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Published on: January 30, 2018
Treatment system for nocturnal enuresis according to an original classification system
H Watanabe1, A Kawauchi, T Kitamori
1Department of Urology, Kyoto Prefectural University of Medicine, Japan.
Insights
This study found that nocturnal enuresis in children is not primarily caused by small bladder capacity or nocturnal polyuria. Instead, it often stems from a disturbance in awakening or nighttime bladder function.
Area of Science:
- Pediatrics
- Urology
- Sleep Medicine
Background:
- Nocturnal enuresis (bedwetting) is a common condition in children.
- Previous theories suggested immature bladder capacity or nocturnal polyuria as primary causes.
- This study investigates alternative etiological factors and classifications for enuresis.
Purpose of the Study:
- To re-evaluate the primary causes of nocturnal enuresis in children.
- To classify enuresis based on objective physiological monitoring.
- To develop targeted therapeutic strategies based on enuresis subtypes.
Main Methods:
- Comparative analysis of bladder capacity in enuretic and non-enuretic children across different age groups.
- Overnight simultaneous monitoring using electroencephalography (EEG) and cystometry.
- Classification of enuresis patients into distinct types based on monitoring data.
Main Results:
- Bladder capacity differences varied by age, suggesting it's not a universal primary cause.
- Nocturnal polyuria was observed in a subset of non-enuretic children.
- Enuresis was classified into three types: Type I and IIa linked to arousal disturbances, Type IIb to nocturnal bladder dysfunction.
- A therapeutic machine was developed for Type I enuresis.
Conclusions:
- Immature bladder capacity and nocturnal polyuria are unlikely primary causes of nocturnal enuresis.
- Arousal disturbances and specific nocturnal bladder dysfunctions are key pathogenetic factors.
- A subtype-specific therapeutic approach, including a novel machine for Type I, shows promise.
Abstract:
Our department has reported recent studies for nocturnal enuresis. The morning bladder capacity in enuretic children was smaller in the 3- and 4-year-old age range but larger in the 7-year and over age range than that in nonenuretic children. 15% of nonenuretic children showed nocturnal polyuria with nocturnal urination after complete awakening more than once per week. It was not likely from this evidence that an immature bladder capacity or nocturnal polyuria was the primary cause of enuresis. Patients with enuresis were classified into three types based on overnight simultaneous monitoring by electroencephalography and cystometry. The pathogenesis of enuresis type I and type IIa was a disturbance of awakening, while that of type IIb was a disturbance of bladder function not shown in the daytime but only at night. An original systematic therapeutic plan was established with the development of an original therapeutic machine primarily for enuresis type I.
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