Prevalence of enuresis and its impact in quality of life of patients with sickle cell disease

ABSTRACT Introduction Evidence indicates an increase in the prevalence of enuresis in individuals with sickle cell disease. The present study aims to evaluate the prevalence and impact of enuresis on quality of life in individuals with sickle cell disease. Materials and Methods This cross-sectional study evaluated individuals with sickle cell disease followed at a reference clinic, using a questionnaire designed to evaluate the age of complete toilet training, the presence of enuresis and lower urinary tract, and the impact on quality of life of these individuals. Results Fifty children presenting SCD (52% females, mean age ten years) were included in the study. Of those, 34% (17/50) presented as HbSC, 56% with HbSS (28/50), 2% Sα-thalassemia (1/5) and 8% the type of SCD was not determined. The prevalence of enuresis was 42% (21/50), affecting 75% of subjects at five years and about 15% of adolescents at 15 years of age. Enuresis was classified as monosymptomatic in 33.3% (7/21) and nonmonosymptomatic in 66.6% (14/21) of the cases, being primary in all subjects. Nocturia was identified in 24% (12/50), urgency in 20% (10/50) and daytime incontinence 10% (5/50) of the individuals. Enuresis had a significant impact on the quality of life of 67% of the individuals. Conclusion Enuresis was highly prevalent among children with SCD, and continues to be prevalent throughout early adulthood, being more common in males. Primary nonmonosymptomatic enuresis was the most common type, and 2/3 of the study population had a low quality of life.

Diagnóstico clínico de disfunção miccional em crianças e adolescentes enuréticos / Clinical diagnosis of bladder dysfunction in enuretic children and adolescents

OBJETIVO: Estimar o valor preditivo da presença de sintomas urinários diurnos para o diagnóstico de disfunção miccional em crianças e adolescentes enuréticos atendidos no Ambulatório de Urodinâmica do Instituto Fernandes Figueira. MÉTODOS: De junho de 1999 a maio de 2002, foram avaliados 91 pacientes, entre 5 e 17 anos de idade, portadores de enurese, mono ou polissintomática, através de anamnese, mapa da micção, exame físico e estudo urodinâmico. A anamnese baseou-se em um modelo desenvolvido para detecção de sintomas urinários diurnos. O valor preditivo da presença destes sintomas para o diagnóstico de disfunção miccional foi estimado neste grupo. RESULTADOS: O percentual de disfunção miccional entre as crianças e adolescentes atendidos por enurese no Ambulatório de Urodinâmica do Instituto Fernandes Figueira foi de 94,5 por cento. A anamnese identificou 97,3 por cento dos pacientes com sintomas urinários diurnos. Apenas 2,7 por cento dos pacientes apresentaram aumento da freqüência urinária detectado apenas pelo mapa da micção. O valor preditivo positivo da presença de sintomas urinários diurnos para o diagnóstico de disfunção miccional foi de 98,6 por cento. Houve associação, estatisticamente significante, entre sintomas urinários diurnos e disfunção miccional (p < 0,005), e o risco de a urodinâmica estar alterada foi de cerca de 20 vezes maior na presença destes. CONCLUSÕES: A presença de sintomas urinários diurnos apresentou um elevado valor preditivo positivo para disfunção miccional. A anamnese foi um instrumento útil para a detecção dos sintomas urinários diurnos, contribuindo para o diagnóstico de disfunção miccional.

Nocturnal enuresis.

Childhood enuresis is a common socially disruptive problem. The possible pathophysiological factors include a disorder of sleep arousal, nocturnal polyuria, and low bladder capacity. The evaluation of a patient with nocturnal enuresis is aimed to exclude any organic pathology, UTI and voiding dysfunction. An approach to management of this common disorder is outlined.

Fisiopatologia e abordagem clínica da Enurese / Pathophysiology and clinical implications of Enuresis

A enurese é condição de ocorrência frequente, sendo responsável por grande apreensão dos pais, quanto ao desenvolvimento psicológico da criança. Apresenta no entanto, expressiva variação clínica, tendo envolvido em sua gênese fatores cerebrais, vesicais e neurológicos, que interagem entre si favorecendo as perdas urinárias noturnas, ou seu adequado controle social. Dentro do conhecimento atual, distúrbios perenes do sono, podem comprometer o controle adequado da bexiga favorecendo a micção noturna, sem que haja o despertar

Childhood enuresis epidemiology, pathophysiology and management

The goal of this article is to review childhood enuresis, which is a common behavioral condition reported in millions of children worldwide. An online computer search was made, and the literature up to 1997 was screened in order to include relevant data for this review. The prevalence of childhood enuresis varies across reviewed studies. This was attributed to a variety of sociodemographic and cultural dynamics of societies. Similarly, the pathophysiology of this ubiquitous symptom is determined by multiple risk factors including biological, psychological, social, and cultural, but the developmental/maturational delay influenced by genetics remains the most plausible explanation. Although a variety of pharmacological and non-pharmacological treatment modalities are traced in the literature, there is yet no agreement on a single strategy. A general agreement about behavioral therapy as the first choice of treatment of this minor malady began to emerge. Additionally, tricyclic antidepressants are the most frequently prescribed drugs for the treatment of childhood enuresis. Enuresis is a pediatric public health problem and concerted efforts at all levels, ie, professional, promotional, educational and public should be made to address its multiple domains such as preventive, etiological and curative

Childhood nocturnal enuresis: a problem to be solved

Nocturnal enuresis is a common problem in paediatrics which causes concern for the child, his parents, and the treating paediatrician. Although the physiopathology is not yet well understood, the most accepted theory is that there is a delay in the development of the micturation reflex, a condition with a genetic predisposition. Management includes a detailed history, a thorough physical examination, and investigations to exclude pathologic causes. Treatment is based on achieving a good communication with the child and his parents by explanation of the benign course and the high spontaneous remission rate, behavioral and conditioning therapy with the use of a buzzer alarm and the gold star chart, and finally the introduction of drugs to accelerate remission; these include imipramine, oxybutinine, and desmopressin

Enuresis en pediatría / Enuresis in pediatrics

La enuresis es un problema frecuente en pediatría; su orgien es aún obscuro y su tratamiento se presta a controersias. Obedece generalmente a un retardo en la maduración neurológica del niño; sin embargo en muchos pacientes es posible reconocer un problema orgánico.

Incidencia de enuresis en el Servicio de Psiquiatría del Hospital Infantil Robert Reid Cabral (Septiembre-Noviembre, 1986)

Se estudió una población de niños de 5-13 años, de ambos sexos; que asistieron a la consulta de Psiquiatría Infantil del Hospital Robert Reid Cabral durante el período que va del 1§ de septiembre '86 al 30 de noviembre de '86; encontrándose que la enuresis estuvo presente en un 10.4% del total de pacientes vistos, siendo predominante en las niñas