Heron Jon, Grzeda Mariusz T, von Gontard Alexander, Wright Anne, Joinson Carol
School of Social and Community Medicine, University of Bristol, Bristol, UK.
Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany.
BMJ Open. 2017 Mar 14;7(3):e014238. doi: 10.1136/bmjopen-2016-014238.
To identify different patterns (trajectories) of childhood urinary incontinence and examine which patterns are associated with bladder and bowel symptoms in adolescence.
Prospective cohort study.
General community.
The starting sample included 8751 children (4507 men and 4244 women) with parent-reported data on frequency of bedwetting and daytime wetting for at least three of five time points (4½, 5½, 6½, 7½ and 9½ years-hereafter referred to as 4-9 years). Study children provided data on a range of bladder and bowel symptoms at age 14 (data available for 5899 participants).
Self-reported bladder and bowel symptoms at 14 years including daytime wetting, bedwetting, nocturia, urgency, frequent urination, low voided volume, voiding postponement, passing hard stools and low stool frequency.
We extracted 5 trajectories of urinary incontinence from 4 to 9 years using longitudinal latent class analysis: (1) normative development of daytime and night-time bladder control (63.0% of the sample), (2) delayed attainment of bladder control (8.6%), (3) bedwetting alone (no daytime wetting) (15.6%), (4) daytime wetting alone (no bedwetting) (5.8%) and (5) persistent wetting (bedwetting with daytime wetting to age 9) (7.0%). The persistent wetting class generally showed the strongest associations with the adolescent bladder and bowel symptoms: OR for bedwetting at 14 years=23.5, 95% CI (15.1 to 36.5), daytime wetting (6.98 (4.50 to 10.8)), nocturia (2.39 (1.79 to 3.20)), urgency (2.10 (1.44 to 3.07)) and passing hard stools (2.64 (1.63 to 4.27)) (reference category=normative development). The association with adolescent bedwetting was weaker for children with bedwetting alone (3.69 (2.21 to 6.17)).
Trajectories of childhood urinary incontinence are differentially associated with adolescent bladder and bowel symptoms. Children exhibiting persistent bedwetting with daytime wetting had the poorest outcomes in adolescence.
识别儿童尿失禁的不同模式（轨迹），并研究哪些模式与青春期的膀胱和肠道症状相关。
前瞻性队列研究。
普通社区。
初始样本包括8751名儿童（4507名男性和4244名女性），其父母报告了五个时间点（4.5岁、5.5岁、6.5岁、7.5岁和9.5岁，以下简称4 - 9岁）中至少三个时间点的尿床和日间遗尿频率数据。研究儿童在14岁时提供了一系列膀胱和肠道症状的数据（5899名参与者可获取数据）。
14岁时自我报告的膀胱和肠道症状，包括日间遗尿、尿床、夜尿、尿急、尿频、低排尿量、排尿延迟、排硬便和低排便频率。
我们使用纵向潜在类别分析从4至9岁儿童中提取了5种尿失禁轨迹：（1）日间和夜间膀胱控制的正常发育（占样本的63.0%），（2）膀胱控制延迟获得（8.6%），（3）仅尿床（无日间遗尿）（15.6%），（4）仅日间遗尿（无尿床）（5.8%），以及（5）持续性遗尿（尿床伴日间遗尿至9岁）（7.0%）。持续性遗尿类别通常与青少年膀胱和肠道症状的关联最强：14岁时尿床的比值比 = 23.5，95%置信区间（15.1至36.5），日间遗尿（6.98（4.50至10.8）），夜尿（2.39（1.79至3.20）），尿急（2.10（1.44至3.07））和排硬便（2.64（1.63至4.27））（参考类别 = 正常发育）。仅尿床的儿童与青少年尿床的关联较弱（3.69（2.21至6.17））。
儿童尿失禁轨迹与青少年膀胱和肠道症状的关联各不相同。表现为尿床伴日间遗尿持续存在的儿童在青春期的结局最差。
