1. Value of the ICCS screening tool for patient subtyping
S.Karamaria, C. Van Herzeele, J. Vande Walle
Department of Paediatric Nephrology/Urology
Value of the ICCS screening tool for patient subtyping

2. ICCS Standardization Reports

3. ICCS Screening Tool: literature

4. ICCS Screening Tool: literature
International consensus
Diagnosis and management of enuresis in primary care
Value?

5. ICCS Screening Tool
Basic
Optimal
Vande Walle et al. 2012

6. ICCS Screening Tool: diaries
3-4 days (weekend/holiday)
Time
Volume of drinks (mL)
Urinary volume (mL)
Leakage of urine?
7 consecutive nights
Bedtime
Wake up time
Dry or wet night?
Diaper weight in the morning (net)
Volume of first morning void
Volume of nocturia void?
Bowel movement during the day?
nocturnal urine production
Vande Walle et al. 2012
Van Herzeele et al. 2015

7. ICCS Screening Tool: treatment choices
Desmopressin or enuresis alarm
Basic
Optimal
Normal MVV
Reduced MVV
Normal nocturnal diuresis
alarm OR desmopressin
alarm
Nocturnal polyuria
desmopressin
alarm and desmopressin
Screening + family preference and motivation
Vande Walle et al. 2012

8. ICCS Screening Tool: predictive value
urgency
87% sensitivity
frequency
postponing
only 13% of the patients with LUTS or comorbidities missed
New ICCS definitions: 25.3% MNE
Old ICCS definitions: 52.2% MNE
Vande Walle et al. 2012/2013

9. ICCS Screening Tool: Example: DRIP study
DRIP = Desmopressin Response in the treatment of PNE
Re-analysis: ‘do screening parameters predict response to desmopressin?’

10. ICCS Screening Tool: Example: re-analysis DRIP study
Demographic predictors: gender, weight, BMI, family history, country, age (p<.001)
Van Herzeele et al. 2015

11. ICCS Screening Tool: Example: re-analysis DRIP study
Demographic predictors: gender, weight, BMI, family history, country, age (p<.001)
Enuretic predictors: number of wet nights per week (p<.0001), nocturnal diuresis, MVV
Van Herzeele et al. 2015

12. ICCS Screening Tool: Example: re-analysis DRIP study
Demographic predictors: gender, weight, BMI, family history, country, age (p<.001)
Enuretic predictors: number of wet nights per week, nocturnal diuresis (p<.0001), MVV
Van Herzeele et al. 2015

13. Response to desmopressin: DRIP (40%) ↔ initial papers (50-60%)
ICCS Screening Tool: Example: re-analysis DRIP study
Demographic predictors: gender, weight, BMI, family history, country, age (p<.001)
Enuretic predictors: number of wet nights per week, nocturnal diuresis, MVV (p<.0001)
Response to desmopressin: DRIP (40%) ↔ initial papers (50-60%)
Patient selection!
Van Herzeele et al. 2015

14. ICCS Screening Tool: Example: re-analysis DRIP study
Demographic predictors: gender, weight, BMI, family history, country, age (p<.001)
Enuretic predictors: number of wet nights per week, nocturnal diuresis, MVV (p<.0001)
>80%
6.98%
9.63%
3.16%
Van Herzeele et al. 2015

15. ICCS Screening Tool: conclusions
Raises awareness
Provides current information to the family and the physician
Detects children with NMNE and children that need extra evaluation
Helps choose the most appropriate therapy
Provides prognostic information for the response to treatment
Overrides false advise and misinformation from unregulated sources
Limits recommendations to evidence based treatment strategies

16. Sevasti karamaria Trainee in Paediatric Nephrology