Pediatric Nephrology Department, Dr. Sheikh Children's Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Arch Iran Med. 2012 Nov;15(11):702-6.
Nocturnal enuresis is divided into monosymptomatic nocturnal enuresis (MNE) and non-monosymptomatic nocturnal enuresis (NMNE). This study reviews clinical and ultrasonography (US) findings in enuretic children, and compares the organic and functional pathologies of the lower urinary tract (LUT) in children with MNE to those who have NMNE.
We enrolled 111 neurologically normal children with chief complaints of enuresis in this study. Participants included 60 boys and 51 girls, aged 5 - 17 years. There were 43 (38.8%) patients diagnosed with MNE and 68(61.2)% with NMNE. Urine analysis, urine culture and kidney-bladder US were performed for patients. Some patients underwent a voiding cystoureterography (VCUG), urodynamic study (UDS), or both.
Patients were divided into three groups: i) MNE, ii) NMNE without daytime incontinence (NMNE - daytime incontinence), and iii) NMNE plus daytime incontinence (NMNE + daytime incontinence). Constipation (P = 0.011), encopresis (P = 0.003) and urge incontinence (P = 0.001) were significantly more frequent in patients with NMNE +daytime incontinence. Bladder wall thickness (BWT) was the most common US finding. One patient with MNE and 9 with NMNE+ daytime incontinence had vesicoureteral reflux (VUR; P = 0.016). Posterior urethral valve (PUV) was reported in one patient with NMNE. Evidence of bladder dysfunction was noted in about half of the patients who underwent UDS, with a higher prevalence in cases that had NMNE +daytime incontinence (P = 0.297). Bowel symptoms and VUR were significantly more prevalent in cases with NMNE + daytime incontinence.
We recommend VCUG in enuretic children who have daytime incontinence. In addition our study has revealed that symptoms suggestive of an overactive bladder (OAB) are not good indicators for bladder dysfunction.
遗尿症分为单症状性夜间遗尿症（MNE）和非单症状性夜间遗尿症（NMNE）。本研究回顾了遗尿症患儿的临床和超声（US）表现，并比较了 MNE 患儿与 NMNE 患儿下尿路（LUT）的器质性和功能性病变。
我们招募了 111 名主诉遗尿的神经正常儿童参与本研究。参与者包括 60 名男孩和 51 名女孩，年龄 5-17 岁。其中 43 例（38.8%）诊断为 MNE，68 例（61.2%）为 NMNE。对患者进行了尿液分析、尿液培养和肾脏-膀胱 US。部分患者行排尿性膀胱尿道造影（VCUG）、尿动力学检查（UDS）或两者。
患者分为三组：i）MNE；ii）无日间尿失禁的 NMNE（NMNE-日间尿失禁）；iii）伴有日间尿失禁的 NMNE（NMNE+日间尿失禁）。NMNE+日间尿失禁组便秘（P=0.011）、粪失禁（P=0.003）和急迫性尿失禁（P=0.001）更为常见。膀胱壁厚度（BWT）是最常见的 US 表现。1 例 MNE 患者和 9 例 NMNE+日间尿失禁患者存在输尿管反流（VUR；P=0.016）。1 例 NMNE 患者存在后尿道瓣膜（PUV）。UDS 检查约一半的患者存在膀胱功能障碍证据，NMNE+日间尿失禁组更为常见（P=0.297）。NMNE+日间尿失禁组的膀胱症状和 VUR 更为常见。
我们建议日间遗尿的遗尿症患儿行 VCUG。此外，我们的研究还表明，提示逼尿肌过度活动（OAB）的症状并非膀胱功能障碍的良好指标。
