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The pseudo-obstructed bladder in enuretic children
Insights
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.
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.
Abstract:
In a minority of enuretic children with severe day symptoms, and especially when there is urinary infection, there a bladder diverticula and trabeculation and possbily also harmful vesicoureteric reflux which suggest the presence of an infravesical obstruction. However, in 11 children with this syndrome who underwent urodynamic studies, no anatomical or functional obstruction was demonstrable. It is contended that the obstructive signs are the result of uninhibited detrusor contractions being voluntarily resisted by contraction of the external urethral sphincter so that abnormallay high intravesical pressures result. Management involves the use of detrusor-inhibitory drugs. Ureteric reimplantation may be needed for reflux. In the majority of cases symptoms improve with time but the bladder diverticula persist.