Tonsillectomy does not improve bedwetting: results of a prospective controlled trial
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Published on: November 6, 2019
Carmin M Kalorin1, Jason Mouzakes, John P Gavin
1Department of Urology, Albany Medical Center, Albany, New York, USA. carminkalorin@yahoo.com
Insights
This study found no link between enlarged tonsils and bedwetting or daytime incontinence in children. Tonsillectomy did not improve urinary incontinence rates compared to a control group.
Area of Science:
- Pediatric Urology
- Otolaryngology
- Sleep Medicine
Background:
- Sleep disordered breathing associated with tonsillar hypertrophy is a suspected cause of childhood enuresis.
- Tonsillectomy is sometimes performed to address urinary incontinence in children.
Purpose of the Study:
- To investigate the association between tonsillar hypertrophy and nocturnal/daytime urinary incontinence in children.
- To compare incontinence rates before and after tonsillectomy versus a control group.
Main Methods:
- Prospective study of 326 toilet-trained children (3-15 years old).
- 257 children underwent tonsillectomy; 69 served as a control group.
- Voiding questionnaires assessed incontinence preoperatively and at 3/6 months postoperatively.
Main Results:
- Preoperative incontinence rates were similar between tonsillectomy (33% nocturnal, 17% daytime) and control groups (35% nocturnal, 14% daytime).
- Postoperative cure rates for bedwetting at 6 months were 50% in the tonsillectomy group and 48% in the control group.
- No significant differences in the improvement or cure of daytime incontinence were observed between groups.
Conclusions:
- No association was found between tonsillar hypertrophy and urinary incontinence in children.
- Tonsillectomy did not demonstrate a significant benefit for treating nocturnal or daytime enuresis compared to non-airway/urinary surgery.
Purpose:
Sleep disordered breathing caused by tonsillar hypertrophy has been implicated as a cause of primary and secondary nocturnal enuresis in children. We prospectively studied the preoperative and postoperative rates of nocturnal and daytime incontinence in a group of children with tonsillar hypertrophy undergoing tonsillectomy compared to a matched control group undergoing surgery unrelated to the airway or urinary tract.
Materials And Methods:
A total of 326 toilet trained children 3 to 15 years old were included, with 257 in the tonsillectomy group and 69 in the control group. Severity of tonsillar hypertrophy was graded preoperatively on a scale of 1 to 4. A voiding questionnaire regarding number of bedwetting and daytime incontinence episodes per week, voids per day, bowel movements per week, secondary or primary enuresis and family history was completed by parents preoperatively, and at 3 and 6 months postoperatively.
Results:
Preoperatively the respective rates of nocturnal enuresis and daytime incontinence were 33% and 17% in the tonsillectomy group (p=0.89), and 35% and 14% in the control group (p=0.3). The respective cure rates for bedwetting at 3 and 6 months postoperatively were 40% and 50% in the tonsillectomy group (p=0.60), and 35% and 48% in the control group (p=0.61). Similarly no difference was seen in improvement or cure of daytime incontinence at 3 and 6 months postoperatively.
Conclusions:
We found no association between tonsillar hypertrophy and urinary incontinence before or after tonsillectomy.
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