Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; Centre for Child Incontinence, Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
Centre for Child Incontinence, Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
J Pediatr Urol. 2018 Apr;14(2):160.e1-160.e6. doi: 10.1016/j.jpurol.2017.09.021. Epub 2017 Oct 27.
Bladder capacity in children with nocturnal enuresis is assessed by maximal voided volumes (MVV) obtained through daytime frequency volume (FV) charts. Although a degree of association has been demonstrated, daytime MVV does not consistently correspond with the nocturnal bladder capacity (NBC) in monosymptomatic nocturnal enuresis (MNE). It was hypothesized that isolated reduced NBC is a common phenomenon in children with nocturnal enuresis, despite normal daytime bladder function.
The aim of this study was to evaluate NBC in children with MNE and normal daytime voided volumes. Specifically, it aimed to determine the prevalence and degree of reduced NBC when using nocturnal urine production (NUP) during wet nights as a surrogate estimate of NBC. Furthermore, it aimed to investigate the relationship between NBC and desmopressin response.
Data from 103 children aged 5-15 years consecutively treated for MNE in a tertiary referral centre and with normal MVV on daytime FV charts were collected for this cohort study. Home recordings were completed for 2 weeks at baseline and during desmopressin dose titration. Estimated nocturnal bladder capacity (eNBC) was assessed separately each night as the total NUP causing a wet night. If NUP during a wet night was less than MVV, it was considered to be reduced eNBC during that particular night.
Surprisingly, 82% (n = 84) of the children with MNE and normal daytime MVV experienced at least one wet night, with NUP below the daytime MVV indicative of a reduced eNBC. For 84 patients, mean percentage of wet nights with reduced eNBC (NUP below MVV) was 49% (SD ± 31). A total of 11% of children with frequently reduced eNBC (>40% of wet nights with reduced eNBC) responded to desmopressin (Summary Fig.). Of the children with frequently reduced NBC, 91% experienced wet nights, with NUP <65% of expected bladder capacity (EBC).
A significant proportion of children with MNE and normal MVV during the daytime frequently experienced wet nights, with a NUP well below their MVV and even <65% of EBC. This indicated that bladder reservoir dysfunction during sleep is relatively common in MNE. This abnormality was not reflected on daytime recordings, and thus nighttime data with NUP must be collected. This phenomenon may explain treatment failure to desmopressin, despite adequate antidiuretic response.
通过日间频率-容量图表获得的最大排空量（MVV）来评估遗尿症儿童的膀胱容量。尽管已经证明存在一定程度的相关性，但日间 MVV 并不总是与单症状性夜间遗尿症（MNE）的夜间膀胱容量（NBC）相一致。因此假设，尽管日间膀胱功能正常，但夜间遗尿症儿童中孤立性 NBC 减少是一种常见现象。
本研究旨在评估 MNE 儿童的 NBC，并评估日间正常排空量。具体而言，旨在确定使用夜间尿液产生（NUP）作为 NBC 替代估计值时，夜间遗尿症儿童 NBC 减少的患病率和程度。此外，还旨在研究 NBC 与去氨加压素反应之间的关系。
这项队列研究收集了连续在三级转诊中心接受 MNE 治疗且日间 FV 图表上 MVV 正常的 103 名 5-15 岁儿童的数据。在基线和去氨加压素剂量滴定期间完成了为期 2 周的家庭记录。每晚分别评估估计的夜间膀胱容量（eNBC），作为导致尿床的总 NUP。如果夜间尿床时的 NUP 低于 MVV，则认为该特定夜间的 eNBC 减少。
令人惊讶的是，82%（n=84）患有 MNE 且日间 MVV 正常的儿童至少有一个尿床之夜，NUP 低于 MVV，表明 eNBC 减少。对于 84 名患者，平均每晚 eNBC 减少的湿夜百分比（NUP 低于 MVV）为 49%（SD ± 31）。有 11%的遗尿症儿童对去氨加压素有反应（总图表）。在经常出现 eNBC 减少的儿童中（>40%的湿夜有 eNBC 减少），91%的儿童有夜间尿床，NUP<65%的预期膀胱容量（EBC）。
相当一部分日间 MVV 正常的遗尿症儿童经常出现夜间尿床，NUP 远低于 MVV，甚至<65%的 EBC。这表明，睡眠期间的膀胱储尿功能障碍在 MNE 中相对常见。这种异常并未反映在日间记录中，因此必须收集夜间 NUP 数据。这种现象可能解释了尽管抗利尿反应充分，但去氨加压素治疗失败的原因。
