Bladder Dysfunction in Children With Refractory Monosymptomatic Primary Nocturnal Enuresis

Yeung, Chung‐Kwong; Chiu, Hsiao-Chen; Sit, F.K.Y.

doi:10.1097/00005392-199909000-00024

Cited by 56 publications

(80 citation statements)

References 19 publications

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“…12,13 The MNE population has been divided into polyuric and nonpolyuric with the latter considered detrusor-dependent with small functional bladder capacity 1,6,14 or minor bladder dysfunction, which is common in daytime symptomatic enuretic patients. 15 In the polyuric group of MNE vasopressin has been advocated, with an overall positive response rate ranging from 50% to 75%. 13,14 Not all polyuric bedwetters are vasopressin responders, and so other factors have been suggested as being responsible for nocturnal bedwetting.…”

Section: Discussionmentioning

confidence: 99%

Sodium Fraction Excretion Rate in Nocturnal Enuresis Correlates With Nocturnal Polyuria and Osmolality

et al. 2004

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Purpose: We verify the sodium fraction excretion rate (FE Na) and potassium fraction excretion (FE K) rates in monosymptomatic nocturnal enuresis. We also correlate FE Na and FE K to urinary osmolality, nocturnal polyuria and vasopressin in the same population.Materials and Methods: A total of 438 children 6 to 15 years old (mean age 9.7) presenting with monosymptomatic nocturnal enuresis were recruited from different centers. Inclusion criteria were 3 or greater wet nights a week, no daytime incontinence and no treatment in the previous 2 months. Exclusion criteria were cardiopathy, endocrinopathy, psychiatric problems and urinary tract abnormalities. Micturition chart, diurnal (8 am to 8 pm) and nocturnal (8 pm to 8 am) urine collection, including separate diuresis volumes, (Na, K and Ca) electrolytes and osmolality were evaluated, as well as serum electrolytes, creatinine and nocturnal (4 am) vasopressin. Diurnal and nocturnal FE K and FE Na were calculated. ANOVA test, chi-square test, Student's t test and Pearson correlation test were used for statistical analysis.Results: Nocturnal polyuria (diurnal to nocturnal diuresis ratio less than 1) was found in 273 children (62.3%, group 1 and nocturnal urine volumes were normal in 165 with enuresis (37.7%, group 2). Nocturnal FE Na was abnormal in 179 children (40.8%), including 118 in group 1 (43.2%) and 61 in group 2 (36.9%) (chi-square not significant). FE Na was also increased in nocturnal versus daytime diuresis (Student's t test p Ͻ0.001). In group 1 nocturnal FE Na correlated with nocturnal diuresis (Pearson correlation p ϭ 0.003, r ϭ ϩ0.175), while daytime FE Na and nocturnal FE Na correlated with diurnal diuresis (Pearson correlation p ϭ 0.001, r ϭ ϩ0.225 and Pearson correlation p ϭ 0.001, r ϭ ϩ0.209, respectively). In group 2 nocturnal FE Na did not correlate with diuresis (Pearson correlation p ϭ 0.103, r ϭ ϩ0.128) but correlated with vasopressin values (Pearson correlation p ϭ 0.042, r ϭ Ϫ0.205). Urine osmolality was reduced in 140 children (31.9%) and correlated with nocturnal diuresis (Pearson correlation p ϭ 0.003, r ϭ Ϫ0.321). Vasopressin was decreased in 332 children (75.8%, 62.6% in group 1 and 13.2% in group 2). No significant difference was found between sexes and age of enuretic subgroups.Conclusions: Nocturnal FE Na correlates with nocturnal diuresis, whereas daytime FE Na does not. FE K in daytime and nighttime diuresis does not statistically differ in nocturnal polyuric and nonpolyuric enuretic groups. Osmolality correlates with nocturnal diuresis, and vasopressin at 4 am was lower in the nocturnal polyuric group. The hypothesis of a subset of enuretic patients presenting with nocturnal polyuria associated with high nocturnal natriuria and low vasopressin values has been confirmed. KEY WORDS: enuresis, polyuria, vasopressins, electrolytes, desmopressin Pathogenesis of monosymptomatic nocturnal enuresis (MNE) is still debated as different etiopathogenetic hypotheses have been proposed, accepted or rejected during the last century....

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Section: Discussionmentioning

confidence: 99%

Sodium Fraction Excretion Rate in Nocturnal Enuresis Correlates With Nocturnal Polyuria and Osmolality

et al. 2004

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“…Although urine output and bladder capacity were not measured in the present study, the results may nevertheless be useful in understanding the pathophysiology of enuresis. We intended to exclude bladder problems by assessing the history, but apparently bladder problems may not always be easy to detect, or detrusor overactivity might occur only during sleep [20].…”

Section: Discussionmentioning

confidence: 99%

Treatment of primary monosymptomatic nocturnal enuresis with desmopressin: predictive factors

et al. 2001

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On behalf of the Swedish Enuresis Trial (SWEET) Group (see Appendix) Objective To investigate predictive factors for the outcome of treatment of primary monosymptomatic nocturnal enuresis (PMNE) with desmopressin. Patients and methods Data from a large open multicentre study were analysed. The study comprised 399 children with PMNE who were recruited for long-term desmopressin treatment. Before treatment a history was taken and the children observed for 4 weeks. After a 6-week dose-titration period with desmopressin, the children were classi®ed into four groups depending on the response rate. Results The children who improved during desmopressin treatment were older, had fewer wet nights during the observation period and had only one wet episode during the night, mostly after midnight. Many of them did not require the maximum dose of desmopressin to become dry. No hereditary factor for the response to desmopressin was found. Conclusion Those most likely to be permanently dry with desmopressin treatment are older children who respond to 20 mg desmopressin and who do not wet frequently.

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“…Yeung performed ambulatory cystometries and found that bladder overactivity is an important cause of therapyresistant nocturnal enuresis. 8 Newer theories point to the role of the central nervous system in bedwetting. Parents of children who wet the bed often claim that they are "deep sleepers."…”

Section: Why Does Nocturnal Enuresis Occur?mentioning

confidence: 99%

Nocturnal enuresis

Kiddoo¹

2012

CMAJ

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Bladder Dysfunction in Children With Refractory Monosymptomatic Primary Nocturnal Enuresis

Cited by 56 publications

References 19 publications

Sodium Fraction Excretion Rate in Nocturnal Enuresis Correlates With Nocturnal Polyuria and Osmolality

Sodium Fraction Excretion Rate in Nocturnal Enuresis Correlates With Nocturnal Polyuria and Osmolality

Treatment of primary monosymptomatic nocturnal enuresis with desmopressin: predictive factors

Nocturnal enuresis

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