Tonsillectomy does not improve bedwetting: results of a prospective controlled trial

Abstract

Purpose: Sleep disordered breathing caused by tonsillar hypertrophy has been implicated as a cause of primary and secondary nocturnal enuresis in children. We prospectively studied the preoperative and postoperative rates of nocturnal and daytime incontinence in a group of children with tonsillar hypertrophy undergoing tonsillectomy compared to a matched control group undergoing surgery unrelated to the airway or urinary tract. Materials and Methods: A total of 326 toilet trained children 3 to 15 years old were included, with 257 in the tonsillectomy group and 69 in the control group. Severity of tonsillar hypertrophy was graded preoperatively on a scale of 1 to 4. A voiding questionnaire regarding number of bedwetting and daytime incontinence episodes per week, voids per day, bowel movements per week, secondary or primary enuresis and family history was completed by parents preoperatively, and at 3 and 6 months postoperatively. Results: Preoperatively the respective rates of nocturnal enuresis and daytime incontinence were 33% and 17% in the tonsillectomy group (p = 0.89), and 35% and 14% in the control group (p = 0.3). The respective cure rates for bedwetting at 3 and 6 months postoperatively were 40% and 50% in the tonsillectomy group (p = 0.60), and 35% and 48% in the control group (p = 0.61). Similarly no difference was seen in improvement or cure of daytime incontinence at 3 and 6 months postoperatively. Conclusions: We found no association between tonsillar hypertrophy and urinary incontinence before or after tonsillectomy.

The association between sleep‐disordered breathing and enuresis in children

“…At 6 months the cure rate was 50% for the T&A group and 48% for the control group. 6 No statistical differences were noted between the groups.…”

“…Kalorin et al is a noteworthy study with contrary results. 6 This prospective controlled trial revealed no improvement in NE. 6 This study clearly raises the possibility that T&A is incidental to the expected natural resolution of NE over time.…”

“…6 This prospective controlled trial revealed no improvement in NE. 6 This study clearly raises the possibility that T&A is incidental to the expected natural resolution of NE over time. Limitations of the Kalorin et al study included the method of diagnosis of airway obstruction and lack of PSG testing.…”

“…Only one of the seven studies had a control population and had contrary results. 6 The study population included 326 children with NE, followed prospectively and randomized into 257 children who underwent T&A, and 69 controls. The preoperative incidence of NE was 33% for the T&A group and 35% for the control group.…”

“…6 Kalorin et al also used bedwetting as the preferred terminology, raising the possibility that a broader than expected rate of enuresis was reported. 6 Although Kalorin et al runs contrary to previous assertions, our systematic review incorporates varied scientific studies and a larger sample size showing an improvement in NE in postoperative T&A pediatric patients. However, caution must be exercised as pointed out by the Kalorin et al study.…”