Chandra Manju, Saharia Reeta, Hill Vanessa, Shi Qiuhu
Division of Pediatric Nephrology, Schneider Children's Hospital at North Shore and North Shore University Hospital, Manhasset, New York 11030, USA.
J Urol. 2004 Jul;172(1):311-6. doi: 10.1097/01.ju.0000132363.36007.49.
We analyzed the relative contribution of detrusor instability and difficult arousal from sleep in the genesis of nocturnal enuresis (NE), and evaluate a clinical feature that may prospectively help differentiate patients with monosymptomatic NE (mono NE) from those with diurnal voiding symptoms (DVSs) of urgency and urge incontinence associated with NE (NE + DVSs).
Patients referred for voiding problems and 627 controls were evaluated for NE, DVSs, nocturia and arousal from sleep on a scale of 1 to 8. Patients were categorized into 3 groups-mono NE of primary or secondary onset (200, boys 71%, girls 29%), primary or secondary NE + DVSs (329, boys 43%, girls 57%) and isolated DVSs (146, boys 21%, girls 79%).
DVSs were noted in 49% of boys and 76% of girls with NE, although 40% of patients or parents did not complain of DVSs. The DVSs were elicited on detailed interrogation or on finding evidence of urinary incontinence on perineal examination. While one-third of controls and patients with isolated DVSs manifested nocturia at least twice a month, only 6% of bedwetters did so. Difficult arousal from sleep (scores 6 to 8) was more prevalent in patients with NE (59%) than controls (20%) or patients with isolated DVSs (5%), and in patients with mono NE and primary NE than in NE + DVSs or secondary NE, with reverse prevalence for nocturia. Easy sleep arousal (scores 1 to 3) was noted in 65% of patients with secondary NE + DVSs vs up to 6% of other NE subgroups. Compared to patients with mono NE, those with NE + DVSs had a higher prevalence of urinary tract infection (UTI), encopresis, psychosocial/learning problems, and family history of UTI and DVSs, ie problems associated with detrusor instability.
DVSs accompany NE in two-thirds of patients but can be missed during a cursory history. Difficult sleep arousal seems to have a major role in primary mono NE, and detrusor instability in secondary NE + DVSs. In patients with NE a history of frequent nocturia, easy sleep arousal, UTI, encopresis, psychosocial learning problems or family history of UTI and DVSs should raise the suspicion for associated undisclosed DVSs.
我们分析了逼尿肌不稳定和睡眠唤醒困难在夜间遗尿（NE）发生中的相对作用，并评估一种临床特征，该特征可能有助于前瞻性地区分单纯性NE（单症状NE）患者与伴有NE的日间排尿症状（DVS，即尿急和急迫性尿失禁）患者。
对因排尿问题前来就诊的患者和627名对照者进行NE、DVS、夜尿症和睡眠唤醒情况评估，评估范围为1至8分。患者分为3组：原发性或继发性单症状NE组（200例，男孩占71%，女孩占29%）、原发性或继发性NE + DVS组（329例，男孩占43%，女孩占57%）和孤立性DVS组（146例，男孩占21%，女孩占79%）。
患有NE的男孩中有49%、女孩中有76%存在DVS，尽管40%的患者或其父母未主诉DVS。通过详细询问或在会阴检查中发现尿失禁证据可引出DVS。虽然三分之一的对照者和孤立性DVS患者每月至少出现两次夜尿，但尿床者中只有6%如此。睡眠唤醒困难（评分6至8分）在NE患者中（59%）比对照者（20%）或孤立性DVS患者（5%）更常见，在单症状NE和原发性NE患者中比在NE + DVS或继发性NE患者中更常见，夜尿情况则相反。继发性NE + DVS患者中有65%睡眠唤醒容易（评分1至3分），而其他NE亚组中这一比例最高为6%。与单症状NE患者相比，NE + DVS患者尿路感染（UTI）、大便失禁、心理社会/学习问题以及UTI和DVS家族史的患病率更高，即与逼尿肌不稳定相关的问题。
三分之二的NE患者伴有DVS，但在简略病史询问中可能被遗漏。睡眠唤醒困难似乎在原发性单症状NE中起主要作用，而逼尿肌不稳定在继发性NE + DVS中起主要作用。对于NE患者，频繁夜尿、睡眠唤醒容易、UTI、大便失禁、心理社会学习问题或UTI和DVS家族史应引起对未被发现的相关DVS的怀疑。
