***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Patients with symptoms of frequency and urgency often complain that their symptoms are exacerbated by tea or coffee . A series of 20 women with confirmed detrusor instability and 10 asymptomatic women were given 200 mg of caffeine citrate and urodynamic studies were performed . In the group with detrusor instability there was a statistically significant increase in detrusor pressure on bladder filling following administration of caffeine , but no difference in volume at first contraction , height of contraction or bladder capacity . Normal women had no abnormality on cystometry PURPOSE We estimated the spectrum and risk factors for daytime urinary incontinence in school-age children . MATERIAL S AND METHODS A vali date d , reproducible , parent administered daytime incontinence question naire was distributed to r and omly selected school children . The question naire elicited information on demographic factors , prenatal and developmental factors , and bowel and urinary history . The spectrum of daytime urinary incontinence was measured by recording the frequency and amount of incontinence . RESULTS Parents of 2,856 children ( mean age 7.3 years ) completed the question naire . Overall 16.9 % reported any daytime urinary incontinence in the previous 6 months , with 64 % of cases being very mild , 14.8 % mild , 11.6 % moderate and 9.6 % severe . There was low agreement between frequency and amount of incontinence ( weighted kappa 0.03 ) but risk factors were similar . Independent risk factors were nocturnal enuresis ( OR 7.2 , 95 % CI 3.4 to 15.2 ) , female gender ( 5.4 , 2.6 to 11.1 ) , social concerns ( 3.4 , 1.4 to 8.3 ) , urinary tract infection ( 5.6 , 2.0 to 15.6 ) and encopresis ( 3.3 , 1.4 to 7.7 ) . Expressed as population attributable risk , 36 % of moderate to severe daytime incontinence can be attributed to encopresis , nocturnal enuresis , social concerns , female gender or urinary tract infection . Urinary tract infection was a risk factor for boys but not for girls ( interaction p < 0.01 ) . CONCLUSIONS Daytime urinary incontinence in children is a common but heterogeneous disorder . Episodes may be frequent or major or both but appear to share the same causal pathway . Given the risk factors identified , interventions should target endogenous/physiological and environmental factors Fifty-six patients 5.9–15.2 years old with dysfunctional elimination syndrome ( DES ) unimproved by previous therapies were r and omly distributed into two voiding training programs : group 1 contained 26 patients su bmi tted to 24 training sessions over a 3-month period ; group 2 contained 30 patients su bmi tted to 16 sessions over a 2-month period . Both groups adhered to a voiding and drinking schedule , received instruction on adequate toilet posture , were reinforced through the maintenance of voiding diaries , and went through proprioceptive and pelvic floor muscle training ( Kegel exercises ) . Group 2 patients also received biofeedback therapy .  Clinical evaluation was carried out before each program ’s initiation and 1 , 6 , and 12 months after each program ’s termination . All patients were su bmi tted to renal ultrasonography and dynamic ultrasonography before and 6 months after each program ’s conclusion . Millivoltage recordings of pelvic floor muscles were compared before and after training . Urinary continence was improved after completion of either training program . Only those patients who received biofeedback training showed a significant decrease in postvoiding residual ( PVR ) urine as detected by dynamic ultrasonography . Our results show that either training regime can reduce episodic urinary incontinence and urinary tract infection but that further study is required to identify the optimal training duration Objective The purpose was to evaluate the efficacy of the addition of short-term desmopressin to enuretic alarm in patients with primary monosymptomatic nocturnal enuresis ( PMNE ) . Material s and methods A total of 52 children with PMNE were included in this study . The patients were r and omized into two groups . In group 1 ( n = 30 ) , the patients were given 6 weeks of additional oral desmopressin to 12 weeks of enuretic alarm therapy , as a single dose of 0.2 mg at the first 3 weeks and 0.4 mg at the following 3 weeks . In group 2 ( n = 28 ) , the patients were given 12 weeks of enuretic alarm therapy alone . According to the number of wet nights after 12 weeks of treatment , the patients were defined as complete responders ( dry or more than 75 % reduction in wet nights ) , partial responders ( 50 to 75 % reduction ) and non-responders ( less than 50 % reduction ) . Relapse was defined as the reappearance of > 1 wet night per week for complete responders and > 50 % increase in pre-treatment wetting frequency for partial responders , and all these patients were called relapsers . Results The mean number of wet nights after 3 and 6 weeks treatment was significantly lower in group 1 compared to group 2 . However , there was no significant difference between the groups regarding the mean number of wet nights after 12 and 24 weeks of treatment . There was no significant difference between the groups regarding the number of responders , partial responders , non-responders and relapsers . In the group with additional desmopressin therapy given , the number of patients who ab and oned therapy was lower than the alarm therapy alone group , but it was not statistically significant . Conclusion Our data showed that the addition of short-term desmopressin to alarm therapy was more effective only in the period when it was given , and it did not change the response to alarm therapy in the long term Abstract Sixty‐four enuretic children with a mean age of 8.4 years were assessed over an 8‐week study to observe their response to a number of commonly used methods of treatment for enuresis . This was a double‐blind study with patients being assigned to one of eight possible treatment conditions . Imipramine , an alarm device , r and om awakening , and placebo were compared . These treatments were also studied in combination . The most practical and efficacious treatment was the individual use of either alarm or imipramine . R and om awakening and r and om awakening plus placebo were indistinguishable from placebo and were not at all effective Objective : To clarify the effects of systematic treatment based on overnight simultaneous monitoring by electroencephalography ( EEG ) and cystometry ( CM ) on each type of enuresis . Methods : For enuresis type I , the change in the awakening response during the conditioning treatment with a therapeutic machine was observed . For enuresis type IIa , the effect of imipramine on the EEG was observed . For enuresis type IIb , the effect of oxybutynin hydrochloride on the cystometrogram ( CMG ) was observed . Results : Values , in which the awakening score on the second night was subtracted from the score on the last night , were significantly higher in the effective cases than in the unchanged cases . Out of the 3 patients in whom imipramine was effective , an awakening response on the EEG was observed in 2 . Neither of the 2 unchanged cases showed an awakening response . Out of 4 patients in whom oxybutynin hydrochloride was effective , uninhibited contractions ( UIC ) on the CMG disappeared in 3 . UIC stopped in neither of the 2 unchanged cases . Conclusions : Improvement of the awakening response plays an important role in the effectiveness of conditioning treatment with our therapeutic machine . The generation of awakening response is thought to be the most important result of imipramine directly concerned with its clinical effect on enuresis type IIa . The main result with oxybutynin hydrochloride in enuresis type IIb is thought to be related to its antispasmodic effect OBJECTIVES To evaluate the effectiveness of alarm-based combination therapy using desmopressin and imipramine for primary monosymptomatic nocturnal enuresis . METHODS Of the 105 patients , 37 were treated with alarm monotherapy ( monotherapy group ) , 35 were treated with desmopressin combined with an alarm ( desmopressin  group ) , and 33 were treated with imipramine combined with an alarm ( imipramine group ) . The therapeutic effects were evaluated at 3 and 6 months . The relapse rates and predictive factors of the therapies were also studied . RESULTS No significant differences were found in the changes in the frequency of wet nights among the three groups , although the frequencies in all three groups decreased significantly with the therapeutic duration . Although the improvement rates at 3 months did not differ among the three groups , the improvement rate of 80 % in the desmopressin group and 79 % in the imipramine group at 6 months were greater than the 59 % rate in the monotherapy group . After cure , no patients relapsed in the monotherapy group , and 3 ( 43 % ) each did so in the desmopressin and imipramine groups . In comparing the improved cases in each group , no significant differences were found in background factors . CONCLUSIONS Desmopressin and imipramine combined with an alarm was no more effective than alarm monotherapy . As for alarm monotherapy , other therapeutic modalities should be considered if it has not proved effective after 3 months . In such a situation , combination therapy may be effective as a second choice . No predictive factors for the therapeutic effects in the three modalities were found OBJECTIVES Conditioning treatment is the most effective therapy for nocturnal enuresis , precluding the use of drugs . An ordinary alarm clock can be used as an enuresis alarm . We sought to assess its clinical utility as a new means of conditioning treatment . METHODS Using the ordinary home alarm clock , 125 enuretic children were enrolled into two treatment groups . Group I included 70 children who set the alarm so as to get up and void in the toilet at a critical time when the bladder was full and they were still dry . Group II included 55 children who used the alarm to be awakened for voiding after 2 to 3 hours of sleep regardless of whether they were dry or wet . All children were motivated to use the alarm clock continuously for 4 months . RESULTS Initial success was achieved in 54 ( 77.1 % ) of 70 group I and 34 ( 61.8 % ) of 55 group II children . Three months after treatment was stopped , success was still maintained in 46 ( 65.7 % ) and 31 ( 56.4 % ) children in groups I and II , respectively , but dropped to 41 ( 58.6 % ) and 29 ( 52.7 % ) , respectively , after 6 months . The relapse rate after 3 and 6 months was 14.8 % and 24.1 % for group I and 8.8 % and 14.7 % for group II , respectively . CONCLUSIONS The ordinary alarm clock performs as well as currently used enuresis alarms . It is an effective , elective , noncontact alarm that does not wait for bedwetting to initiate a conditioning reflex . It is both reliable and safe Abstract One hundred and fifteen enuretic children were assigned to five treatment groups . Three groups received Mowrer-type continuous signal ( C.S. ) , Twin-Signal ( T.S. ) or intermittent Twin Signal ( T.S.-I.R. ) conditioning treatment , and two groups were given “ placebo ” or “ arousal ” control treatments . Over a one-month period , there was no difference between conditioning and control procedures , and it was concluded that further research is needed to determine the basis of treatment response . There was no evidence in support of the escape training hypothesis , and the twin-signal modification to st and ard bell- and -pad treatment is not recommended . The investigation confirmed the success of conditioning treatment in bringing about the initial arrest of enuresis ( i.e. in 81.4 per cent of the cases ) but the relapse rate was high . The investigation provided tentative evidence that intermittent conditioning treatment offers one way of reducing the frequency of relapse . The problem of obtaining satisfactory parental co-operation in a badly housed working-class population was apparent , and ways of reducing the dem and s that treatment imposes on parents are indicated . The results are discussed with regard to theories of  conditioning treatment  of nocturnal enuresis , and possible improvements in this technique of treatment Abstract Bedwetting has been a major and unsolved problem for the severely retarded . To solve this problem , an intensive training program was design ed similar to a recently developed program for daytime toilet training of the retarded . Some distinctive features of the new procedure were frequent positive reinforcement for correct toileting , a negative reinforcer for accidents , positive practice in night time toileting , increased level of urination by forcing drinking , immediate detection of correct and incorrect toileting , and Positive Practice for accidents . Of twelve retarded adult bedwetters , the average bedwetter required only one night of intensive training . Several days of apparatus monitoring were used following the training but proved unnecessary for two-thirds of the trainees . Accidents were reduced by about 85 % during the first week after training , and almost entirely ( 95 % ) during the fifth week with no relapse during a 3 month follow-up . No reduction of accidents result ed when the same bedwetters were given a control procedure that provided no positive or negative reactions other than the sounding of an alarm upon bedwetting . The Dry-Bed procedure appears to be a very rapid solution to the problem of enuresis among the retarded and may be applicable to other difficult population s and also to normals PURPOSE This r and omized blinded clinical study was design ed to compare the efficacy of tolterodine treatment combined with behavioral modification , behavioral modification alone and behavioral modification plus placebo in children with nonneurogenic , nonanatomical voiding dysfunction . MATERIAL S AND METHODS A 
    Output:
    
In single small trials , rewards , lifting and waking and bladder training were each associated with significantly fewer wet nights , higher full response rates and lower relapse rates compared to controls .
Simple behavioural interventions appeared to be less effective when compared with other known effective interventions ( such as enuresis alarm therapy and drug therapies with imipramine and amitriptyline ) .
However , the effect was not sustained at follow-up after completion of treatment for the drug therapies .
Based on one small trial , cognitive therapy also appeared to be more effective than rewards .
When one simple behavioural therapy was compared with another , there did not appear to be one therapy that was more effective than another .
Simple behavioural methods may be superior to no active treatment but appear to be inferior to enuresis alarm therapy and some drug therapy ( such as imipramine and amitriptyline ) .
Simple behavioural therapies could be tried as first line treatment before considering enuresis alarm therapy or drug therapy , which may be more dem and ing and have adverse effects , although evidence supporting their efficacy is lacking