RESUMO
To determine the etiology and pathogenesis of enuresis among primary school children by using a special ultrasound [US] protocol for the assessment of bladder dysfunction and to compare excretion of urinary sodium and calcium in enuretic children. We conducted this cross sectional study on 66 enuretic children aged 6-12 years from September 2005 to January 2006 in Isfahan University of Medical Sciences, Iran. Ultrasound [US] was designed for the evaluation of bladder parameters using bladder volume and wall thickness index [BVWI%], and expected percentage bladder volume index for kidney volume. Sixty children [90.9%] had nocturnal enuresis, 5 [7.5%] had diurnal enuresis and one child [1.6%] had nocturnal and diurnal enuresis. Urinary infection was detected in one child [1.5%]. The incidence of urinary system abnormalities was 10.6% in all enuretic children. Hypercalciuria was seen in 9.2% and natriuresis in 20.3%. Normal bladder function [BVWI 70% to <130%] was seen in 67%, small bladder with a thick wall [BVWI <70%] in 27% and large bladder capacity with a thin wall [BVWI >130%] was seen in 6% of children with primary nocturnal enuresis [PNE]. There was a significant difference in BVWI between children with PNE and secondary nocturnal enuresis [P=0.01]. Enuresis is a common problem among school children and associated urinary abnormalities are not uncommon. Our results show that US measured bladder parameters can provide useful clues for the underlying bladder dysfunction and may help to guide clinical management
RESUMO
To estimate the prevalence of enuresis in primary school children in Iran and to determine the factors associated with this disorder. A cross-sectional time-ordered study was performed at the Faculty of Medicine, Isfahan Medical University, Isfahan, Iran from September 2005 to January 2006. A total of 4500 self-administered questionnaires were distributed to parents of children aged 6-12 years attending 30 primary schools. From an overall response rate of 69.9%, enuresis was reported in 216 children [7%], comprising 6.2% for nocturnal enuresis according to ICD10 and 3.3% according to DSM IV, 0.5% for diurnal enuresis and 0.8% for combined day and night wetting. Primary nocturnal enuresis was reported in 166 children [5.3%]. Seventy-one [50.7%] of the 140 children with nocturnal enuresis had ?3 wet nights per week. A positive family history in father and mother was seen in 51% and 39% of children with primary nocturnal enuresis respectively. Using logistic regression analysis, younger age [p<0.002], gender [p<0.0001] and low level of education of mother [p<0.028] were significant predictors of enuresis. Positive history of enuresis in father was a significant predictor of primary nocturnal enuresis [p<0.012]. The prevalence of nocturnal enuresis in Iran is lower than those reported in western countries, however, higher percentage demonstrated severe enuresis. The prevalence of diurnal enuresis is lower than previous studies. Age, gender and the educational level of the mother are the main risk determinants of enuresis and the prevalence of primary nocturnal enuresis appears to be significantly related to positive history of enuresis in father