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

ABSTRACT

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