Are uroflowmetry and post - void residual urine tests necessary in children with primary nocturnal enuresis?

ABSTRACT Objectives: To examine the benefits of repetitive uroflowmetry and post void residual urine (PVR) tests in children with primary nocturnal enuresis (PNE). Material and methods: Children aged ≥6 years with PNE who visited our clinics for management of enuresis were included for study. Patients were requested to complete a questionnaire including baseline characteristics and Dysfunctional Voiding Symptom Score (DVSS), 2-day bladder diary, and Rome III criteria for constipation. Two uroflowmetry and PVR tests were requested. Children with congenital or neurogenic genitourinary tract disorders were excluded. All children underwent urotherapy and desmopressin combined with anticholinergics or laxatives if indicated. The definition of abnormal flow patterns (≥1 abnormal), elevated PVR (≥1 abnormal), small maximal voided volume (MVV), nocturnal polyuria (NP) and response to treatment complied with the ICCS standardization document. Kaplan-Meier survival analysis and Cox proportional-hazards regression tests were used to evaluate the predictors of response. Results: In total, 100 children aged 8.5±2.3 years were enrolled for study (M: F=66:34) with 7.3±7.4 months of follow-up. Poor correlation was observed between DVSS/small MVV and PVR (p>0.05). Univariate analysis revealed that elevated PVR is associated with significantly less hazard of complete response to medical treatment (HR: 0.52, p=0.03), while not significantly associated with abnormal flow patterns, NP, constipation or small MVV. Multivariate analysis revealed that only elevated PVR (HR 0.30, 95% CI 0.12-0.80) and NP (HR 2.8, 95% CI 1.10-7.28) were significant predictors for complete response. Conclusions: In managing pediatric enuresis, elevated PVR is a significant predictor for lower chance of complete response to treatment whether they had high DVSS or not.

Enuresis and overactive bladder in children: what is the relationship between these two conditions?

ABSTRACT Objective: Evaluate clinical aspects associated with the presence of nocturnal enuresis (NE) in children with a diagnosis of overactive bladder (OAB). Material and Methods: A data base of 200 children who were evaluated by a structured questionnaire was analysed retrospectively . OAB was defined as the presence of urinary urgency (n=183 cases) and/or daytime urinary incontinence associated with holding maneuvers (n=168 cases). Inclusion criteria were a confirmed diagnosis of OAB, age 5-16 years, and no anatomical or neurological alterations of the urinary tract. Patients were divided into enuretics and non-enuretics. The two groups were compared with respect to sex, age, skin color, presence urinary infection, urgency, urge incontinence, non-urge incontinence, pollakiuria, urinary dysfunction, nocturia, holding maneuvers, number of episodes of enuresis and bowel alterations. In a univariate analysis, the chi-square test was used to compare proportions, with p-values <0.05 being considered significant. A multivariate analysis was conducted to identify independent predictive factors. Results: Enuresis was diagnosed in 141/200 children. The two groups were similar with respect to sex, age and skin color. No difference was found in relation to urinary infection, non-urge incontinence, urinary dysfunction, nocturia, encopresis or constipation. The two groups were significantly different with regard to some symptoms related to OAB such as urgency (p=0.001), urge incontinency (p=0.001) and holding maneuvers (p=0.033). Following multivariate analysis, only holding maneuvers (p=0.022) remained as an independent predictive factor. Conclusion: The only independent predictive factor for resolution of enuresis in children with OAB, as detected in the multivariate analysis, was holding maneuvers.

Characteristic of Monosymptomatic and Nonmonosymptomatic Childhood Nocturnal Enuresis in Benin City; Nigeria

Background. In recent years; nocturnal enuresis (NE) has been classified into monosymptomatic nocturnal enuresis (MNE) and nonmonosymptomatic nocturnal enuresis (NMNE) on the basis of the absence or presence of daytime voiding symptoms. Identifying clinical features that differentiate MNE from NMNE would aid in quick diagnosis; which would foster the introduction of early and appropriate therapeutic care options.Objective. To identify distinguishing characteristics of MNE and NMNE in Nigerian children.Methods. The parents of children in public primary and secondary schools in Egor local government area; Edo State; were interviewed using a semi-structured questionnaire.Results. The total studied population included 1 221 parent/child pairs. Of the children studied; 228 were enuretic. There were 149 (65.4%) MNE and 79 (34.6%) NMNE children. Enuretic children with a history of multiple wetting per night or whose parents observed difficulty awakening them from sleep were significantly more likely to be in the NMNE group.Conclusion. MNE is twice as common as NMNE and the main distinguishing features between the two groups of enuretic children are multiple wetting at night and difficulty awakening the child from sleep. These were significantly more commonly observed among the NMNE group of children

Nocturnal enuresis and its impact on growth

Nocturnal enuresis is a common developmental-behavioral problem in children. The present study was conducted to estimate the prevalence of primary nocturnal enuresis and to determine its impact on physical growth of the first grade elementary school children. This is a cross-sectional study carried out on 350 first-grade children [6 to 6.5 yr old] elementary schools in Gonabad through random stratified sampling. All children had primary nocturnal enuresis. A questionnaire containing demographic criteria and various factors that may play a role in bed-wetting was filled out; a digital scale and a non-expanding measuring tape were used to collect data. Diagnosis of enuresis considered nocturnal voiding twice a week for at least three consecutive months. The prevalence of primary nocturnal enuresis was 21% for boys and 14.9% for girls, and the overall prevalence was 17.5%. The average weight of enuretic children was lower than that of the non-affected ones. In addition, these children were in average shorter compared to those without enuresis. This study demonstrates that growth failure is a coexisting problem in children with primary nocturnal enuresis. Since enuresis and other stressful conditions in family can cause growth failure in children, the treatment of enuresis eliminating a stressful condition could be an effective measure in improving children's physical growth

Prevalence of bedwetting in children in the city of Mosul, North of Iraq

The mental and behavioral disorders at the same level of other illnesses, creating significant economic difficulties for children, patients and their families. Main objective, of this study was to determine the prevalence of bedwetting in children [68- years] in Mosul city and some risk factor. To achieve the above aim a cross sectional study design was adopted. The survey was carried out at some primary schools were chosen as a study setting. This survey was conducted during a four months period [1st of November 2006- 28th of February 2007]. The study enrolled that Out of [600] questionnaire forms sent to the selected families. [596] were received [the response rate was 99.3%]. This study include a questionnaire send to the selected families of the children. Of the total number of children surveyed, More than one tenth [13.8%] of pupils aged 68- years were bedwetter, boys were more affected than girls. The present study revealed that bedwetting is significantly influenced by multiple factors those were male sex, small age group, large family size, birth order, education of father and mother, socioeconomic status and diseases of father, as stressful life events, sleep pattern and family history of same condition. Where as mothers disease is poorly associated with occurrence of such events. The present study suggests that more than one tenth of the children had bedwetting which are related to male sex, age of the child, large family size, birth order, education of father and mother, and family history of the same condition

Nocturnal enuresis in children

Nocturnal enuresis is a common childhood problem which affects around 15-25% of 5 year olds and upto 2% of young adults. The etiology is multifactorial and a number of theories have been proposed. Studies indicate a hereditary basis for nocturnal enuresis. A detailed history, relevant physical examination and urinalysis is important for evaluation. Non-pharmacological treatment is preferred due to a high success rate and no potential adverse effects. A positive approach by the physician is necessary to enhance the motivation of the family and the child in the treatment

Pattern of primary nocturnal enuresis in primary school children (first grade) in assiut city

Objectives :To assess the prevalence of nocturnal enuresis in primary school children; first grade (6-7 years old) in Assiut City and study its pattern and risk factors. Patients and Methods: A random cross-sectional study including 1519 children was conducted in 10 primary schools in Assiut City throughout a period of six months. A self-administered questionnaire was completed voluntarily by the parents. Children reporting two or more incidences of nocturnal enuresis per month during the past year were considered positive repliers and were subjected to further evaluation. The control group consisting of 100 age-matched non-enuretic children presenting for other urologic or non-urologic problems mandating a plain abdominal X-ray was subjected to the same evaluation. In these children the possible detection of spina bifida was the point of concern. Results: The response rate to the questionnaire was 79. The prevalence of enuresis was 20.2. Out of the enuretic children; 87.6complained of nocturnal enuresis only; 72.3of them were primary enuretics. Monosymptomatic enuresis was observed in 46.3of the cases. Marked enuresis (every night) affected 53.7of the total number of enuretic children. Statistically significant risk factors were deep sleep and a high educational level of the parents. Primary nocturnal enuresis was insignificantly associated with a positive family history; family size or birth rank. In primary nocturnal enuretics the results of the urogenital and neurological examinations were normal in 90.5and 80.6; respectively; and only 4received a specific treatment. A large amount of post-void residual urine was observed in 7.4. Spina bifida occulta was observed in 10.8of primary nocturnal enuretics and in 11 of the control group. Conclusions: This is the first large population-based study of the prevalence of age-related enuresis in Assiut; but it does not differ much from those reported in other parts of the world. Enuretic children and their parents are mildly concerned about enuresis. Investigations for monosymptomatic primary nocturnal enuresis are not of considerable diagnostic value or cost effectiveness

Primary noctural enuresis : a clinical urodynamic. evaluation and analysis of therapeutic options

Objective To assess the clinical evaluation; urodynamic data and therapeutic options in patients with primary nocturnal enuresis. Patients and Methods A total of 473 patients aged between 5 and 35 years were evaluated clinically and underwent urine analysis and cultures as well as plain radiography of the abdomen. Intravenous urography was done when indicated. A urodynamic study was done in patients with polysymptomatic enuresis; a failed previous therapy and enuresis in adults. Initially; patients with monosymptomatic enuresis and those who had polysymptomatic enuresis with a stable detrusor function were managed by conditioning therapy using a calendar. When urodynamic studies detected detrusor instability (DI); the patients were initially treated by anti-muscarinics. Results Monosymptomatic enuresis was diagnosed in 329 patients; while the remaining 144 patients had polysymp-tomatic enuresis. Detrusor instability was detected in 36 of the monosymptomatic patients and in 93 of the polysymptomatic patients. Bladder capacities at the first sensation (FS); at normal sensation and at the maximum cystometric capacity (MCC) showed a statistically significant increase in patients with stable detrusor function compared to those with DI. The detrusor pressure (Pdet) was significantly higher at the first sensation and at the MCC in patients with DI than in patients with a stable detrusor. Conditioning therapy showed satis-factory results in 74of the patients with a better outcome in those with monosymptomatic enuresis. Antimuscarinics treated 91 of both monosymptomatic and polysymptomatic enuretics with DI. Conclusion Conditioning therapy using a calendar can offer a good therapeutic modality to most patients with primary nocturnal enuresis with stable detrusor function avoiding the costs and side effects of drugs. Pharmacotherapy should only be used when this conditioning therapy fails. Filling cystometry can detect detrusor instability as a cause of enuresis that helps in the proper choice of antimuscarinics as a primary line of treatment