Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden.
J Pediatr Urol. 2019 Feb;15(1):31.e1-31.e5. doi: 10.1016/j.jpurol.2018.08.006. Epub 2018 Aug 10.
Enuretic children wet their beds either because of nocturnal polyuria or nocturnal detrusor overactivity. Polyuric children often respond to desmopressin, whereas children with nocturnal detrusor overactivity are often therapy resistant and may have low daytime voided volumes. It is logical to assume that the enuretic event in children with nocturnal polyuria occurs with a full bladder, i.e. with the enuretic voided volume (EVV) close to the child's expected bladder capacity (EBC) for his/her age. However, the EVV has only rarely been studied, and little is known about how it relates to case history, polyuria, or daytime bladder function. The aim of this study was to look at EVV and relate it to voiding chart data and treatment response.
Anamnestic data and voiding charts, including measurement of nocturnal urine production and EVV, in enuretic children with or without concomitant daytime incontinence attending a tertiary center were retrospectively reviewed. The EVV was analyzed and compared to anamnestic data, voiding chart data, and response to therapy in accordance with the guidelines of the International Children's Continence Society.
Data were available for 220 children (age 5-24, median 9), 40 of whom were girls. The prevalence of previous or present daytime incontinence was 42.4%, and 50.5% sometimes experienced urgency. The average EVV was 54.9 ± 32.8% of EBC. EVV correlated highly significantly to nocturnal urine production (p < 0.001). Still, EVV ≥ EBC was observed in only 16 children. EVV was slightly larger in girls (p = 0.013) and in children with urgency (p = 0.034), but there were no significant EVV differences between children responding or not responding to antidiuretic, anticholinergic, or antidepressant therapy. Relevant data are summarized in the Table below.
Case history and daytime voiding chart data give very little information about nocturnal bladder function. The EVV is strongly influenced by nocturnal urine production but only rarely reaches up to a level close to or exceeding the EBC. The enuretic event only very rarely represents the emptying of a full bladder. Thus, a component of nocturnal detrusor overactivity can be assumed to be present in almost all enuretic children, even in children with nocturnal polyuria. The value of the EVV is limited in predicting response to therapy.
遗尿儿童尿床要么是因为夜间多尿，要么是因为夜间逼尿肌过度活动。多尿儿童通常对去氨加压素有反应，而夜间逼尿肌过度活动的儿童通常对治疗有抵抗力，并且可能白天排空量较低。合理的假设是，夜间多尿儿童的遗尿事件发生在膀胱充盈时，即遗尿时的排空量（EVV）接近儿童年龄的预期膀胱容量（EBC）。然而，EVV 很少被研究，关于它与病史、多尿或白天膀胱功能的关系知之甚少。本研究旨在观察 EVV，并将其与排尿图数据和治疗反应相关联。
回顾性分析在三级中心就诊的伴有或不伴有日间遗尿的遗尿儿童的病史和排尿图数据，包括夜间尿液产生和 EVV 的测量。根据国际儿童尿控协会的指南，分析并比较 EVV 与病史、排尿图数据和治疗反应。
共 220 名儿童（年龄 5-24 岁，中位数 9 岁）的数据可用，其中 40 名为女孩。以前或现在有日间遗尿的患病率为 42.4%，50.5%的儿童有时会出现尿急。平均 EVV 为 EBC 的 54.9±32.8%。EVV 与夜间尿液产生高度相关（p<0.001）。然而，只有 16 名儿童的 EVV 大于 EBC。女孩的 EVV 稍大（p=0.013），尿急的儿童的 EVV 稍大（p=0.034），但对抗利尿、抗胆碱能或抗抑郁治疗有反应或无反应的儿童之间的 EVV 差异无统计学意义。相关数据总结在下面的表格中。
病史和日间排尿图数据几乎不能提供有关夜间膀胱功能的信息。EVV 受夜间尿液产生的影响很大，但很少达到接近或超过 EBC 的水平。遗尿事件很少代表排空充满的膀胱。因此，可以假设几乎所有遗尿儿童都存在夜间逼尿肌过度活动的成分，即使是夜间多尿的儿童。EVV 的价值在于预测治疗反应的能力有限。
