Department of Women's and Children's Health, Uppsala University, Sweden.
Department of Women's and Children's Health, Uppsala University, Sweden.
J Pediatr Urol. 2024 Apr;20(2):219.e1-219.e6. doi: 10.1016/j.jpurol.2023.10.036. Epub 2023 Nov 1.
The voiding chart is part of the initial evaluation of enuresis, since the data gathered this way are assumed to carry predictive information. However, there is little evidence that the voiding chart actually does predict therapy response. Lundmark & Nevéus performed a pilot investigation in 2020 and found that anamnestic and voiding chart data did not predict response to second-line therapies. This study aims at evaluating whether these findings could be replicated.
This is an evaluation of clinical practice. All patients in a tertiary outpatient clinic with enuresis resistant to first-line therapy (i.e. the enuresis alarm and desmopressin medication) during the evaluation period were included in the study. Baseline anamnestic data focused on bladder and bowel habits, were gathered and the families were instructed to complete a voiding chart including measurements of nocturnal urine production. The children were then treated in accordance with international guidelines, which are anticholinergics and antidepressants as second- and third-line treatment, respectively. Desmopressin was added if needed.
In total, 70 patients were included. At the end of the study 37 of these patients were dry, 11 patients were still wetting their beds and 22 patients were lost to follow-up. Of the dry patients 21 became dry on anticholinergics (and/or mirabegron, with or without desmopressin), five on tricyclic antidepressants (with or without desmopressin), seven after a new attempt with the alarm and five became dry spontaneously. The only statistically significant differences between responders and non-responders to the various treatments were that children responsive to anticholinergics had harder and more infrequent stools (p = 0.04 and p = 0.03, respectively).
This study found that anamnestic and voiding chart data do not predict response to treatment in children with therapy-resistant enuresis. Because of this and the fact that we lose some children who need our help by demanding that they complete a voiding chart before initiating treatment, we question the use of this instrument in the evaluation of therapy-resistant enuresis.
排尿图是遗尿初始评估的一部分，因为通过这种方式收集的数据被认为具有预测信息。然而，几乎没有证据表明排尿图实际上可以预测治疗反应。Lundmark 和 Nevéus 在 2020 年进行了一项试点研究，发现病史和排尿图数据不能预测二线治疗的反应。本研究旨在评估这些发现是否可以复制。
这是一项临床实践评估。在评估期间，对所有在一线治疗（即遗尿报警器和去氨加压素药物）无效的三级门诊遗尿患者进行了研究。基线病史数据集中在膀胱和肠道习惯上，并指导家庭完成包括夜间尿量测量的排尿图。然后，根据国际指南对儿童进行治疗，抗胆碱能药物和抗抑郁药分别作为二线和三线治疗。如果需要，添加去氨加压素。
共有 70 名患者入选。研究结束时，其中 37 名患者已治愈，11 名患者仍遗尿，22 名患者失访。在治愈的患者中，21 名患者在使用抗胆碱能药物（和/或米拉贝隆，有或没有去氨加压素）后治愈，5 名患者在使用三环类抗抑郁药（有或没有去氨加压素）后治愈，7 名患者在重新使用报警器后治愈，5 名患者自发治愈。在各种治疗方法的反应者和无反应者之间，唯一具有统计学显著差异的是对抗胆碱能药物有反应的儿童的粪便更硬且更不频繁（p=0.04 和 p=0.03）。
本研究发现，病史和排尿图数据不能预测治疗抵抗性遗尿症儿童的治疗反应。由于这一点，以及由于要求他们在开始治疗前完成排尿图，我们失去了一些需要我们帮助的儿童，我们质疑在治疗抵抗性遗尿症的评估中使用这种工具。
