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Screening of urinary tract abnormalities among day and nightwetting children
M R Järvelin1, N P Huttunen, J Seppänen
1Department of Paediatrics, University of Oulu, Finland.
Insights
Urinary tract imaging is not needed for children who only wet the bed at night. However, daytime wetting in children warrants further investigation with ultrasonography, uroflowmetry, and other urological methods.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
- Child Health
Background:
- Urinary tract abnormalities can be a cause of wetting in children.
- Previous studies have evaluated diagnostic methods for childhood wetting with varying results.
Purpose of the Study:
- To assess the utility of urinary tract ultrasonography and uroflowmetry in detecting abnormalities in children experiencing nocturnal enuresis (nightwetting) versus diurnal enuresis (daywetting).
Main Methods:
- A comparative study involving 145 wetting children (73 nightwetters, 72 daywetters) and 156 non-wetting controls (age 7).
- Evaluations included medical history, ultrasonography, and uroflowmetry, with further investigations (intravenous pyelography, cystography, cystoscopy, cystometry) for abnormal findings.
Main Results:
- Ultrasonography revealed abnormalities in 6.8% of nightwetters, 13.9% of daywetters, and 2.6% of controls; the difference in daywetters was significant (p<0.01).
- Fractioned voiding curves were noted in 1.4% of nightwetters and 9.7% of daywetters, a significant difference (p<0.05).
- Marked structural or functional disorders were found in 15.3% of daywetters, compared to 1.4% of nightwetters and 0.6% of controls.
Conclusions:
- Imaging of the urinary tract is generally unnecessary for children with isolated nightwetting.
- Children experiencing daytime wetting, especially with clinical symptoms of voiding disturbances, benefit from focused evaluation with ultrasonography, uroflowmetry, and potentially advanced radiological or urological investigations.
Abstract:
In order to detect possible urinary tract abnormalities among wetters, assessments of previous history completed by ultrasonography of the urinary tract and uroflowmetry were obtained for 145 wetting children and a random sample of 156 sex-matched non-wetting children drawn from a population of 3,375 seven-year-olds. Ultrasonography revealed abnormalities, including both morphological ones and cases with incomplete bladder emptying, in 5 out of 73 nightwetters (6.8%, 95% confidence limit, CL, 1.1-12.6), 10 out of 72 day and day and nightwetters (hereafter daywetters) (13.9%, CL 5.9-21.9) and 4 controls (2.6%, CL 0.1-5.0), the figure for the daywetters differing significantly from that for the controls (p less than 0.01). A fractioned voiding curve was recognized in 1 nightwetter (1.4%, CL -1.3-4.0), 7 daywetters (9.7%, CL 2.9-16.6) and 7 controls (4.5%, CL 1.2-7.7) the difference between the nightwetters and daywetters being significant (p less than 0.05). Depending on the previous history and abnormal findings in ultrasonography or uroflowmetry, examinations were continued with intravenous pyelography, voiding cystography, cystoscopy and/or by cystometry. Finally, marked structural or functional disorders of the urinary tract were detected in 11 out of 72 daywetters (15.3%, CL 7.0-23.6), 1 out of 73 pure nightwetters and 1 out of 156 control children. It is concluded that imaging of the urinary tract is not necessary for pure nightwetters, while ultrasonography or uroflowmetry and more sophisticated radiological or urological methods should be focused on those children with daytime wetting and clinical symptoms of voiding disturbances.