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Related Experiment Videos

The pseudo-obstructed bladder in enuretic children

J H Johnston, S A Koff, K I Glassberg

    British Journal of Urology
    |December 1, 1978
    PubMed
    Summary

    This study investigates bladder issues in children with severe daytime enuresis. Findings suggest uninhibited bladder contractions, not physical blockage, cause high pressures, managed with medication.

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    Area of Science:

    • Pediatric Urology
    • Urodynamics
    • Childhood Lower Urinary Tract Dysfunction

    Background:

    • Enuretic children with severe daytime symptoms, particularly those with urinary infections, may exhibit bladder diverticula, trabeculation, and vesicoureteric reflux.
    • These signs often suggest infravesical obstruction, a condition previously thought to cause these urinary issues in children.

    Purpose of the Study:

    • To investigate the underlying cause of obstructive signs in enuretic children with severe daytime symptoms.
    • To evaluate the role of urodynamic studies in diagnosing bladder dysfunction in this pediatric population.

    Main Methods:

    • Urodynamic studies were performed on 11 children presenting with severe daytime enuresis, bladder diverticula, trabeculation, and/or vesicoureteric reflux.
    • Assessment focused on identifying anatomical or functional infravesical obstruction.

    Main Results:

    • No anatomical or functional infravesical obstruction was demonstrated in the studied children.
    • Obstructive signs are proposed to result from uninhibited detrusor (bladder muscle) contractions met by voluntary external urethral sphincter contraction, leading to abnormally high intravesical pressures.

    Conclusions:

    • The obstructive signs in these enuretic children are likely due to functional issues (detrusor overactivity and sphincter dyssynergia) rather than physical blockage.
    • Management strategies include detrusor-inhibitory medications and, if necessary, ureteric reimplantation for reflux. Symptoms often improve with time, though bladder diverticula may persist.

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