Editorial Comment: A few older patients with persistent vesicoureteral reflux continue tohave trouble with breakthrough urinary tract infections despite normal voiding patterns. Anopen surgical approach in an adult is a far more difficult procedure than in a child, particularlya young child. In this short preliminary report on 6 females the authors were successful inperforming an extravesical ureteral reimplant using a modified detrusorrhaphy dissection.

The procedure is well documented and illustrated. A minimally invasive approach, eitherlaparoscopic or vesicoscopic, may become the procedure of choice in those adults with failedendoscopic injection.

Douglas A. Canning, M.D.

Effect of Alarm Treatment on Bladder Storage Capacities in Monosymptomatic Nocturnal En-uresis

C. TANELI, P. ERTAN, F. TANELI, A. GENç, C. GUNSAR, A. SENCAN, E. MIR AND A. ONAG, Departments of PediatricSurgery, Pediatrics and Clinical Biochemistry, Faculty of Medicine, Celal Bayar University, Manisa,Turkey

Scand J Urol Nephrol, 38: 207–210, 2004

Objective: Despite a great number of studies, very little is known about the mechanism of action ofenuresis alarm systems. Nevertheless, as a result of this treatment many children are able firstly to wakeup before urination occurs and then, in time, to sleep through the night without voiding. The aim of thisstudy was to investigate the effect of enuresis alarms on bladder storage capacities.

Material and Methods: A total of 28 children aged �7 years who were not polyuric but who voided onceevery night, slept alone in their own bedroom and who were willing, along with their family members, tocooperate were recruited. Patients were asked to record their urine output using a frequency/volume chartfor two consecutive days. After these records and the results of physical and laboratory examinations weretaken into consideration, treatment was instituted with the bell-and-pad (alarm) system for a period of 12weeks. At the end of this period, patients were asked to complete another frequency/volume chart.

Results: The pre- and post-treatment maximum functional bladder capacity was 178.35 � 87.86 ml and243.03 � 102.84 ml, respectively and the pre- and post-treatment mean day-time bladder capacity was111.11 � 45.87 and 148.445 � 7.68 ml. Both of these differences were statistically significant (p �0.0001and �0.0001, respectively). The maximum nocturnal bladder capacity was found to be increased from177.85 � 84.95 to 255.25 � 124.52 ml after treatment (p �0.0001).

Conclusion: Treatment with the alarm system for a period of 12 weeks was seen to be associated with asignificant increase in bladder storage capacities (maximum nocturnal bladder capacity, maximum func-tional bladder capacity and mean day-time bladder capacity).

Alarm Treatment is Successful in Children With Day- and Night-Time Wetting

F. J. M. VAN LEERDAM, M. N. BLANKESPOOR, A. J. VAN DER HEIJDEN AND R. A. HIRAING, Department of SocialMedicine, Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam,TNO Prevention and Health, Leiden and Sophia Children Hospital, Erasmus University Rotterdam,Rotterdam, The Netherlands

Scand J Urol Nephrol, 38: 211–215, 2004

Objective: To assess the effect of alarm treatment in children with day- and night-time wetting comparedto those with night-time wetting only.

Material and Methods: A total of 37 consecutive children (25 boys, 12 girls), all of whom suffered from bothday- and night-time wetting, were compared to a group of 21 boys and 16 girls with nocturnal enuresis only.In both groups the age range was 5–13 years. Inclusion criteria were at least two wet nights a week in theprevious 4 weeks combined with day-time wetting. The parents were asked to complete a diary during thestudy period.

Results: Sixty-five percent of the children with day- and night-time wetting became dry at night, theaverage time needed being 49 days (range 22–134 days). Seventy-six percent of the children with onlynight-time wetting became dry at night, the average time needed being 52 days (range 22–121 days). Nosignificant differences were found between the success rates for the two groups or between the different agegroups in the two groups. Of the children with day- and night-time wetting who became dry at night afteralarm treatment, 42% also became dry during the day-time. Two years after alarm treatment, 15/16 tracedchildren were still dry at night and all 10 traced children were still dry during the day-time.

Conclusions: As with children with only night-time wetting, the majority of children with day- andnight-time wetting become dry at night with the use of an enuresis alarm. The results are good comparedto the spontaneous cure rate. By using alarm treatment at night, children often also become dry during theday.

Editorial Comment: Taneli et al found that the median number of daytime voids, maximumfunctional bladder capacity, mean daytime bladder capacity and maximum nocturnal bladder

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