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

Abstract

Objectives: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.

<p>Evaluation of Functional Bladder Capacity in Children with Nocturnal Enuresis According to Type and Treatment Outcome</p>

“…Instead, they confirmed that elevated PVR and NP were significant predictors for medical treatment. 1 Beksac et al also revealed that PVR could predict treatment prognosis. 12 In this study, the response rate increased with FBC and FBC/EBC ratio, but there was no significant difference among CR, PR, and NR.…”

“…20 Thus, practical consensus guidelines for the management of NE suggest that a reduced FBC for age is associated with a lower response rate to desmopressin. 1 However, some studies reported that a small FBC was not associated with treatment response. Chang et al found no significant association between a reduced FBC and response to medical treatment.…”

“…The prevalence of NE is 16.1% and 10.1% at 5 and 7 years of age, respectively, and decreases with age. 1,2 The etiology of NE includes nocturnal polyuria (NP), small functional bladder capacity (FBC), an arousal problem, or a mixture of these. 1 In NE patients, the evaluation of small FBC is important in the diagnosis and monitoring treatment response.…”

“…1,2 The etiology of NE includes nocturnal polyuria (NP), small functional bladder capacity (FBC), an arousal problem, or a mixture of these. 1 In NE patients, the evaluation of small FBC is important in the diagnosis and monitoring treatment response. The International Children's Continence Society (ICCS) recommends the use of 48-hour frequency/volume (48-h F/V) charts for evaluating FBC.…”

Validation of Serbian Version of Dysfunctional Voiding Symptom Score (DVSS) Questionnaire

“…This questionnaire was named the DV Symptom Score (DVSS). So far, the DVSS was used in many studies for the follow-up of patients with DV, and for the estimation of treatment effectiveness [ 6 , 7 , 8 ]. It was also used in DV patients with attention-deficit or hyperactivity disorder [ 6 ].…”