1. Brain focused treatment 2 nd CNN Department of Urology, Kyoto Prefectural University of Medicine Akihiro Kawauchi, M.D., Ph.D.

2. Nocturnal enuresis ： Voiding during sleep Causes: Sleep (including nocturnal polyuria), bladder or both

8. Brain focused treatment?

9. The Health-related Quality of Life in patients and mothers of patients with nocturnal enuresis

10. The health-related quality of life in enuretic children evaluated before and after treatment (Kid-kindle) Emotional well-being Family Friend Physical well-being Self-esteem School 0.02 Before treatment 16.6±2.6 17.1±2.4 12.5±4.1 14.7±3.4 16.2±2.9 13.7±3.1 17.3±2.0 17.7±2.2 13.2±3.8 15.7±2.8 16.7±2.8 14.2±3.2 Healthy volunteers After treatment P value** Before treatment vs. Healthy volunteers P value* Before vs. after treatment Domain 0.36 16.9±2.6 0.3817.3±2.3 0.46 0.97 0.16 12.8±3.8 15.7±2.9 16.2±1.1 14.3±1.1 0.08 0.26 0.04 0.27 0.34 * paired-t test* * t test J Urol, in press

11. Role physical Social functioning General health Physical functioning Body pain Vitality 91.9±9.1 91.7±10.5 90.7±13.5 88.9±17.3 71.9±22.2 73.1±17.0 65.3±16.0 66.2±17.1 60.1±10.166.1±16.6 89.5±16.3 88.4±17.2 Role emotional Mental health 89.9 ±17.1 90.4 ±16.3 70.8±17.272.6±16.8 The health-related quality of life in mothers of enuretic children evaluated before and after treatment (SF36) Before treatment Healthy volunteers Domain 0.89 0.44 0.68 0.71 0.01 0.66 0.84 0.48 91.2±15.5 72.8±19.8 67.2±16.2 64.8±17.9 89.1±15.8 88.6 ±17.7 72.4±17.6 After treatment 92.5±8.8 P value** Before treatment vs. Healthy volunteers 0.58 0.35 0.91 0.69 0.03 0.86 0.62 0.54 P value* Before vs. after treatment * paired-t test * * t test J Urol, in press

12. The health-related quality of life in mothers of enuretic children evaluated with STAI and SDS before and after treatment Before treatment Healthy volunteers After treatment SDS 42.0 ±7.8 STAI state trait 37.3 ±12.8 0.003 38.7 ±11.2 0.02 39.9 ±9.1 37.7 ±14.2 0.22 37.9 ±11.50.20 38.7 ±8.2 38.0 ±7.3 0.40 38.4 ±8.50.49 P value** Before treatment vs. Healthy volunteers P value* Before vs. after treatment * paired-t test * * t test J Urol, in press

13. Sleep and bladder

14. Dynamic change in bladder capacities in 24 nonenuretics and 36 enuretics Urology, 2003 Capacity (ml) Functional Bladder Capacity (FBC) Nocturnal Bladder Capacity (NBC) Enuretic Bladder Capacity (EBC)

15. EBC (ml) Ｐ＜ 0.01 Ｐ＜ 0.001 Ｐ＜ 0.05 Changes in enuretic bladder capacity (EBC) during alarm therapy Enuresis, 1997

17. Sleep and Desmopressin

19. Effect of DDAVP on awakening ability ＸＸ Ｘ Ｘ Ｘ Ｘ ○ ○ 9 10 11 12 1 2 3 4 5 6 7 8 June/1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 ○ ： Awakening without wetting × ： Bedwetting Time Am ○ ○ DDAVP 20μg

20. Latero-dorsal tegmental nucleus (LDT) response to administration of DDAVP intravenous injection Direct administration Urology 2004

21. To establish “Brain focused treatment”, causes of NE in CNS should be clarified.