| Enuresis is one of the most common urinary diseases in preschool and school-age children. The disease will affect psychological development of the patients. The standard clinical randomized controlled trials evaluate the value of behavior therapy, alarm therapy and drug therapy on the treatment of childhood enuresis objectively. A guideline of the diagnosis and treatment of enuresis has been published by the International Children's Continence Society, ICCS in 2010. Desmopressin is now recognized as the first line drug treatment in childhood enuresis. With the advent of new formulations in recent years, there have been several randomized clinical studies comparing the use of two different formulations of desmopressin on efficacy, tolerance of the patient and side effects. This article searchs the relevant literature and evaluate the compliance, efficacy and safety of different formulations of desmopressin in the treatment of childhood enuresis through Meta-analysis.The baseline data similarities of various clinical trials which use tradition Chinese medicine to treat childhood enuresis are poor. Since that the composition of prescriptions differs among each other, it is useless to evaluate these clinical trials objectively via Meta-analysis. The fundamental reason is that there is lack of guidelines of childhood enuresis in Traditional Chinese Medicine. The Traditional Chinese Medicine Association has organized pediatricians to establish a scientific and practical "Guildline of Chinese medicine in the treatment of childhood enuresis". This article investigates the diagnosis and treatment in Traditional Chinese Medicine through Delphi method, in order to provide a reference for the Chinese medicine guildline of childhood enuresis. 1. Meta-analysis of different formulations of desmopressin in the treatment of childhood enuresis.Selective and deletion criteria are set according to the research. Use key words to search databases including Chinese Biomedical Literature Database, Chinese Academic Journal Database, Cochrane Library, Medline, EMBASE and OVID. Acquire full texts of the relavant articles on comparison between different formulations of desmopressin in the treatment of childhood enuresis. Assess the quality of the literature. Analyse the selective literature by RevMan 5.0 Meta-analysis. Evaluate the compliance, efficacy and tolerance of different formulations of desmopressin in the treatment of childhood enuresis.2. Evaluation of the diagnosis and treatment of childhood enuresis in Tradition Chinese Medicine via Delphi methods.Summary current guildline of diagnosis and treatment of enuresis and include the possible relavant items of enuresis in a questionnaire. Select of 30～40 senoir Chinese medicine pediatricians who have more than 15 years working experience and have a certain expertise on enuresis. Use Delphi methods to evaluate the diagnosis and treatment of childhood enuresis in Tradition Chinese Medicine by questionnaires. Form a primary draft to provide a reference for the Chinese medicine guildline of childhood enuresis.Results1. Meta-analysis of different formulations of desmopressin in the treatment of childhood enuresis.1) There is no significant difference between sublingual and tablet Desmopressin in efficacy of the treatment of childhood enuresis, MD=-0.02 (95% CI:[-0.31, 0.26]), P=0.87. 2) Desmopressin nasal spray is more effective than desmopressin tablets in the treatment of childhood enuresis, MD=-0.43 (95% CI:[-0.60,-0.26]), P <0.00001.3) Sublingual Desmopressin has significantly better compliance than tablets Desmopressin in the treatment of childhood enuresis, OR=2.19 (95% CI:[1.20, 4.01]), P=0.01.2. Evaluation of the diagnosis and treatment of childhood enuresis in Tradition Chinese Medicine via Delphi methods.1) According to the questionnaire results designed by Delphi method:enuresis in children has four syptoms including "Shen Qi Bu Zu", "Fei Pi Qi Xu", "Shi Re Yu Jie", and "Xin Shen Shi Jiao". The average values of these four symptoms each is 1.97,1.97,1.65,1.62; the sum of either symptom is≥50% full score. Coefficient of variation of each is 0.09,0.09,0.36, and 0.37.2) In the diagnosis of "Shen Qi Bu Zu", the values which range between 1 and 2, and sum≥50% full score include:nocturnal enuresis, nocturnal polyuria, night enuresis more than once, polyuria, long and clear urine, waist soreness, soft knees, pale, feeling cold, pale tongue, white moss and slippery pulse, and weak pulse.3) In the diagnosis of "Fei Pi Qi Xu", the values which range between 1 and 2, and sum≥50% full score include:nocturnal enuresis, daytime enuresis, night urination, and urination during the day, more than one night enuresis, large volume urine output, long and clear urine, loose stools, frequent urination, pale, poor appetite, sweating, pale tongue, pink tongue, thin white moss, weak pulse, and slow pulse.4) In the diagnosis of "Shi Re Yu Jie", the values which range between 1 and 2, and sum≥50% full score include:nocturnal enuresis, daytime enuresis, nocturnal polyuria, less urine, yellow urine, dry and hard stool, teeth at night, constipation, thirst, night insomnia, red eyes, red tongue, yellow moss, and slippery pulse.5) In the diagnosis of "Xin Shen Shi Jiao", the values which range between 1 and 2, and sum≥50% full score include:nocturnal enuresis, nocturnal polyuria, emaciated, hyperactivity, deep sleep, poor memory, night insomnia, easy to cry, easily frightened, night sweating, red tongue, little moss, and breakdown pulse.6) The value of "Suo Quan Wan" in treating"Shen Qi Bu Zu" syndrome of childhood enuresis is 1.58; R value is 6.06, which indicates recognition of this prescription in treating "Shen Qi Bu Zu" syndrome.7) The value of "Bu Zhong Yi Qi Tang" in treating "Fei Pi Qi Xu" syndrome of childhood enuresis is 2.00; R value is 66.00, indicating advocating of this prescription in treating "Fei Pi Qi Xu" syndrome.8) The value of "Long Dan Xie Gan Tang" in treating "Shi Re Yu Jie" syndrome of childhood enuresis is 1.70; R value is 0.09; CV value of 0.38. While the value of "Ba Zheng San" is 1.15; R value is 18.18. The results suggest that these two prescriptions are recommended in the treatment of "Shi Re Yu Jie" syndrome.9) The value of "Jiao Tai Wan" in treating "Xin Shen Shi Jiao" syndrome of childhood enuresis is 1.94; R value is 0; CV values of 0.12, indicating approval of this prescription in the treatment of "Xin Shen Shi Jiao" syndrome.ConclusionThis articles shows that there is no significant difference between sublingual and tablet Desmopressin in efficacy of the treatment of childhood enuresis via Meta analysis. But sublingual Desmopressin has significantly better compliance than tablets. Delphi method demonstrates there are four common types of childhood enuresis in Tradition Chinese Medicine including "Shen Qi Bu Zu", "Fei Pi Qi Xu", "Shi Re Yu Jie", and "Xin Shen Shi Jiao". Summary the TCM clinical characteristics of differentiation in each four syndrome. The corresponding treatment of each four kinds of TCM syndromes is "Suo Quan Wan", "Bu Zhong Yi Qi Tang", "Long Dan Xie Gan Tang" and "Jiao Thai Wan". |
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