Quality of life in enuretic children

ABSTRACT Introduction: Nocturnal enuresis is a highly incident chronic disorder that generates countless problems to the child and their parents. Bed-wetting has significant negative impacts on self-esteem and the performance of children. The aim of the current study is to assess the quality of life of enuretic children, as well as its association to sex and age. Patients and Methods: Thirty-nine enuretic children (23 boys) and 49 healthy children (27 boys) without any history of previous treatment for enuresis or voiding dysfunction were included. Age ranged between 6 and 11 years old. The "AUQEI" questionnaire was applied in a private environment to all children by the same researcher (psychologist) to evaluate quality of life. Results: Enuretic children displayed loss in quality of life when compared to non-enuretic (35.9% of enuretic x 16.3% of non-enuretic, p=0.035). They were mostly affected in their daily activities (p=0.02). No significant differences were found in the association of sex and gender with quality of life. These results suggest that, children with nocturnal enuresis have 2.87 times more chances of having loss in quality of life compared to non-enuretic. Conclusions: Enuresis has a great impact in quality of life of children. This impact is not related to the age or sex of the child.

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.

Clinical course of a cohort of children with non-neurogenic daytime urinary incontinence symptoms followed at a tertiary center / Curso clínico de uma coorte de crianças com incontinência urinária diurna não neurogênica acompanhada em serviço terciário

Abstract Objective: To characterize a cohort of children with non-neurogenic daytime urinary incontinence followed-up in a tertiary center. Methods: Retrospective analysis of 50 medical records of children who had attained bladder control or minimum age of 5 years, using a structured protocol that included lower urinary tract dysfunction symptoms, comorbidities, associated manifestations, physical examination, voiding diary, complementary tests, therapeutic options, and clinical outcome, in accordance with the 2006 and 2014 International Children's Continence Society standardizations. Results: Female patients represented 86.0% of this sample. Mean age was 7.9 years and mean follow-up was 4.7 years. Urgency (56.0%), urgency incontinence (56.0%), urinary retention (8.0%), nocturnal enuresis (70.0%), urinary tract infections (62.0%), constipation (62.0%), and fecal incontinence (16.0%) were the most prevalent symptoms and comorbidities. Ultrasound examinations showed alterations in 53.0% of the cases; the urodynamic study showed alterations in 94.7%. At the last follow-up, 32.0% of patients persisted with urinary incontinence. When assessing the diagnostic methods, 85% concordance was observed between the predictive diagnosis of overactive bladder attained through medical history plus non-invasive exams and the diagnosis of detrusor overactivity achieved through the invasive urodynamic study. Conclusions: This subgroup of patients with clinical characteristics of an overactive bladder, with no history of urinary tract infection, and normal urinary tract ultrasound and uroflowmetry, could start treatment without invasive studies even at a tertiary center. Approximately one-third of the patients treated at the tertiary level remained refractory to treatment.

Resumo Objetivo: Caracterizar uma coorte de crianças com incontinência urinária diurna não neurogênica acompanhada em serviço terciário. Métodos: Análise retrospectiva de 50 prontuários de crianças com controle miccional ou idade mínima de cinco anos, por meio de protocolo estruturado, que incluiu sintomas de disfunção do trato urinário inferior, comorbidades, manifestações associadas, exame clínico, diário miccional, exames subsidiários, opções terapêuticas e evolução clínica, conforme normatizações da International Children's Continence Society, de 2006 e 2014. Resultados: Eram do sexo feminino 86% dos pacientes. A idade média foi de 7,9 anos e o seguimento médio de 4,7 anos. Urgência (56%), urgeincontinência (56%), retenção urinária (8%), enurese noturna (70%), infecção do trato urinário (62%), constipação (62%) e perda fecal (16%) foram os principais sintomas e comorbidades. Exames de ultrassom apresentaram alterações em 53% dos casos e o estudo urodinâmico em 94,7%. Na última consulta, 32% dos pacientes ainda apresentavam incontinência urinária. Ao analisar os métodos diagnósticos, observou-se concordância de 85% entre o diagnóstico preditivo de bexiga hiperativa obtido pela história clínica mais exames não invasivos e o diagnóstico de hiperatividade detrusora obtido pelo estudo urodinâmico. Conclusão: O subgrupo de pacientes com quadro clínico característico de bexiga hiperativa, sem antecedentes de infecção urinária, ultrassom de vias urinárias e urofluxometria normal poderia iniciar tratamento sem a necessidade de estudos invasivos, até em serviço terciário. Aproximadamente um terço dos pacientes com incontinência urinária atendidos em serviços terciários permaneceu refratário ao tratamento.

Prevalence of Daytime Urinary Incontinence and Related Risk Factors in Primary School Children in Turkey

PURPOSE: Urinary incontinence is one of the major urinary symptoms in children and adolescents and can lead to major distress for the affected children and their parents. In accordance with the definitions of the Standardization Committee of the International Children's Continence Society, daytime urinary incontinence (DUI) is uncontrollable leakage of urine during the day. The aim of this cross-sectional study was to investigate the prevalence and associated risk factors of DUI in Turkish primary school children. MATERIALS AND METHODS: The questionnaire, which covered sociodemographic variables and the voiding habits of the children, was completed by the parents of 2,353 children who were attending primary school in Denizli, a developing city of Turkey. The children's voiding habits were evaluated by use of the Dysfunctional Voiding and Incontinence Symptoms Score, which is a validated questionnaire. Children with a history of neurological or urological diseases were excluded. RESULTS: The participation rate was 91.9% (2,164 people). The overall prevalence of DUI was 8.0%. The incidence of DUI tended to decrease with increasing age and was not significantly different between genders (boys, 8.8%; girls, 7.3%; p=0.062). Age, maternal education level, family history of daytime wetting, settlement (urban/rural), history of constipation, urinary tract infection, and urgency were independent risk factors of DUI. CONCLUSIONS: Our findings showed that DUI is a common health problem in primary school children. In an effort to increase awareness of children's voiding problems and the risk factors for urinary dysfunction in the population, educational programs and larger school-based screening should be carried out, especially in regions with low socioeconomic status.

Prevalence of nocturnal enuresis in school aged children. The role of personal and parents related socio-economic and educational factors

Nocturnal enuresis is a common psychosocial concern for both parents and children. In the present study we have determined the prevalence of nocturnal enuresis in Urmia, Iran children and associated personal and familial factors with this problem. A cross sectional epidemiological study for detection of nocturnal enuresis prevalence rate and evaluation of associated familial and personal factors in elementary school children [7-11 years old] from Urmia were investigated. The subjects were selected by cluster sampling method. Chi square test and logistic regression were used in univariate and multivariate respectively. Of the 1600 questionnaires distributed, 918 [57%] were completed and included in the final analysis. The rest, which were not filled by parents and also those out of our study age range were excluded. Gender of the subjects was almost equally distributed [48.6% males and 51.4% females]. Prevalence of nocturnal enuresis was 18.7% [n=172] and prevalence of daytime incontinence was 5.5% [n=51]. There was no significant gender difference between these two groups. Enuretics had crowded families, positive family history, low educational level of parents, jobless father, working mother, single parent, poor school performance, positive history of urinary tract infection [UTI]. Our results with enuresis prevalence and associated factors were comparable to other epidemiological studies from various countries. We found that Iranian families do not pay sufficient attention to their enuretic children

Enuresis / Enuresis

La enuresis es un problema pediátrico muy importante, ya que produce considerable ansiedad, angustia y sufrimientos tanto al niño como a los padres y es una razón de consulta frecuente para pediatría.