Tryggve Nevéus

Uppsala University | UU · Department of Women's and Children's Health

Introduction Nocturnal enuresis is a very common and socially distressing condition among children. There are qualitative studies published in children with bowel and bladder problems with a focus on health-related quality of life and the burden of the condition, but there is a lack of knowledge of the experience of managing the treatment procedure...

Aim There is limited knowledge about the perceptions of HPV vaccination in middle‐school children. This qualitative study aimed to explore their views. Methods We conducted focus group interviews with children, 10–11 years of age, who had been offered HPV vaccination through the school health services in mid‐north Sweden in spring of 2023. Data we...

Introduction Bedwetting, also known as enuresis, is the second most common chronic health problem among children and it affects their everyday life negatively. A first-line treatment option is the enuresis alarm. This method entails the child being awoken by a detector and alarm unit upon urination at night, thereby changing their arousal mechanism...

Aim To look for predictors to response and adherence to the enuresis alarm while exploring the possibility of families managing therapy independently. Methods We used a body‐worn alarm linked to a smartphone app. Subjects with enuresis were recruited both via paediatric nurses and independently as families bought the alarm and downloaded the app o...

Background: Human papillomavirus (HPV) vaccines effectively prevent, and can even eliminate, HPV-related cancers. Currently, vaccination rates are suboptimal in the national Swedish school-based vaccination program. School nurses play a key role in all aspects of the vaccination process. Therefore, this study aims to explore school nurses' perceiv...

Aim: The alarm is a first-line treatment of nocturnal enuresis. However, the therapy is labor-intensive for both families and healthcare providers. Our aim was to see whether the treatment could be successfully used by the families, without support from healthcare providers. Methods: An alarm linked to an application on a parent's smartphone was...

Much has happened since the end of the era when enuresis was blamed on the parents or the children themselves. Still, there are large gaps in our knowledge and large parts of modern enuresis management guidelines are (still) not based on firm evidence. In this review I will question the following commonly made assumptions regarding enuresis evaluat...

Extended summary Background and aim Two central problems with the enuresis alarm are the family workload and the lack of predictors of therapy response. We wanted to look at predictors of alarm response in a setting reflecting clinical reality. Methods An alarm linked to a smartphone app was provided to enuretic children managed at pediatric outp...

Nocturnal enuresis affects one in ten children at school start and lingers until adulthood in approximately one percent of the population. The condition is often inherited, and the pathogenesis is usually a combination of nocturnal polyuria, nocturnal detrusor overactivity, and/or high arousal thresholds. Enuresis adversely affects quality of life...

Background Constipation, daytime incontinence and nocturnal enuresis often overlap. Treatment of constipation has been shown to be an important aspect of therapy for children with daytime incontinence. However, the value of fecal disimpaction, as a part of constipation therapy, in children with enuresis has not been evaluated. Aim Our aim was to e...

Objective According to international guidelines, children with enuresis are recommended urotherapy, or basic bladder advice, before treatment with evidence-based alternatives such as the enuresis alarm is given. The efficacy of this strategy has, however, not been supported by controlled studies. We wanted to test if basic bladder advice is useful...

Background: HPV vaccination of both girls and boys can protect against infection and eliminate the risk for HPV-associated cancer. Due to a common misconception that the virus only poses risks to women, vaccine coverage is suboptimal among men in many countries. It is urgent to identify barriers to vaccination of boys and men. Methods: We conduc...

Vesicoureteral reflux (VUR) is associated with increased risks of urinary tract infection, renal scarring and reflux nephropathy. We review advancements over the last two decades in our understanding and management of VUR. Over time, the condition may resolve spontaneously but it can persist for many years and bladder/bowel dysfunction is often inv...

Enuresis (bedwetting) is not, as was previously thought, a primarily psychiatric condition. The true pathogenetic mechanisms are nocturnal polyuria, nocturnal detrusor overactivity and high arousal thresholds. The condition is often inherited and is more common among boys. There are two established first-line therapies: the enuresis alarm and desmo...

Introduction The case history is the primary tool when investigating the enuretic child. To further determine whether nocturnal polyuria or detrusor overactivity is present, a full voiding chart, is the method of choice. However, there is no robust evidence that daytime voiding chart data actually do predict nocturnal detrusor function. Aim The ai...

Background Enuresis is an extremely common condition which, although somatically benign, poses long-term psychosocial risks if untreated. There are still many misconceptions regarding the proper management of these children. Aim A cross-professional team of experts affiliated with the International Children's Continence Society (ICCS) undertook to...

Objective: To investigate whether rapid maxillary expansion (RME) is a useful treatment method for nocturnal enuresis (NE) and whether the treatment effect is due to placebo. The study also aimed to identify prognostic variables in patients responding to treatment. Materials and methods: Thirty-eight children with therapy-resistant NE were recru...

This study investigates boys’ awareness and thoughts about human papillomavirus (HPV) and HPV vaccination, perceived benefits of vaccinating men, information sources and intention to be vaccinated against HPV. We used a qualitative approach and interviews were conducted with 31 upper secondary school male students. Two main themes 1) Promotion of e...

Background: As much as 20% of all cases of hypertension are associated with kidney malfunctions. We have previously demonstrated in animals and in pediatric patients that hydronephrosis causes hypertension, which was attenuated by surgical relief of the ureteropelvic junction (UPJ) obstruction. This retrospective cohort study aimed to investigate:...

By collecting and analyzing diapers, we identified a >6-fold increase in carriage of extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae for healthy preschool children in Sweden (p<0.0001). For 6 of the 50 participating preschools, the carriage rate was >40%. We analyzed samples from 334 children and found 56 containing >1 ESBL produc...

Objectives: Detrusor overactivity and constipation often co-exist in children with enuresis. Constipation is known to be linked to detrusor overactivity. The voiding chart is the best non-invasive way to investigate bladder function, whereas the ultrasonographical detection of rectal dilatation is the best way to objectify constipation. We wanted t...

Introduction: Enuretic children wet their beds either because of nocturnal polyuria or nocturnal detrusor overactivity. Polyuric children often respond to desmopressin, whereas children with nocturnal detrusor overactivity are often therapy resistant and may have low daytime voided volumes. It is logical to assume that the enuretic event in childr...

Disorders of the paediatric lower urinary tract can conveniently be classified into disturbances of the storage or voiding phase. Among disorders of urine storage, daytime urge incontinence and nocturnal enuresis are by far the most prevalent. The usual cause behind the former is detrusor overactivity, while various combinations of detrusor overact...

To promote the standardization of nephro-uroradiological terms used in children, the European Society of Paediatric Radiology uroradiology taskforce wrote a detailed glossary. This work has been subsequently submitted to European experts in pediatric urology and nephrology for discussion and acceptance to improve the quality of radiological reports...

Objective: Recent clinical studies have suggested an increased risk of elevated arterial pressure in patients with hydronephrosis. Animals with experimentally induced hydronephrosis develop hypertension, which is correlated to the degree of obstruction and increased oxidative stress. In this prospective study we investigated changes in arterial pr...

In 2012, human papillomavirus (HPV) vaccination was introduced free of charge in the Swedish national school-based vaccination programme for 10-12-year-old girls, and as catch-up vaccination for young women. In Sweden, there is an ongoing discussion about including boys in the national vaccination programme. Few studies are undertaken about adolesc...

To promote the standardization of nephro-uroradiological terms used in children, the European Society of Pediatric Radiology uroradiology taskforce wrote a detailed glossary. This work has been subsequently submitted to European experts in pediatric urology and nephrology for discussion and acceptance to improve the quality of radiological reports...

Introduction: Nocturnal enuresis and sleep disordered breathing are common childhood problems that are reported to be associated with each other. Sleep disordered breathing is often found in children with upper airway obstruction and, according to some studies, its presence is associated with an increased risk of nocturnal enuresis. Respiration du...

Aim: There have not been any continence-specific measurement tools in Swedish that have allowed clinicians to investigate the quality of life (QoL) in children with bladder dysfunction. This study evaluated the QoL in Swedish children with nocturnal enuresis and tested the reliability of a Swedish translation of the Paediatric Incontinence Questio...

Enuresis was historically viewed as a primarily psychiatric disorder, but this understanding has changed dramatically since the end of the last century, when it became clear that somatic factors, such as nocturnal polyuria as a result of vasopressin deficiency, nocturnal detrusor overactivity and high arousal thresholds, all play a crucial role in...

BACKGROUND Parents' beliefs about human papillomavirus (HPV) vaccination influence whether they allow their daughters to be vaccinated. We examined the association between parents' refusal and sociodemographic background, knowledge and beliefs about HPV, and the HPV vaccination in relation to the Health Belief Model. METHODS The sample consisted o...

Objectives: Infectious gastroenteritis is one of the most common diseases among children and has a considerable impact on health and socio-economy. Day care centres are high-risk environments for infections. The aim of this study was to investigate if asymptomatic preschool children constitute a reservoir for potential enteropathogens. Study desi...

Introduction: A significant minority of children with enuresis do not respond to either desmopressin or the enuresis alarm. Anticholinergics have not proven as successful as expected. The fourth evidence-based treatment, the tricyclic antidepressant imipramine, is cardiotoxic when overdosed, which has led to diminished use. Aim: The aim was to d...

The aim of this cross-sectional study was to evaluate relationship satisfaction in parents of children with nocturnal enuresis and put it in context by comparisons with normative data. The secondary aim was to investigate the potential differences in feelings of incompetence in the parenting role and parental conflict among parents of children with...

Objective To improve primary prevention of human papillomavirus (HPV) infection by promoting vaccination and increased condom use among upper secondary school students. Design Cluster randomised controlled trial. Setting 18 upper secondary schools in Sweden. Participants Schools were first randomised to the intervention or the control group, after...

The primary evaluation of the enuretic child is simple. In most cases, a thorough history and the completion of a bladder diary are enough. If the enuresis is secondary, a urine dipstick is also needed, and if there are bothersome daytime symptoms, these need to be evaluated and treated before the enuresis. Children with warning signs such as sever...

OBJECTIVE: To evaluate whether rapid maxillary expansion (RME) could reduce the frequency of nocturnal enuresis (NE) in children and whether a placebo effect could be ruled out. METHODS: Thirty-four subjects, 29 boys and five girls with mean age of 10.7 ± 1.8 years suffering from primary NE, were recruited. All subjects were nonresponders to the fi...

The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.jpurol.2015.04.001. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Background: There are two firstline, evidence-based treatments available for nocturnal enuresis: desmopressin and the enuresis alarm. Prior to use of these therapies, international experts usually recommend that the children also be given basic bladder training during the daytime. The rationale behind this recommendation is that daytime bladder tr...

Objective: Renal disorders can cause hypertension, but less is known about the influence of hydronephrosis on blood pressure. Hydronephrosis due to pelvo-ureteric junction obstruction (PUJO) is a fairly common condition (incidence in newborns of 0.5-1%). Although hypertensive effects of hydronephrosis have been suggested, this has not been substan...

Aim: The impact of the original International Children's Continence Society (ICCS) terminology document on lower urinary tract (LUT) function resulted in the global establishment of uniformity and clarity in the characterization of LUT function and dysfunction in children across multiple healthcare disciplines. The present document serves as a stan...

Objective The main objective was to compare children with frequent enuresis (FE) and children with infrequent enuresis (IE) using anamnestic data and variables related to bladder and kidney function. A secondary aim was to look at the group of children who wet their beds every single night, a phenomenon we chose to call constant enuresis (CE). Sub...

Aim According to a number of small case series, orthodontic treatment may have antienuretic effects. Thus, we evaluated whether widening of the palate can alleviate enuresis and whether prognostic information can be gained from examining children's nocturnal respiration and nasal airway dimensions. Methods Children with therapy-resistant enuresis u...

Background Sweden introduced a school-based human papillomavirus (HPV) vaccination programme in 2012, and school nurses are responsible for managing the vaccinations. The aim of the present study was to investigate the attitudes and experiences of school nurses regarding the school-based HPV vaccination programme 1 year after its implementation. M...

To explore why parents refused to allow their 10- to 12-year-old daughters to receive the human papillomavirus (HPV) vaccination from the Swedish school-based vaccination programme. Individual interviews with 25 parents who had been offered, but not consented to, their daughters receiving the HPV vaccination. Five themes emerged through the intervi...

Although there is a known association between enuresis and snoring or sleep apneas, respiration during sleep has not been thoroughly studied in enuretic children. This study was performed with the aim of filling this gap in our knowledge. Thirty-four children with therapy-resistant enuresis, but no history of heavy snoring or sleep apneas, underwen...

To explore the everyday dilemmas of parents living with a child with nocturnal enuresis and to describe their support needs in relation to healthcare professionals. The study was conducted in 2011 in Uppsala County, Sweden. Parents of 13 children with enuresis, 10 mothers and three fathers, participated in qualitative semi-structured in-depth inter...

This review aims to provide researchers and clinicians involved with the adult lower urinary tract with background knowledge regarding the early development of bladder function and its most common disturbances in childhood. Bladder development begins in weeks 4-6 and the detrusor muscle is formed during weeks 9-12 of gestation. Higher CNS centres a...

Pyelonephritis in childhood may, in the worst cases, lead to long-term cardiovascular morbidity due to tubulointerstitial renal scarring. Renal damage is the end result of an interplay between (1) urinary tract anatomy and function, (2) bacterial virulence factors, and (3) the host innate immune system, which on the one hand manages bacterial clear...

Background The reabsorption of filtered plasma proteins, hormones and vitamins by the renal proximal tubules is vital for body homeostasis. Studies of megalin-deficient mice suggest that the large multi-ligand endocytic receptor megalin plays an essential role in this process. In humans, dysfunctional megalin causes the extremely rare Donnai-Barrow...

Dilating vesicoureteral reflux (VUR) has been linked to febrile urinary tract infection (UTI) and renal scarring. It is unclear, however, whether children with reflux should be treated surgically or medically, or just kept under close surveillance with prompt treatment of UTIs. This lack of evidence makes parental preferences a crucial factor in th...

The term enuresis, or nocturnal enuresis, is applied to any involuntary micturition while asleep in a child aged 5 years or more. The International Sleep Disorder Classification rightly classifies enuresis as a parasomnia. Enuresis has long been known to be strongly influenced by hereditary factors. Several different genetic loci have been implicat...

Nocturnal polyuria, nocturnal detrusor overactivity and high arousal thresholds are central in the pathogenesis of enuresis. An underlying mechanism on the brainstem level is probably common to these mechanisms. Enuretic children have an increased risk for psychosocial comorbidity. The primary evaluation of the enuretic child is usually straightfor...

We compared the rates of febrile urinary tract infection, kidney damage and reflux resolution in children with vesicoureteral reflux treated in 3 ways, including antibiotic prophylaxis, endoscopic therapy and surveillance with antibiotics only for symptomatic urinary tract infection. Children 1 to younger than 2 years with grade III-IV reflux were...

We compared the development of new renal damage in small children with dilating vesicoureteral reflux randomly allocated to antibiotic prophylaxis, endoscopic treatment or surveillance as the control group. Included in the study were 128 girls and 75 boys 1 to younger than 2 years with grade III-IV reflux. Voiding cystourethrography and dimercapto-...

Purpose To compare the development of new renal damage in small children with dilating vesicoureteral reflux randomly allocated to antibiotic prophylaxis, endoscopic treatment or surveillance (control group). Material and Methods Included were 203 children, 128 girls and 75 boys, aged 1 to less than 2 years with reflux grade III to IV. Voiding cys...

We evaluated renal function at a median follow-up of 18 (range 10.3-22.1) years after total body irradiation in 18 patients treated with stem-cell transplantation (SCT) (autologous SCT in 15 and allogeneic SCT in three) for hematologic malignancies and compared them with 18 healthy controls. No patient had chronic graft-versus-host disease. We foun...

We provide updated, clinically useful recommendations for treating children with monosymptomatic nocturnal enuresis. Evidence was gathered from the literature and experience was gathered from the authors with priority given to evidence when present. The draft document was circulated among all members of the International Children's Continence Socie...

Imipramine is the only evidence-based treatment available for enuretic children resistant to standard therapy. The drug's antienuretic effect is probably due to noradrenergic facilitation. The drug is, however, potentially cardiotoxic. In this study, the non-cardiotoxic noradrenergic antidepressant reboxetine was tested as an alternative to imipram...

To highlight recent advances in enuresis research. Many discoveries have distanced us from the time when bedwetting was considered a psychiatric disorder. Instead, it is now agreed that nocturnal polyuria, detrusor overactivity, and high arousal thresholds are, in various combinations, central to enuresis pathogenesis. All three mechanisms have bee...

AimAdapt to Spanish the 2006 ICCS standardization of terminology of lower urinary tract function in children and adolescentsMaterial and methodDiscussions have been held at the Consensus Meeting on terminology and concepts. Members of the Spanish group of urodynamics and of the SINUG (Ibero American Society of Neurourology and Urogynecology) have p...

Enuretic children sleep "deeply" in the sense that they are difficult to arouse from sleep, but not in the sense that their sleep is necessarily polysomnographically different from other children. The enuretic children's arousal difficulties may be due to a disturbance at the brainstem level and/or to frequent arousal stimuli from the bladder. It m...

The anticholinergic drug tolterodine has been suggested to be useful in therapy-resistant enuresis. Imipramine has a proven efficiency in unselected enuretic patients, but due to its side-effect profile it is only indicated, if at all, in therapy-resistant cases. We therefore compared these two drugs to placebo. Twenty-seven children with enuresis...

PurposeWe updated the terminology in the field of pediatric lower urinary tract function.Materials and Methods Discussions were held in the board of the International Children's Continence Society and an extensive reviewing process was done involving all members of the International Children's Continence Society, the urology section of the American...

Bladder dysfunction and nocturnal enuresis are the most common urological disorders in children. The development of continence and voluntary voiding requires maturation of the neural system and the establishment of sound micturition habits. While the conscious sensation of bladder fullness is usually gained during the second year of life, the abili...

The impact of the original International Children's Continence Society (ICCS) terminology document on lower urinary tract (LUT) function resulted in the global establishment of uniformity and clarity in the characterization of LUT function and dysfunction in children across multiple healthcare disciplines. The present document serves as a stand-alo...

Children with enuresis that neither responds to the alarm or to desmopressin medication usually have nocturnal detrusor over-activity combined with high arousal thresholds as a cause for their bedwetting. The evaluation of these children is focused on 1) excluding underlying pathology such as kidney disease, urinary tract infection or neurogenic bl...

To investigate whether the norepinephrine reuptake inhibitor reboxetine is effective as a non-cardiotoxic alternative to imipramine in the treatment of therapy-resistant enuresis. Twenty-two children with severely socially handicapping enuresis resistant to urotherapy, the enuresis alarm, desmopressin and anticholinergics (all children had tried al...

Nocturnal polyuria is considered a major pathogenetic factor in nocturnal enuresis, and the antidiuretic drug desmopressin, given at bed-time, is consequently recognized as a first-line treatment alternative. The aim of this open, non-randomized study was to see whether diuretic medication, given in the afternoon, could give similar therapeutic ben...

Since antidiuretic treatment with desmopressin in the evening has proven effective against enuresis, it would not be surprising if diuretic treatment in the afternoon would have similar effects. We are currently testing this in an open pilot investigation. A total of 33 children including 12 girls with a mean age +/-SD of 7.6 +/- 2.3 years with mon...

Imipramine has a proven effect in enuresis but is now seldom used. We reviewed the records of children who had been treated with imipramine to determine prognostic indicators. The records of all enuretic children treated with imipramine at our clinic were retrospectively evaluated, with special emphasis on history, and for most children bladder vol...

Endoscopic injection of dextranomer/hyaluronic acid (Dx/HA) copolymer is an increasingly established treatment for primary vesicoureteral reflux (VUR) in children. We performed a retrospective analysis to assess this treatment for VUR associated with either double ureters or a small kidney. The study included 68 children with duplex ureters and 40...

To review what is known about the role of sleep and arousal mechanisms in the pathogenesis of nocturnal enuresis. A review of the literature was carried out. The sleep of enuretic children, although polysomnographically quite normal, is exceedingly "deep"; that is enuretic children have high arousal thresholds. Apart from some overlap between enure...

To test the hypotheses that vasopressin deficiency or hypercalciuria are important in polyuric and non-polyuric bedwetting, as nocturnal polyuria is a pathogenetic factor in enuresis responsive to antidiuretic therapy with desmopressin. Vasopressin deficiency has been implicated as a cause of nocturnal polyuria, but measurements of vasopressin in p...