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Enuresis and the voiding cystourethrogram: a re-evaluation
S K Sujka1, M R Piedmonte, S P Greenfield
1Department of Urology, State University of New York, Buffalo.
Urology
|August 1, 1991
Summary
Nocturnal enuresis in children without urinary tract infections (UTIs) can indicate vesicoureteral reflux (VUR). A contrast voiding cystourethrogram (VCUG) is recommended for screening, as common symptoms do not reliably predict VUR presence.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
- Nephrology
Background:
- Nocturnal enuresis is a common pediatric complaint.
- Vesicoureteral reflux (VUR) is a significant risk factor for renal scarring and recurrent urinary tract infections (UTIs).
- Predicting VUR in children with enuresis and sterile urine is clinically important.
Purpose of the Study:
- To evaluate the prognostic value of specific historical details in predicting vesicoureteral reflux (VUR) in children with nocturnal enuresis and no history of urinary tract infection (UTI).
- To determine if clinical symptoms can reliably identify children requiring a contrast voiding cystourethrogram (VCUG).
Main Methods:
- Prospective evaluation of 83 children with nocturnal enuresis and no UTI history.
- Assessment of four historical details: primary vs. secondary enuresis, daytime wetting, urgency, and frequency.
- Linear logistic regression analysis to correlate symptoms with VUR detected via VCUG.
Main Results:
- Vesicoureteral reflux (VUR) was detected in 16% of patients (13/83), with varying grades (I-IV).
- No single symptom or combination of symptoms reliably predicted the presence of VUR.
- Renal scarring was observed in 16% of patients with VUR.
Conclusions:
- Clinical symptoms are not reliable predictors of VUR in children with nocturnal enuresis and sterile urine.
- A significant proportion of children with these symptoms have VUR, underscoring the need for screening.
- Screening with a contrast voiding cystourethrogram (VCUG) should be considered for children presenting with nocturnal enuresis and no history of UTI.