Monosymptomatic and non-monosymptomatic nocturnal enuresis: a clinical evaluation

ABSTRACT

Nocturnal enuresis is divided into monosymptomatic nocturnal enuresis [MNE] and non-monosymptomatic nocturnal enuresis [NMNE]. This study reviews clinical and ultrasonography [US] findings in enuretic children, and compares the organic and functional pathologies of the lower urinary tract [[UT] in children with MNE to those who have NMNE. We enrolled 111 neurologically normal children with chief complaints of enuresis in this study. Participants included 60 boys and 51 girls, aged 5-17 years. There were 43 [38.8%] patients diagnosed with MINE and 68 [61.2%] with NMNE. Urine analysis, urine culture and kidney-bladder US were performed for patients. Some patients underwent a voiding cystoureterography [VCUG], urodynamic study [UDS], or both. Patients were divided into three groups i] MNE, ii] NMNE without daytime incontinence [NMNE - daytime incontinence], and iii] NMNE plus daytime incontinence [NMNE + daytime incontinence]. Constipation [P= 0.011], encopresis [P= 0.003] and urge incontinence [P = 0.001] were significantly more frequent in patients with NMNE + daytime incontinence. Bladder wall thickness [BWT] was the most common US finding. One patient with MNE and 9 with NMNE + daytime incontinence had vesicoureteral reflux [VUR; P 0.016]. Posterior urethral valve [PUV] was reported in one patient with NMNE. Evidence of bladder dysfunction was noted in about half of the patients who underwent UDS, with a higher prevalence in cases that had NMNE + daytime incontinence [P = 0.297]. Bowel symptoms and VUR were significantly more prevalent in cases with NMNE + daytime incontinence. We recommend VCUG in enuretic children who have daytime incontinence. In addition our study has revealed that symptoms suggestive of an overactive bladder [OAB] are not good indicators for bladder dysfunction