Bladder and Brain Functional Changes in Children With Severe Refractory Nocturnal Enuresis: Post Treatment Evaluation

Abstract

Purpose Our previous study demonstrated an interaction between bladder overactivity and deranged brain arousability in children with severe nocturnal enuresis (NE). We therefore evaluated bladder and brain functional changes in this cohort after treatment focused on the underlying bladder dysfunction. Material and Methods Patients presenting with severe NE (>6wet nights/week) and normal non enuretic children were recruited.Children received treatment targeting at the underlying pathophysiologies and bladder dysfunction. Sleep awakening threshold, P300 ERPs latency and PPI of startle amplitude were measured in all subjects at entry and after 6 months of treatment. On followup evaluation bladder function was primarily assessed by uroflowmetry and ultrasonosonography and UD assessment has been repeated if required. The results were then compared with the results of initial assessments. Results Fifty-two children with NE (M/F: 37/15, Mean age: 9.2 + 1.25yrs) and 15 age-matched normal children were prospectively evaluated. On follow up all children had significant reduction in NE episodes. Bladder volume increased significantly in those children who had an early reduced bladder volume (p Conclusions Brain function normalized in parallel to improvement of bladder dysfunction after successful treatment, indicating bladder dysfunction may inversely affect brain function.The interaction between bladder and brain dysfunctions and normalization of the former upon improvement of the latter provides further evidences of a bladder-brain dialogue.