Association between enuresis and obesity in children with primary monosymptomatic nocturnal enuresis

ABSTRACT Objective The purpose of this study was to determine whether the presence of obesity was related with symptoms of nocturnal enuresis (NE) and the efficacy of behavioral intervention in the treatment of NE. Materials and Method The patients diagnosed with primary monosymptomatic nocturnal enuresis (PMNE) were studied retrospectively. NE severity was classified as mild, moderate, and severe according to the frequency of enuresis. The children were divided into three groups, namely normal weight (5th-84th percentile), overweight (85th-94th percentile), and obesity (≥95th percentile), according to their Body Mass Index (BMI) percentage. The relationship between obesity level and enuresis severity was analyzed. After three months of behavioral therapy, the efficacy of treatment among normal, overweight, and obese groups were evaluated. Moreover, the predictive risk factors for treatment failure were investigated. Results The rates of severe enuresis in patients with normal weight, overweight, and obesity were 63.9%, 77.5%, and 78.6%, respectively. Obese children depicted higher odds of having severe enuresis compared with normal-weight children (OR: 1.571; 95% confidence interval [CI]: 1.196-2.065; P=0.001). The odds of presenting with severe enuresis were 1.99 times higher in children who are obese or overweight compared to children with normal weight (OR: 1.994; 95% CI: 1.349-2.946; P=0.001). The complete response of the normal group was higher than those of the overweight and obese groups (26.8% vs. 14.0%, P=0.010; 26.8% vs. 0.0%, P=0.000). Overweight children showed higher complete response than obese ones (14.0% vs. 0.0%, P=0.009). Logistic regression analysis revealed that obesity level and enuresis frequency were significantly related to the treatment failure of behavioral intervention. Conclusions Obesity is associated with severe enuresis and low efficacy of behavioral therapy in children with nocturnal enuresis.

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.

Capacidad vesical funcional mediante ultrasonido en pacientes con enuresis primaria monosintomática / Functional bladder capacity by ultrasound in patients with monosymptomatic primary enuresis

La enuresis primaria monosintomática es un problema clínico común que afecta del 5 al 10% de los niños en edad escolar. La etiología exacta no se conoce, pero se ha propuesto una capacidad vesical funcional disminuida como factor predisponente. Existen pocos reportes en la literatura del uso de ultrasonido para su evaluación. Objetivo: Determinar si la capacidad vesical funcional medida por ultrasonido está disminuida en enuresis primaria monosintomática comparada con población sana. Pacientes y Método: Estudio trasversal analítico de febrero de 2014 a mayo de 2015 incluyendo 40 pacientes con enuresis y 40 sin enuresis, 5 a 15 años de edad, midiendo la capacidad vesical funcional mediante ecógrafo Siemens Acuson S2000TM con transductor 3,5 y 5 MHz por un solo operador cegado. Se realizó estadística descriptiva y analítica mediante el programa IBM SPSS 20 TM. Resultados: Los pacientes con enuresis presentaron menor capacidad vesical funcional 171,7 ml vs controles 225,5 ml (p = 0,025). Resultó factor de riesgo OR = 2,81 (IC 95%: 1,06-7,42) tener un familiar de primera línea con antecedente de enuresis y OR = 4,0 (IC 95%: 1,48-10,78) para segunda línea. La capacidad vesical funcional presentó correlación débil con la capacidad vesical normal estimada mediante la fórmula de Kaefer. Conclusión: La capacidad vesical funcional es menor en quien padece enuresis que en los que no la padecen y existe poca correlación con las fórmulas que determinan la capacidad vesical normal esperada como la de Kaefer. Se reafirmó que el antecedente hereditario de enuresis juega un papel importante como factor de riesgo.

Nocturnal enuresis is a common clinical problem affecting 5% to 10% of school-age children. Etiology is not known but a diminished functional bladder capacity it has been proposed as a predisposing factor. There exist only a few studies evaluating it by ultrasound. Objective: To identify if there is a difference of the functional bladder capacity measured by ultrasound between nocturnal enuresis group and healthy children. Patients and Method: A cross-sectional study from February 2014 to May 2015 including two groups, nocturnal enuresis and a control group of 40 patients each, 5 to 15 years old. A single blinded operator measured the functional bladder capacity by ultrasound with an Acuson S2000 SiemensTM 3.5 and 5 MHz transducer. Analytics and descriptive statistics were performed using IBM SPSS 20TM software. Results: Patients with enuresis showed a decreased functional bladder capacity vs. controls (171.7 ml vs 225.5 ml; p = 0.025). A history of first-degree relative with enuresis increased the risk of having enuresis OR = 2.81 (95% CI: 1.06-7.42), a second-degree relative presented OR = 4.0 (95% CI: 1.48-10.78). Functional bladder capacity presented a weak correlation with the bladder capacity estimated by Kaefer’s formula. Conclusion: The functional bladder capacity is lower in the patients with nocturnal enuresis when compared to control group. There is little correlation between functional bladder capacity and Kaefer’s formula to determine the normal bladder capacity. We reaffirmed that the family history with enuresis strongly increases the risk of developing nocturnal enuresis.

Avaliação da enurese noturna em crianças com distúrbios respiratórios obstrutivos (DRO) durante o sono, antes e após adenotonsilectomia / Nocturnal enuresis in children with obstructive breathing disorders during sleep, before and after adenotonsilectomy

Introdução: Distúrbios respiratórios obstrutivos (DRO) são frequentes em crianças e têm como sua principal causa a hipertrofia das tonsilas. A enurese noturna tem sido associada aos DRO, causando assim importante impacto psicossocial. Objetivo: Avaliar a associação entre enurese e DRO em crianças e sua possível melhora após adenoidectomia e/ou tonsilectomia. Métodos: Foram estudadas 138 crianças do Ambulatório de Distúrbios do Sono, com idade entre 5 e 12 anos, com indicação de adeno e/ou tonsilectomia por DRO. Foram analisadas variáveis como: sexo, idade e presença de enurese. As crianças foram reavaliadas três a seis meses após o tratamento cirúrgico. Resultado: Dentre as 138 crianças, 31 (22,5%) apresentavam enurese noturna. Houve predomínio na faixa etária de cinco a sete anos, com distribuição igual entre os gêneros. Houve melhora da enurese em 21 (67,7%) dos pacientes após o procedimento cirúrgico, em sete (70%) das dez crianças nas quais persistiu a enurese, também houve persistência dos roncos. Conclusão: A enurese noturna é frequente em crianças com DRO e pode ter melhora após tratamento da causa da obstrução respiratória, sugerindo interação entre SAOS e enurese noturna.

Prevalence of bedwetting for children in Mosul city

The mental and behavioral disorders, just as the other types of illnesses, creats significant economic difficulties for children, patients and their families. The main objective of this study was to determine the prevalence of bedwetting in Mosul city and some risk factors related to it. To achieve the above mentioned aim, a cross -sectional study design was adopted, some primary schools were chosen as a study setting. The questionnaire forms were sent to the selected families. Out of 600 questionnaires, [596] were received [99.3%]. More than one tenth [13.8%] of pupils aged 6-8 years were bedwetters, while boys were more affected than girls. The present study revealed that bedwetting is significantly influenced by multiple factors including gender, child's age group, family size, birth order, education of parents, socioeconomic status of the family and diseases of father; as stressful life events, in addition to sleep pattern and family history of having the same condition. Whereas mothers disease is poorly associated with the occurrence of bedwetting. The present study shows that more than one tenth of the children suffered from bedwetting, which appeared in male children, small children, large family sizes, birth order, poor education of father and mother, and family history of holding the same condition

Enuresis persisting into adulthood

Nocturnal enuresis is a very common finding in children to the extent that many families and caregivers, alike, may dismiss it as a developmental stage rather than a disease. Persistence of nocturnal enuresis into adulthood, however, has received little discussion and is surrounded by fallacies. All existing literature cited in PubMed between 1970 and 2005 were reviewed using the search entries "nocturnal enuresis AND adult". Of the 220 papers reviewed, enuresis persisting into adulthood was covered in only 87. Those aspects pertinent to this subset of patients were placed in focus. In contrast to the numerous researches on childhood enuresis, persistent adulthood enuresis is an underdiscussed subject, distinct in a few aspects of its etiology and management described herein

Effect of the rapid maxillary expansion on the treatment of primary nocturnal enuresis [clinical study]

The present study was conducted to evaluate the effect of rapid maxillary expansion [RME] the primary nocturnal enuresis [NE]. A sample consists of 19 patients, with resistant primary nocturnal enuresis, aged 6-15 years, treated by banded Hyrax expander in the College of Dentistry University Baghdad, 7 patients out of study group considered as control group at first to exclude placebo effect of the appliance. CT scan was used to evaluate the increase in the nasal cavity width at the level of inferior choncha, rhinomanometry used to assess nasal airflow and nasal resistance, osmolality measured to evaluate plasma antidiuretic hormone [ADH] all these parameters done before and 2-3 months at expansion in Al-Kadhymia Teaching Hospital. Patients in the study group underwent rapid maxilla expansion in 10-15 days, after 2 to 3 months of expansion most of the patients show complete dryness and others show notable improvement in nocturnal enuresis. The improvement in nocturnal enuresis following rapid maxillary expansion may be due to: -1-Restoration of normal sleep patterns, that make the patient wake easily, this caused by improvement nasal breathing, snoring, deep sleep, and treatment of mouth breathing following rapid maxilla expansion. -2-Increase in the antidiuretic hormone secretion, that causes decrease in the plasma osmolality and urine production following rapid maxillary expansion

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

Cystoscopy- assisted delayed urethroplasty for complete posterior urethral disruption following pelvic fracture

Herein, we present our results in managing complete posterior urethral tear associated pelvic fracture. We treated 12 young male patients subjected to road traffic accident. Patients' average age was 23.5 years. All patients were treated by initial insertion of suprapubic cystocatheter followed by dejayed transperineal anastomotic urethroplasty. The technique was assisted by suprapubic cystoscopy. Follow up was done for an average duration of 18.2 months with assessment of continenbe status, sexual potency and voiding pattern. Three out of 12 cases [25%], developed anastomotic stricture treated by internal urethrotomy. Decreased erectile quality affected 2 cases [17%], while one patient [8.4%], reported nocturnal enuresis. These results compare favorably with many other series. So, we can conclude that, in our hand, delayed perineal anastomotic urethroplasty is an optimal choice for such cases. In addition, the use of suprapubic cystoscopy helps in assessment of bladder neck and bladder, as well as, it helps in surgical manipulation of proximal part of the urethra

Nocturnal enuresis in children prevalence, predisposing factors, and the relationship with upper respiratory obstruction

The aim of this study is to detect the percentage of nocturnal enuresis from the point of sex, age, kind of enuresis [primary and secondary] and to know the percentage of the most predisposing factors of it, and to determine the relationship between sharing these factors and the severity of this case, and to determine the relationship between the nocturnal enuresis and the upper respiratory obstruction as one of the predisposing factors. Definition of nocturnal enuresis: It is the persistent sleep wetting more than once a month past the age of five year. It is a symptom and not a disease state affecting 15-20% of 5 years old, 5-10% of 10 years-old, and 1-2% of 15 years old. Although the etiology of enuresis remains controversial, evidence supports the theory of maturation lag and/or development delay that may be influenced by a number of factors including stress, nocturnal polyuria, genetic predisposition and infection although psychopathology and enuresis may coexist, the majority of enuretics don't suffer from a psychological disorder. However, enuretics often have lower self-esteem and are more likely to underachieve compared with nonenuretics. Recent evidence does not support the theory that enuresis represents a sleep stage remains a possibility. Treatment of childhood enuresis must begin with careful history physical examination, urinalysis, and urine culture to determine if one is dealing with uncomplicated or complicated enuresis. The majority of patients have uncomplicated enuresis and there are a number of treatment options available to the physician that can be tailored to the individual patient. Behavioral modification techniques specifically conditioning therapy yield the highest reported long-term cure rates averaging 80%. This approach compared with pharmacologic therapy requires greater commitment and involvement of physician, parents and child. Imipramin has been the most commonly used drug. Desmopressin has shown promising results with similar reported response rates. Both drugs are associated with high relapse rates following discontinuation of treatment. Anticholinergics may be beneficial in those children who also have daytime frequency or enuresis. Regardless of the choice of treatment, parental support, reassurance and encouragement of the parents and child by the physician are necessary for optimal results. With the aim of detecting the percentage of most predisposing factors of nocturnal enuresis in children. The study was carried out throughout the 2003-2004 years in/2200/children of/5-15/years old, the doctor investigated only/206/child of them. The doctor investigated the parent, a good physical examination was done especially to investigate the upper respiratory obstruction. Ages of studied children-Number-Percentage:-; 5-30-14.5%; 6-27-13.1%; 7-26-12.6%; 8-27-13.1%; 9-24-11.6%;. Age-Number-Percentage:-;-10-19-9.2%-;-11-22-10.6%-;-12-15-7.2%-;-13-8-3.8%-;-14-5-2.4%-;-15-3-1.4%-; Table/1/. Sex of studied children: Sex-Male-Female; Number--125-81; Percentage--60.6%-39.3%; Table/2/. Kind of enuresis:-Kind-Primary-Secondary; Number--185-21; Percentage--89.8%-10.1%; Table/3/. The percentage of the most predisposing factors:-; O-Factors-Numbers-Percentage; Family history-142-68.9%;--Punishment-159-77.2%; Early toilet training-116-56.2%; Deep sleep-143-69.4%; Male sex-125-60.6%; Female sex-81-39.3%; Poor family-117-56.7%; Drinking before sleep-112-54.3%; Winter-120-58.2%; Illiteracy of father-42-20.3%; Illiteracy of mother-56-27.18%; Small age of mother-65-31.5%; Upper respiratory obstruction-39-18.9%; Table/4/. This study which was concentrated on/206/children of/2200/children at Aleppo in 2003-2004 concluded the following:-The percentage of male is 60.6% and female is 39.3%. -The percentage of primary enuresis is 89.8% and secondary enuresis is 10.1%. -The most category of age is 6-8 years and its percentage is 38.8%-The percentage of the most predisposing factors is 77.2% of punishment, then 69.4% of deep sleep, then 68.9% of familial history, then 60.6% of male sex, and other factors. -Sharing between two factors makes the case worse and the higher percentage is 63.09% which it is sharing between family history and punishment. -Upper respiratory obstruction is one of the predisposing factors of nocturnal enuresis

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