least twice a week for three months or more.

Primary nocturnal enuresis (PNE), a prevalent pediatric disorder, suffers from therapeutic limitations characterized by low efficacy and high relapse rates. Targeting its core pathophysiology could significantly improve treatment outcomes. Growing evidence implicates circadian dysregulation in PNE pathogenesis. Our preliminary fMRI cohort identified abnormal functional connectivity between the suprachiasmatic nucleus (SCN, the central circadian pacemaker) and superior temporal gyrus in PNE patients, with clinical data confirming circadian realignment correlates with symptom remission. Small-scale pilot studies and clinical observations indicate that modulating central and peripheral circadian rhythms significantly alleviates PNE symptoms. This study will establish a circadian-focused PNE cohort to quantify therapeutic efficacy and elucidate underlying mechanisms, ultimately driving the development of mechanism-based therapies for PNE.

Urine storage and voiding are fundamental physiological processes. In clinical settings, many cases of lower urinary tract dysfunction (LUTD) are closely associated with abnormal conditioned reflexes formed in the central nervous system during the urine storage or voiding phases. Relaxation, as a core physiological and psychological state, has been shown to promote effective urine storage and facilitate smooth voiding. By repeatedly training individuals to establish a new conditioned reflex linking the sensation of urinary urgency with a state of relaxation, it may be possible to improve bladder storage capacity and voiding function. Based on this concept, the investigators have developed the world's first Micturition Desire-Relaxation Training Device (Chinese Patent No.: ZL 2020 1 0397789.4). This study aims to evaluate the clinical efficacy of this device in treating LUTD in children.

The aim of this randomized controlled trial is to evaluate the effects of Structured Pelvic Floor Muscle Rehabilitation (SPFMR) in children with Primary Monosymptomatic Nocturnal Enuresis (PMNE) who are undergoing desmopressin asetat (DDAVP) treatment prescribed by a pediatric urologist. The study aims to investigate whether SPFMR can reduce the frequency and severity of enuresis episodes and whether it can also reduce relapse rates in the short- and long-term follow-up. The main questions the study seeks to answer are: * Does SPFMR reduce the frequency and severity of enuresis episodes in children with PMNE? * Does SPFMR treatment reduce relapse rates in children with PMNE in the long term? Researchers will compare the group receiving SPFMR in addition to DDAVP treatment with a control group receiving only DDAVP treatment. This comparison will help evaluate the effect of SPFMR on the severity of enuresis episodes and relapse rates. Participants will: * Receive DDAVP treatment (SPFMR group and Control group) * Participate in SPFMR sessions ( SPFMR group) * Keep a diary of enuresis frequency and severity * Assess relapse during short- and long-term follow-up The hypotheses of the study are: H0: Adding SPFMR to desmopressin treatment for children with PMNE has no short-term effect on the severity of enuresis episodes. H1: Adding SPFMR to desmopressin treatment for children with PMNE has a short-term effect on the severity of enuresis episodes. H0: Adding SPFMR to desmopressin treatment for children with PMNE has no long-term effect on the severity of enuresis episodes. H2: Adding SPFMR to desmopressin treatment for children with PMNE has a long-term effect on the severity of enuresis episodes.

1. Primary Aim: To evaluate the efficacy of atomoxetine in reducing the frequency of primary nocturnal enuresis episodes in children with ADHD. 2. Secondary Aim: To determine if improvements in attention symptoms correlate with reductions in nocturnal enuresis episodes.