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[Enuresis--causes, diagnosis and therapy]
1Urologische Klinik und Abteilung für Kinderurologie, St. Antonius-Hosptial Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen.
Insights
This study investigated 672 children with enuresis (bedwetting), identifying functional, anatomical, and psychogenic causes. Treatment varied by cause, including medication, surgery, and psychotherapy for effective management.
Area of Science:
- Pediatric Urology
- Child Psychology
- Medical Diagnostics
Context:
- Enuresis affects a significant pediatric population, necessitating comprehensive diagnostic approaches.
- Understanding the diverse etiologies of enuresis is crucial for effective treatment.
Purpose:
- To categorize the causes of primary and secondary enuresis in children.
- To evaluate the diagnostic methods for identifying enuresis etiologies.
- To correlate specific enuresis causes with appropriate treatment modalities.
Summary:
- A systematic investigation of 672 children with enuresis identified three main etiological groups: functional micturition disorders (46.4%), pathological anatomical changes (33.2%), and psychogenic disorders (20.4%).
- Diagnostic methods included medical history, physical examination, urinalysis, sonography, urodynamic tests, voiding cystogram, urethral calibration, and urethrocystoscopy.
- Treatments comprised drug therapy and biofeedback for functional disorders, surgery for anatomical abnormalities, and psychotherapy for psychogenic causes.
Impact:
- Provides a classification framework for enuresis etiologies in children.
- Highlights the importance of a multi-faceted diagnostic approach for enuresis.
- Informs evidence-based treatment strategies for pediatric enuresis based on identified causes.
Abstract:
672 children aged between 4 and 16 years were treated for primary or secondary enuresis between 1980 and 1986. The group included more girls than boys. A systematic diagnostic investigation, consisting of a detailed medical history, physical examination, urinalysis and sonography of the kidneys and bladder, was carried out in all cases. This investigation was followed by urodynamic tests to detect any functional disorders of the lower urinary tract. Finally, a voiding cystogram, urethral calibration and urethrocystoscopy were conducted to screen for morphological changes. Three major groups of causes of enuresis were identified. Functional miction disorders were found in 312 (46.4%) children. In these cases there was an inability to voluntarily control the detrusor, detrusor-sphincter dyssynergia and hyperactivity of the detrusor. 223 (33.2%) of the children had pathological anatomical changes of the urinary tract, such as malformations leading to vesicoureteral reflux, vesicular diverticula, duplication of the upper urinary tract, megaureter, urethral stenosis or urethral valves, with associated infection. Psychogenic disorders were diagnosed in 137 (20.4%) cases. The first group received drug treatment and biofeedback training for reestablishment of conscious control over the vegetative functions of the lower urinary tract. The second group underwent surgery for correction of the pathological anatomical changes. The third group was referred for psychotherapy.