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Functional daytime incontinence: clinical and urodynamic assessment
J D van Gool1, M A Vijverberg, T P de Jong
1Division of Children's Surgical Associates Ltd., Philadelphia, PA.
Insights
Diagnosing daytime wetting in children requires specific questions about bladder function, distinguishing it from functional incontinence. Urodynamics helps identify four key bladder/sphincter dysfunction patterns, crucial for effective treatment.
Area of Science:
- Pediatric Urology
- Pediatric Nephrology
- Child Health
Background:
- Daytime wetting in children is often categorized as enuresis diurna or functional incontinence.
- Standard history-taking may not sufficiently differentiate these conditions, necessitating targeted questioning.
Purpose of the Study:
- To develop and validate a questionnaire, supported by urodynamics, for precise diagnosis of daytime wetting in children.
- To identify distinct patterns of bladder/sphincter dysfunction contributing to daytime wetting.
Main Methods:
- A validated questionnaire focusing on daytime wetting, nighttime wetting, micturition, and urge symptoms was administered.
- Urodynamic studies were employed to elucidate the pathophysiology of bladder/sphincter dysfunction in 156 children with persistent daytime wetting.
Main Results:
- Four primary patterns of bladder/sphincter dysfunction were identified: urge syndrome, staccato voiding, fractionated/incomplete voiding, and lazy bladder syndrome.
- A significant correlation was observed between recurrent urinary tract infections (UTIs) and non-neuropathic bladder/sphincter dysfunction.
Conclusions:
- History-taking combined with urodynamics effectively categorizes bladder/sphincter dysfunction in children with daytime wetting.
- Early detection and management of bladder/sphincter dysfunction are vital for children with recurrent UTIs, particularly those with vesico-ureteral reflux.
Abstract:
Assessment of children with daytime wetting starts with the distinction between 'enuresis diurna' and 'functional incontinence', incontinence being defined as any form of wetting caused by bladder/sphincter dysfunction. Standard history-taking does not allow for a sharp enough distinction: pertinent questions have to be asked about daytime wetting, night-time wetting, micturition, and about urge and reactions to urge. By using urodynamics to expose the pathophysiology behind the patterns of bladder/sphincter dysfunction, these questions were formulated and validated in a series of 156 children, referred with persistent daytime wetting to a programme for cognitive bladder training. With history-taking organized into a simple questionnaire, complemented by urodynamics, four patterns of bladder/sphincter dysfunction emerged: urge syndrome, staccato voiding, fractionated and incomplete voiding, and lazy bladder syndrome. A strong correlation was found between recurrent urinary tract infections and non-neuropathic bladder/sphincter dysfunction, implying that detection and treatment of bladder/sphincter dysfunction is essential in every child with recurrent urinary tract infections, especially in the presence of vesico-ureteral reflux.