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Somatic correlates of functional enuresis
A von Gontard1, B Benden, K Mauer-Mucke
1Dept. of Child and Adolescent Psychiatry, University of Cologne, Köln, Germany.
Insights
This study found significant somatic correlates in children with functional enuresis (day and/or night wetting), including bladder issues and abnormal voiding patterns. These findings have implications for classifying and treating childhood incontinence.
Area of Science:
- Pediatric Urology
- Child Psychiatry
- Clinical Diagnostics
Background:
- Functional enuresis is a complex condition with varied causes.
- Identifying non-neurologic, non-structural incontinence correlates is crucial for diagnosis.
Purpose of the Study:
- To identify specific, non-invasive somatic correlates of enuresis in child psychiatric patients.
- To differentiate subtypes of enuresis based on physiological findings.
Main Methods:
- Prospective examination of 167 children (5-10 years) with day/night wetting.
- Utilized urinalysis, ultrasonography (bladder wall, residual volume), uroflowmetry, pelvic-floor-EMG, EEG, and pediatric-neurologic exams.
Main Results:
- Day wetters showed higher rates of antibiotic prophylaxis, larger residual volumes, thicker bladder walls, abnormal uroflowmetry, and less relaxed EMG.
- Voiding postponers had more uroflow anomalies; primary nocturnal enuretics with micturition issues had less relaxed EMGs.
- 10% of children had urogenital anomalies; EEG/neurological signs did not significantly differ between groups.
Conclusions:
- Enuresis exhibits a high rate of functional somatic correlates.
- Findings support clinical and theoretical implications for enuresis classification and management.
- Non-invasive somatic assessments are valuable in pediatric enuresis evaluation.
Abstract:
Functional enuresis is a heterogeneous group of syndromes with different aetiology and pathophysiology. The aim was to identify specific somatic correlates of enuresis non-invasively in child psychiatric patients after exclusion of neurologic and structural forms of incontinence. One hundred sixty-seven consecutive children, aged 5 to 10 years with day and/or night wetting were examined prospectively with: urinalysis and bacteriology; ultrasonography, including bladder wall thickness and residual volume; uroflowmetry and pelvic-floor-EMG; EEG; and a complete paediatric-neurologic examination. Day wetting children had a significantly higher rate of previous antibiotic prophylaxis, larger residual volume, thicker bladder walls; the uroflow curves were significantly less bell- and more staccato-shaped, the EMG less relaxed. Voiding postponers showed a tendency towards more uroflow anomalies than urge incontinent children. Primary and secondary enuretics did not differ on most parameters, but primary nocturnal enuretics with micturition problems had significantly less relaxed EMGs than monosymptomatic enuretics. Although day wetters had more pathological EEGs and neurological signs, these differences did not reach significance. The overall rate of urogenital anomalies was 10%. In conclusion, enuresis has a high rate functional somatic correlates with clinical and theoretical, classificatory implications.