Eberdt-Gołąbek BoŻena, Zmysłowska Krystyna, Słowik MaŁgorzata, Gładysz Dominika, Hozyasz Kamil K
Institute of Mother and Child in Warsaw, Poland: Nephrology Clinic for Children.
Institute of Mother and Child in Warsaw, Poland: Department of Pediatrics.
Pol Merkur Lekarski. 2015 Apr;38(226):196-202.
Primary monosymptomatic nocturnal enuresis (PMNE) is the most frequent (85%) type of enuresis in children. It remains a diagnostic and therapeutic challenge to establish its etiology and implement a proper treatment.
The aim of the study was to establish the causes of PMNE in children on the basis of own investigations and assess factors having influence over PMNE etiology, which would enable the choice of effective therapy.
The study concerned 85 children with PMNE aged from 5 to 15 years. The patients were under the care of Nephrology Outpatient Clinic at Institute of Mather and Child in years 2009-2014. The detailed medical history, physical examination as well as laboratory investigations of blood and urine, and radiological investigations of the urinary tract, were carried out. Statistical analysis was performed using R software.
In all patients, we have successfully detected the etiology of children of PMNE. The basic, equally frequent (62.3%), PMNE etiopathogenetic factors turned to be: too small bladder capacity resulting from the detrusor hyperactivity, and night polyuria mainly caused by vasopressin deficiency or abnormal eating and hygienic habits, occurring separately or in conjunction with each other. Too small bladder capacity occurred mainly (37.6%, group C) as the only etiological factor of PMNE, and in 24.7% (group A) in a conjunction with nocturnal polyuria due to decreased excretion of vasopressin. Night polyuria was caused by the deficiency of vasopressin in most cases (37.6%) and occurred mainly (24.7%, group D) in a conjunction with small bladder capacity, and rarely alone (12.9%, group B). In 24.7% (group A) it appeared due to eating and hygienic abnormal habits. We have proved statistically significant differences in mean voiding frequency and volume (p<0.0001) between groups A-B and C-D. Mean morning urine specific gravity (p<0.0001) also differed significantly between group C and B (p<0.0001) as well as C and D (p=0.0004).
PMNE in all patients was attributed to specific causes outside the circle of psychological disorders what reduced patient stigmatization. PMNE etiology is very complex and diverse. It still remains a challenge and requires and individual diagnostic and therapeutic approach. Voiding frequency above 8 daily with voiding volumes usually below 100 ml suggest etiology connected with small bladder capacity, while morning urine specific gravities below 1.021 g/ml can be connected with vasopressin deficiency or excessive fluid intake before the bedtime. The developed diagnostic approach along with borderline values are hints that can aid physicians in establishing PMNE causes.
原发性单症状性夜间遗尿症（PMNE）是儿童中最常见（85%）的遗尿类型。确定其病因并实施恰当治疗仍然是一项诊断和治疗挑战。
本研究的目的是基于自身调查确定儿童PMNE的病因，并评估影响PMNE病因的因素，以便能够选择有效的治疗方法。
该研究涉及85名年龄在5至15岁的PMNE儿童。这些患者在2009年至2014年期间由母婴研究所的肾脏病门诊进行护理。进行了详细的病史询问、体格检查以及血液和尿液的实验室检查，还有尿路的放射学检查。使用R软件进行统计分析。
在所有患者中，我们成功检测出了PMNE儿童的病因。基本的、同样常见（62.3%）的PMNE病因学因素为：逼尿肌活动亢进导致膀胱容量过小，以及夜间多尿，主要由抗利尿激素缺乏或异常饮食及卫生习惯引起，单独或相互结合出现。膀胱容量过小主要（占比37.6%，C组）作为PMNE的唯一病因，在24.7%（A组）的情况下与抗利尿激素排泄减少导致的夜间多尿同时出现。夜间多尿在大多数情况下（37.6%）由抗利尿激素缺乏引起，主要（24.7%，D组）与膀胱容量小同时出现，很少单独出现（12.9%，B组）。在24.7%（A组）的情况下，它是由饮食和卫生异常习惯导致的。我们已证明A - B组与C - D组之间平均排尿频率和尿量存在统计学显著差异（p<0.0001）。C组与B组（p<0.0001）以及C组与D组（p = 0.0004）之间的平均晨尿比重也存在显著差异（p<0.0001）。
所有患者的PMNE都归因于心理障碍范畴之外的特定原因，这减少了患者的污名化。PMNE的病因非常复杂且多样。它仍然是一项挑战，需要个体化的诊断和治疗方法。每日排尿频率超过8次且尿量通常低于100毫升提示病因与膀胱容量小有关，而晨尿比重低于1.021克/毫升可能与抗利尿激素缺乏或睡前液体摄入过多有关。所制定的诊断方法以及临界值是有助于医生确定PMNE病因的提示。
