Pediatric Enuresis Research Articles

Professor Wei-bin GAO's experience in treatment of voiding dysfunction with electroacupuncture: 高维滨教授电针治疗排尿功能障碍的临证经验

As a common clinical syndrome, voiding dysfunction is complicated in etiology, involved in a variety of diseases and associated with multi-disciplines of medicine. Either medication or surgery has not obtained the favorable effect on it. Integrated the theories of traditional Chinese medicine and Western medicine and based on the pathogenesis of the disease, the acupoint specificity and neuromodulatory effects, Professor Wei-bin GAO suggested “selecting the acupoints along the affected areas”. The acupoints located near to the lumbar, sacral and abdominal regions are dominated and stimulated with electroacupuncture at different electric waves. In treatment, electric stimulation with disperse and dense waves was adopted. The bone conduction theory of dense-wave electric field was proposed. The same neuromodulation is presented in different diseases such as neurogenic bladder, pediatric enuresis, senile nocturia, benign prostatic hyerplasia, and postpartum of postoperative urination disorders. Hence, the same therapeutic method is adoptable to different diseases with the basic acupoint composition modified.

First uninterrupted sleep periodin children and adolescents with nocturnal enuresis: Added value in diagnosis and follow-up during therapy.

The first uninterrupted sleep period (FUSP, time up to the first episode of enuresis/nocturia after falling asleep) is a frequently investigated parameter in adults with nocturia, as it correlates with quality of life. However, it has not been included in pediatric enuresis studies. Investigate FUSP, circadian renal water and sodium handling, as well as sleep quality before and after desmopressin therapy in enuresis. We conducted a post hoc analysis of a prospective study in 30 treatment-naïve children with enuresis who underwent avideo-polysomnographyand a 24-h urine concentration profile before and after 6 months of desmopressin therapy. We analyzed FUSP, periodic limb movements in sleep(PLMS), and arousal indexes and their correlations with the urinary parameters. Sixteen children with a mean age of 10.9 ± 3.1 years had full registrations and were included in this subanalysis. After therapy, FUSP was significantly longer (p < 0.001), and the PLMS index was lower (p = 0.023). Significant differences in the circadian rhythm of diuresis (night/day diuresis, p = 0.041), nocturnal urinary osmolality (p = 0.009), and creatinine (p = 0.001) were found, demonstrating the increase of urinary concentration overnight by desmopressin, as well as a significant antidiuretic effect (diuresis [p = 0.013] and diuresis rate (p = 0.008). There was no correlation between the difference of FUSP, PLMS index, and urinary parameters. Nevertheless, despite this study being underpowered, there are indications of a correlation between nocturnal diuresis and diuresis rate. Our results support the need for further research regarding FUSP in children with enuresis, in accordance with nocturia studies in adults, as this parameter could be valuable in the follow-up and evaluation of therapeutic strategies for enuresis.

High Prevalence of Dysplastic Development of Sacral Vertebral Arches in Pediatric Enuresis.

This is the first report to compare 3-dimensional computed tomography (3D-CT) images between pediatric patients with enuresis and children without lower urinary tract symptoms who underwent pelvic CT for other reasons. Forty-seven children (33 boys and 14 girls) with primary enuresis underwent 3D-CT of sacrococcygeal bones. The control group consisted of 138 children (78 boys and 60 girls) who underwent pelvic CT for other reasons. First, we determined the presence or absence of unfused sacral arches at the L4-S3 levels in both cohorts. Subsequently, we compared the fusion of sacral arches in age- and sex-matched children from these 2 groups. Dysplastic sacral arches, characterized by lack of fusion at 1 or more levels of the S1-3 arches, were observed in nearly all patients in the enuresis group. In the control group (n=138), 54 of 79 children over 10 years old (68%) exhibited fused sacral arches at 3 S1-3 levels. All 11 control children under 4 years old displayed at least 2 unfused sacral arches at the S1-3 levels. In a comparative study of age- and sex-matched patients with enuresis and control children aged 5 to 13 years (n=32 for each group, with 21 boys and 11 girls; mean age, 8.0±2.2 years [range, 5-13 years]), only 1 patient (3%) in the enuresis group exhibited fusion of all S1-3 arches. In contrast, 20 of 32 control group participants (63%) had 3 fused sacral arches (P<0.0001). Sacral vertebral arches typically fuse by the age of 10 years. However, in this study, children with enuresis exhibited a significantly elevated prevalence of unfused sacral arches, suggesting that dysplastic development of sacral vertebral arches may play a pathological role in enuresis.

Age- and gender-specific normal post void residual urine volume in healthy adolescents

Elevated post void residual (PVR) is a significant risk factor for urinary tract infections (UTI). It is also a significant predictor of treatment outcomes in cases of vesicoureteral reflux, pediatric enuresis, and non-neurogenic LUT dysfunction. However, the absence of age-specific nomograms for adolescents may limit PVR's use in clinical practice. To establish age- and gender-specific normal PVR urine volume in adolescents. Healthy adolescents aged 12-18 years were recruited to undergo two uroflowmetry and PVR studies whenever they felt the urge to urinate. Adolescents with neurological disorders, known LUT dysfunction or UTI were excluded. A total of 1050 adolescents were invited, but only 651 consented. Fourteen participants were excluded due to low bladder volume (BV<100ml) in both assessments (n=12), BV<100ml in one assessment (n=1), or failure to provide relevant history (n=1). From the 1084 uroflowmetry and PVR obtained from 637 adolescents, 190 results were further excluded due to artefacts (n=152), BV<100ml (n=27), PVR >100ml (n=5) and missing information (n=6). Ultimately, 894 uroflowmetry and PVR from 605 adolescents (mean age 14.6±1.5 years) were analyzed. PVRs were higher in adolescents aged 15-18 years than in those aged 12-14 years (P<0.001). Moreover, they were higher in females than in males (P<0.001). Multivariate analysis revealed that PVR was positively influenced by age (P=0.001) and BV (P<0.001). The age- and gender-specific percentiles of PVR in ml and percentage of BV were calculated. We recommend a repeat PVR and close monitoring if PVR is above the 90th percentile, i.e., PVR >20ml (7% BV) for males of both the age groups, and PVR >25ml (9% BV) and PVR >35ml (>10% BV) for females aged 12-14 and 15-18 years, respectively. Further investigation may be warranted if the repeat PVR is above the 95th percentile, i.e., PVR >30ml (8% BV) and >30ml (11% BV) for males aged 12-14 and 15-18 years, respectively, and PVR >35ml (11% BV) and >45ml (13% BV) for females aged 12-14 and 15-18 years, respectively. PVR increases with age and varies by gender; thus, age-and gender-specific reference values should be used. Further data from other countries is required to determine whether the study's recommendations can be applied globally.

Folic Acid and Vitamin B12 Deficiency, Two New Findings in Pediatric Enuresis

Background: Enuresis is one of the most common diseases in children. Although there are several factors involved in the occurrence of this diseases, the root cause of it has remained undetermined. Objectives: Identifying various factors responsible for enuresis may enormously contribute to solving this problem. This study, therefore, aimed to determine the level of vitamin B12 and folic acid in children with enuresis in Gorgan in 2021. Methods: In this case-control study, 43 children with primary enuresis and 99 children without enuresis, as the control group, referring to Taleghani Hospital in 2021 were included. Folic acid and vitamin B12 levels in two groups were measured and analyzed using statistical techniques. Results: Out of all participants, 23 (53.5%) in the case group and 53 (53.5%) in the control group were male. The mean age of children in the case and control groups were 7.60 ± 3.02 and 8.93 ± 3.15, respectively, and the two groups were not significantly different in terms of gender and age. Vitamin B12 and folic acid levels in the case group were significantly lower than those in the control group (P-value = 0.001). There was a significant difference between the case and control groups regarding the mean levels of vitamin B12 and folic acid levels based on sex and gender. Conclusions: In sum, it was found that children with enuresis suffered from deficiency of vitamin B12 and folic acid to some extent, which may have been a factor responsible for delaying the maturation of the central nervous system and, consequently, inducing enuresis in children.

Treating Volitional Elimination Disorders in a Healthy Adult: Applying Cognitive Behavioral Principles in the Absence of Treatment Guidelines

Elimination disorders are common in children, and numerous psychosocial treatments for pediatric enuresis and encopresis are available to guide clinicians. However, only five cases of functional elimination disorders in adults are published to date, all of which involve severe comorbid psychopathology, and no treatment guidelines for adult elimination disorders exist. This case report presents, to our knowledge, the first documented case of functional elimination disorder in an otherwise healthy, high-functioning adult. “Ben” is a 20-year-old male who sought treatment for chronic enuresis and encopresis, as well as difficulties with procrastination of schoolwork. Ben engaged in 21 weeks of cognitive behavioral therapy and reported substantial decreases in elimination disorder symptoms. However, improvements fluctuated throughout treatment and remained present at mild levels at 3-month follow-up. This report outlines the cognitive behavioral interventions applied throughout this treatment, which consisted of pediatric elimination disorder interventions adapted for an adult with additional cognitive behavioral tools.

Review on herbal medicine versus desmopressin therapy for pediatric monosymptomatic enuresis

Review on herbal medicine versus desmopressin therapy for pediatric monosymptomatic enuresis

Clinical Experience of Dr. Guo Yaxiong, Chief Physician, in the Treatment of Pediatric Enuresis

Based on many years of clinical experience, Dr. Guo Yaxiong, Chief Physician, believes that the basic pathogenesis of the disease is bladder disorder, which is located in the bladder and is closely related to the lung, spleen and kidney, and involves the heart and liver. Although the clinical evidence is mainly asthenia syndrome, also visible such as dampness and heat in the liver meridian and mixed evidence of deficiency and reality such as breakdown of the normal physiological coordination between the heart and the kidney can be seen. Treatment is based on open the inhibited lung-energy, strengthening the spleen and warming the kidneys, and at the same time, family care and psychological intervention should be paid attention to.

Progress in the pathogenesis of pediatric enuresis

Enuresis is one of the common diseases of children.It seriously threatens children′s physical and mental health, and it also causes many problems for the families of children with enuresis.The pathogenesis of enuresis is complex and is not yet clear.In recent years, significant progress has also been made in the pathogenesis of enuresis, including increased urine output at night, bladder dysfunction, nocturnal arousal disorders, genetic factors, central nervous system growth retardation and other factors.This article reviews the research progress in the pathogenesis of pediatric enuresis. Key words: Enuresis; Pathogenesis; Pediatric

Two-Week Repeated Oral Dose Toxicity Study of Mantidis Ootheca Water Extract in C57BL/6 Mice.

Background. Mantidis Ootheca (MO), described as the ootheca of Hierodula patellifera Serville, 1839, Tenodera angustipennis (Saussure, 1869), or Statilia maculate (Thunberg, 1784) in Korean Herbal Pharmacopoeia, is an important herbal material that has been traditionally used for treating several medical conditions including renal failure, spermatorrhea, and pediatric enuresis in Korea. Objective. The present study investigated the potential subacute toxicity of MO water extract during a 2-week repeated oral administration of doses of 0, 50, 150, or 450 mg/kg/day to C57BL/6 male mice by gavage. Methods. The following parameters were examined during the study period: mortality, clinical signs, body weight, hematology, serum biochemistry, gross findings, organ weight, and histopathology. All the mice were euthanized at the end of the treatment period. Results. No treatment-related changes in mortalities, clinical signs, body weight, gross finding, and organ weight change were detected after 14 days of oral MO extract administration. In addition, no meaningful MO extract treatment-related changes were observed in the hematological, serum biochemical, and histopathological parameters compared with the normal control group following treatment with doses of up to 450 mg/kg/day. Conclusion. Based on these findings, we concluded that treatment of mice with the water extract of MO did not result in significant toxicity and, therefore, it could be considered safe for further pharmacological studies.

Do uroflowmetry and post - void residual urine tests necessary in children with primary nocturnal enuresis?

ABSTRACTObjectives:To examine the benefits of repetitive uroflowmetry and post void residual urine (PVR) tests in children with primary nocturnal enuresis (PNE).Material and methods:Children aged ≥6 years with PNE who visited our clinics for management of enuresis were included for study. Patients were requested to complete a questionnaire including baseline characteristics and Dysfunctional Voiding Symptom Score (DVSS), 2-day bladder diary, and Rome III criteria for constipation. Two uroflowmetry and PVR tests were requested. Children with congenital or neurogenic genitourinary tract disorders were excluded. All children underwent urotherapy and desmopressin combined with anticholinergics or laxatives if indicated. The definition of abnormal flow patterns (≥1 abnormal), elevated PVR (≥1 abnormal), small maximal voided volume (MVV), nocturnal polyuria (NP) and response to treatment complied with the ICCS standardization document. Kaplan-Meier survival analysis and Cox proportional-hazards regression tests were used to evaluate the predictors of response.Results:In total, 100 children aged 8.5±2.3 years were enrolled for study (M: F=66:34) with 7.3±7.4 months of follow-up. Poor correlation was observed between DVSS/small MVV and PVR (p>0.05). Univariate analysis revealed that elevated PVR is associated with significantly less hazard of complete response to medical treatment (HR: 0.52, p=0.03), while not significantly associated with abnormal flow patterns, NP, constipation or small MVV. Multivariate analysis revealed that only elevated PVR (HR 0.30, 95% CI 0.12-0.80) and NP (HR 2.8, 95% CI 1.10-7.28) were significant predictors for complete response.Conclusions:In managing pediatric enuresis, elevated PVR is a significant predictor for lower chance of complete response to treatment whether they had high DVSS or not.

Professor JIA Chun-sheng's experience for pediatric enuresis

To introduce the experience of professor JIA Chun-sheng in treatment of primary and simple enuresis. Professor JIA Chun-sheng believes that most children with pediatric enuresis have the manifestation of both spleen deficiency and kidney deficiency, and it is rare that the patients have one of the two kinds of manifestation. The pathogenesis is as follows: kidney yang deficiency and depletion, steaming weakness, and caused by spleen qi deficiency qi deficiency and sinking, and the bladder failing to ensure retention results in failure of body fluids to be stored, so that enuresis is induced. On the basis of the above theory, professor JIA Chun-sheng proposed the treatment rules of “nourishing earth and banking up original qi, opening the orifices and awakening the spirit”, and selected Băihuì (▪ GV 20), Qìhăi (▪ CV 6), Guānyuán (▪ CV 4), Zúsānlľ (▪ ST 36), Sānyīnjiāo (▪ SP 6) and Tàixī (▪ Kl 3) as the basic acupoints. Corresponding acupoints were increased or reduced according to different patterns, and good efficacy has been obtained.

Desmopressin Withdrawal Strategy for Pediatric Enuresis: A Meta-analysis.

A high relapse rate after discontinuation of desmopressin treatment of pediatric enuresis is consistently reported. Structured withdrawal strategies have been used to prevent relapse. To assess the efficacy of a structured withdrawal strategy of desmopressin on the relapse-free rate for desmopressin responder pediatric enuresis. Systematic literature search up to November 2015 on Medline, Embase, Ovid, Science Direct, Google Scholar, Wiley Online Library databases, and related references without language restriction. Related clinical trials were summarized for systematic review. Randomized controlled trials on the efficacy of structured versus abrupt withdrawal of desmopressin in sustaining relapse-free status in pediatric enuresis were included for meta-analysis. Eligible studies were evaluated according to Cochrane Collaboration recommendations. Relapse-free rate was extracted for relative risk (RR) and 95% confidence interval (CI). Effect estimates were pooled via the Mantel-Haenszel method with random effect model. Six hundred one abstracts were reviewed. Four randomized controlled trials (total 500 subjects) of adequate methodological quality were included for meta-analysis. Pooled effect estimates compared with the abrupt withdrawal, structured withdrawal results to a significantly better relapse-free rate (pooled RR: 1.38; 95% CI, 1.17-1.63; P = .0001). Subgroup analysis for a dose-dependent structured withdrawal regimen showed a significantly better relapse-free rate (pooled RR: 1.48; 95% CI, 1.21-1.80; P = .0001). The small number of studies included in meta-analysis represents a major limitation. Structured withdrawal of desmopressin results in better relapse-free rates. Specifically, the dose-dependent structured withdrawal regimen showed significantly better outcomes.

Filum Section for Urinary Incontinence in Children with Occult Tethered Cord Syndrome: A Randomized, Controlled Pilot Study

Occult tethered cord syndrome, in which there is normal neuroanatomic imaging despite clinical and urodynamic evidence of neuropathic bladder behavior, is controversial. Several uncontrolled series describe improvement in bladder function following section of the filum terminale. We performed a pilot randomized, controlled study comparing medical treatment to surgical section of the filum plus medical treatment in children with occult tethered cord syndrome. Children refractory to standard medical management for 1 year or more with normal conus position on magnetic resonance imaging and abnormal urodynamics were randomized. Exclusion criteria included any neurological conditions, spinal dysraphism, bladder outlet obstruction and an atonic bladder. Patients were assessed at randomization and 1 year later with a standardized urodynamic score, the validated PEMQOL (Pediatric Enuresis Module on Quality of Life™) scale, and a validated bowel and bladder dysfunction score. After 8 years we accrued 21 patients. The bowel and bladder dysfunction score improved in the surgical and medical arms (20% and 24%) and the urodynamic score improved slightly (6% and 4%, respectively). The PEMQOL Child and Family Impact Scales improved modestly in both groups. All differences were nonsignificant. Interim analysis indicated that more than 700 patients in each arm would be required to demonstrate a statistical difference with respect to urodynamic score based on our preliminary data. There appears to be no objective difference in urological outcome between medical management plus or minus filum section for patients with occult tethered cord syndrome. These data challenge the existence of the concept of occult tethered cord syndrome, in which bowel and bladder dysfunction score is attributed to tethering by the filum despite a normally located conus.

Immediate 1-month efficacy of desmopressin and anticholinergic combination therapy versus desmopressin monotherapy in the treatment of pediatric enuresis: A meta-analysis

Several studies have proposed the combination of desmopressin and anticholinergic as a treatment regimen to address the pathophysiology of polyuria and bladder dysfunction in pediatric enuresis. However, the available literature is inconsistent with regards to the immediate 1-month efficiency of the combination therapy in the treatment for pediatric enuresis. The aim was to assess the immediate 1-month efficacy and safety of desmopressin and anticholinergic agent combination therapy versus desmopressin monotherapy in the treatment of pediatric enuresis using meta-analysis of randomized controlled trials (RCTs). Systematic literature acquisition was carried out on electronic medical databases up to April 2015. RCTs relevant to the topic were critically appraised. Dichotomous data of the 1-month post-treatment response rate (defined as ≥90% reduction of wet nights) were extracted for calculation of the risk ratio (RR) and 95% confidence interval (CI). The Mantel-Haenszel method with the random effects model was used to pool effect estimates. Inter-study heterogeneity and publication bias were assessed. Subgroup analysis was done for the desmopressin treatment-naive versus treatment-resistant groups: PROSPERO (CRD42015017922). Four RCTs of good methodological quality without heterogeneity were included for meta-analysis. The pooled effect estimates showed that combination therapy was associated with a significantly better immediate 1-month response rate than desmopressin monotherapy. Subgroup analysis showed a greater immediate 1-month response rate among desmopressin-resistant patients than treatment-naive patients. No severe adverse events were noted among combination therapy treated groups. The limitation of the current meta-analyses is the small sample size, albeit with high-quality studies pooled for effect estimation. Despite the limitation, the study results were able to consistently illustrate a large treatment effect of combination therapy among desmopressin treatment-resistant patients. It was consistent with the literature review of retrospective and non-comparative studies by Alloussi etal. (2011), who summarized a similar impressive treatment outcome. However, due to the low level of evidence available at the time of their study, only a grade B-C recommendation was given to combination therapy as an approach for second-line treatment. This study also summarized that combination therapy was well tolerated and similar to desmopressin monotherapy. This study was able to summarize the immediate 1-month efficacy of combination therapy compared with desmopressin monotherapy in the treatment of pediatric enuresis. For both treatment-naive and desmopressin-resistant pediatric enuresis, combination therapy of desmopressin with an anticholinergic agent is well tolerated and resulted in a significantly better immediate 1-month response rate than desmopressin monotherapy.

Efficacy of Salvage Interferential Electrical Stimulation Therapy in Patients With Medication-Refractory Enuresis: A Pilot Study

PurposeIn pediatric patients with enuresis, the protocol for salvage therapy in patients in whom first-line therapy was not successful has not yet been established. Interferential electrical stimulation (IF-ES) therapy is advantageous because it is noninvasive and shows high compliance. We aimed to investigate the efficacy and safety of IF-ES therapy on pediatric enuresis in a pilot study.MethodsWe investigated 10 patients who underwent IF-ES therapy between August 2012 and March 2013 at our clinic. Patients with a history of previous treatment with desmopressin and anticholinergic agents for at least 3 months and those in whom alarm treatment previously failed or was refused by parents were eligible. Electrical current was given starting at approximately 20 mA and was increased until the patient complained of discomfort. Treatment was performed once a week, 20 minutes per treatment, 6 times per cycle. After each cycle, an interview was performed and voiding diaries were filled. The physician in charge evaluated improvement according to the International Children's Continence Society criteria.ResultsA final analysis was performed in 10 patients (5 male and 5 female patients) in whom therapy for nocturnal enuresis had failed. Eight patients had nonmonosymptomatic enuresis and 2 had monosymptomatic enuresis. The mean age of the patients was 8.5±2.4 years, and the mean number of treatments was 10.6±3.6 times. A full response was observed in 1 patient (10%); a good response, in 1 patient (10%); a partial response, in 7 patients (70%); and no response, in 1 patient (10%).ConclusionsOur study demonstrated that IF-ES therapy can be a promising treatment for the future, is safe, and can benefit from appropriate clinical trials in carefully selected groups. IF-ES therapy is expected to be a safe and effective treatment modality for children with enuresis.

Association between sleep and behavioural problems among children with enuresis

This study was conducted to describe sleep problems in a sample of children with enuresis and to investigate the association between sleep and behavioural problems. In this cross-sectional study, 100 children with enuresis were recruited from paediatric enuresis clinic. The children's sleep problems and behaviours were assessed by the Children's Sleep Habits Questionnaire and Child Behaviour checklist. The most frequently reported sleep problems were in daytime sleepiness, bedtime resistance and sleep anxiety subscales. Children with T-scores ≥ 60 in internalising, externalising and total behavioural problems had higher scores on daytime sleepiness subscale and total score than children with T-scores < 60. Multivariate logistic regression analysis revealed that daytime sleepiness subscale was significantly related to behavioural disturbances. Sleep problems are common among this sample of children with enuresis, and the presence of sleep disturbance such as daytime sleepiness could explain the association between enuresis and disturbed daytime behaviour.

Mental Health Considerations in Pediatric Enuresis

Enuresis is a common condition during the childhood years. Although distressing to both children and parents, enuresis often goes unreported. Because of its common occurrence, psychiatric nurses should become knowledgeable about enuresis and understand how to assess and treat it when appropriate.

Clinical evaluation of the short-form pediatric enuresis module to assess quality of life

The aim of this study was to determine the psychometric properties of the German version of the Pediatric Enuresis Module to assess Quality of Life, Short Form (PEMQOL-SF) in a sample of parents of children with urinary incontinence. The parents of 88 children (63 male, 25 female, mean age: 9.3 [SD ± 2.5, range 6-18] years) with urinary incontinence were asked to complete the PEMQOL-SF. For evaluation of convergence validity, parents and children completed the respective versions of the DCGM-10 and the PinQ questionnaire. Mean PEMQOL-SF scores were 72.2 [SD ± 14.1] (child impact scale) and 73.7 [SD ± 16.5] (family impact scale). The PEMQOL-SF had a Cronbach's alpha of 0.68 (child impact scale) and 0.80 (family impact scale), respectively. PEMQOL-SF child [family] impact scale scores correlated with the DCGM-10 with scores of r = 0.34 (r = 0.13; self-report version) and r = 0.63 (r = 0.48; proxy version) and with the PinQ with scores of r = -0.31 (r = -0.16; self-report version) and r = -0.63 (r = -0.54; proxy version), respectively. The psychometric properties of the PEMQOL-SF were good for the family impact scale, but poor for the child impact scale. In its present form, the PEMQOL-SF cannot be recommended for routine clinical use. Nevertheless, a reduction of questionnaire items could lead to better psychometric properties.

Clinical Inconsistency of Lower Urinary Tract Symptoms Between Questionnaire and Bladder Diary in Children With Nocturnal Enuresis

Classification of pediatric enuresis into monosymptomatic nocturnal enuresis and nonmonosymptomatic nocturnal enuresis is crucial for management because these cases differ in many clinical respects. However, correct classification is frequently confused based on questionnaire and/or bladder diary. We tested the consistency of information obtained on lower urinary tract symptoms between our questionnaire and bladder diary. A total of 108 physically and neurologically normal patients (mean age 7.2 years) with enuresis were included in the study. All patients filled out the questionnaire and 3-day bladder diary completely. Our questionnaire included items on urinary frequency, daytime incontinence and voiding postponement. A total of 93 patients underwent uroflowmetry and residual urine measurements. We analyzed information on lower urinary tract symptoms from the questionnaire and the bladder diary, as well as the uroflowmetry results. The percentage of children with nonmonosymptomatic nocturnal enuresis was 89.8% and 68.5% based on the questionnaire and bladder diary, respectively. In comparisons between the questionnaire and bladder diary we did not observe any significant consistency regarding urinary frequency (p = 0.912), daytime incontinence (p = 0.356) or voiding postponement (p = 0.505). Maximum voided volume, average voided volume and percent maximum voided volume/expected bladder capacity of children with monosymptomatic nocturnal enuresis were significantly higher than in those with nonmonosymptomatic nocturnal enuresis based on the bladder diary (p = 0.006, 0.001 and 0.041, respectively). By contrast, no significant difference was found between children with monosymptomatic and nonmonosymptomatic nocturnal enuresis based on the questionnaire (p = 0.559, 0.597 and 0.947, respectively). Significant discrepancies in lower urinary tract symptoms were observed between the questionnaire and bladder diary. Therefore, a detailed history and discussion with the patient and family should be performed to correlate with the questionnaire and bladder diary for the proper treatment of children with enuresis. An updated questionnaire containing a detailed scoring system may be needed.