Urodynamic findings in children with primary refractory nocturnal enuresis: 10 years' experience of a tertiary center.

Abstract

To identify correlations between urodynamic study (UDS) findings and urinary symptoms in children with refractory monosymptomatic and nonmonosymptomatic primary nocturnal enuresis. A total of 96 neurologically normal children were enrolled, 44 consecutive boys and 51 consecutive girls, aged 5-18 years, of whom 41 (38.8%) had refractory monosymptomatic nocturnal enuresis (MNE) and 55 (61.2%) had refractory non-MNE (NMNE). We assessed the urodynamics of all children to detect any underlying bladder overactivity. A comparative analysis was carried out between the two groups of patients. Detrusor overactivity (DO), low bladder capacity, low compliance, and increased postvoid residual (PVR) were identified in 70 (72.9%), 35 (36.5%), 43, and 76 (79.2%) patients, respectively. The mean bladder compliance was 21.66 ± 14.52 mL/cmH2O (2-75 cmH2O). Of the NMNE patients, 50 (90.9%) had abnormal urodynamic findings, while 40 (97.5%) had abnormal urodynamic findings in the MNE group. There was a statistically significant relationship between NMNE and both increased PVR and abnormal voiding patterns. Both high PVR and DO were significantly associated with obstructive urinary symptoms. Constipation and history of urinary tract infection (UTI) did not significantly correlate with UDS abnormality (p = 1.0 and p = 0.49, respectively). There was a high prevalence of bladder function disorders in both refractory MNE and NMNE patients in our study. This included small functional capacity, low bladder compliance, and marked DO. A nocturnal enuresis may be the only presenting symptom, however, it may be associated with bladder overactivity, UTI, and constipation; the UDS findings may aid in guiding the assessment and treatment of children suffering from primary refractory nocturnal enuresis and its association with bladder and bowel symptoms.