Here, we report a case of nocturnal enuresis persisting into adulthood treated with Kampo medicine. A 21-year-old woman had a history of nocturnal enuresis every night during childhood and once every 2-3 nights during school age. Although the frequency of urinary incontinence decreased to 1-2 times/week at 19 years of age, nocturnal enuresis persisted into adulthood. She was diagnosed with mild strain of the rectus abdominis muscles and palpable abdominal aortic pulsation above the umbilicus, and keishikaryukotsuboreito (decoction) therapy was initiated. She did not experience urinary incontinence at night for 3 weeks, except for one episode immediately after treatment commencement. She tended to urinate only 4 times from the time she awoke until bedtime ; therefore, we added a small amount of goreisan to her treatment regimen to increase the urinary output and daytime frequency of urination. The frequency of urination increased from 4 to 7 times and stabilized. We discontinued goreisan administration 2 months later, and keishikaryukotsuboreito monotherapy was continued. We did not observe recurrent nocturnal enuresis and, therefore, switched the decoction to an extract. After the symptom stabilized, the dosage of keishikaryukotsuboreito was reduced by half. Nocturnal enuresis occurred only once when the patient missed a dose for 3 consecutive days but did not recur for over 4 months after strict adherence to medication. This case report highlights the role of Kampo therapy as an effective therapeutic option for nocturnal enuresis persisting into adulthood.

BACKGROUND: Pyrethroid (PYR) insecticides are widely used for controlling various pests. There are two types that differ in terms of usage: agricultural-purpose PYR (agriculture-PYR) and hygiene purpose PYR (hygiene-PYRs). Few studies exist on the exposure to these chemicals in small children. In this study, we conducted biomonitoring of urinary pyrethroid metabolites in 1.5-year-old children throughout the year. METHODS: Study subjects were 1075 children participating in an Aichi regional sub-cohort of the Japan Environment and Children's Study as of 18-month health check-up. The concentrations of four specific hygiene-PYR metabolites including 2,3,5,6-tetrafluoro-1,4-benzenedimethanol (HOCH₂-FB-Al), and five common metabolites of hygiene- and agriculture-PYRs including 3-phenoxybenzoic acid (3PBA) and cis- and trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid (DCCA), were measured in urine samples extracted from soiled diapers using a triple quadrupole gas chromatograph-mass spectrometer. RESULTS: The highest detection frequencies were for 3PBA, followed by DCCA, 1R-trans-chrysanthemum dicarboxylic acid, and HOCH₂-FB-Al. Among the six metabolites, urinary concentrations were seasonally varied. However, this variation was not observed in the most studied PYR metabolite, 3PBA. Spearman's correlation analysis demonstrated a significant positive correlation between FB-Al and DCCA (r = 0.56) and HOCH₂-FB-Al and 4-methoxymethyl-2,3,5,6-tetrafluorobenzyl alcohol (r = 0.60). CONCLUSIONS This biomonitoring survey found widespread and seasonally specific exposure to multiple hygiene- and agriculture-PYRs in 1.5-year-old Japanese children.
Agriculture ; Child, Preschool ; Environmental Exposure/analysis* ; Humans ; Infant ; Insecticides ; Japan ; Mass Spectrometry ; Pyrethrins/urine*