Does Urine Flow Pattern of Children with Nocturnal Enuresis Differ According to the Presence or Absence of Daytime Urinary Incontinence?
Taiju Hyuga, Dr., Shigeru Nakamura, Ph.D., Shina Kawai, Dr., Hideo Nakai, Ph.D..
Jichi Medical University, Children's Medical Center Tochigi, Shimotsuke, Japan.
BACKGROUND: Non monosymptomatic nocturnal enuresis (NMNE) was defined as nocturnal enuresis (NE) with daytime urinary symptoms. The ratio of NMNE was reportedly 50-90% of NE, and there exists a rather big difference in each report. Does urine flow pattern of children with NE differ according to the presence or absence of daytime urinary incontinence (DI)? We retrospectively evaluated using triplicate uroflowmetry.
METHODS: Between January 2008 to December 2015, 112 children (mean age 9 years 9 months old) with NE who underwent triplicate uroflowmetry were included into the study. The volume of voided urine, bladder capacity, post-void residual, flow rate and flow shape pattern were evaluated. We classified the results into 5 flow patterns (Normal : N, Tower: T, Staccato: S, Plateau: P, Interrupted: I) according to Automated objective patterning software by Department of Urology, Kyoto University. One of those 5 patterns was assigned for each children, if at least two of the three patterns are identical, even though the pattern did not show complete matching. If all of the three patterns were not identical, the case was assigned as U (Unclassified). Flow shape patterns except for N were defined abnormal (A). We used sum of two scores (urgency, voiding postponement: maximum score as 6) extracted from Dysfunctional voiding symptom score (DVSS) in order to represent objective symptoms of urgency.
RESULTS: 54 and 58 children were included in DI+NE group and isolated NE group, respectively. As for flow shape pattern, N=24, T=18, S=5, P=2, U=5 in DI+NE group, N=29, T=12, S=10, P=2, U=5 in isolated NE group. There was no difference between N and A in both groups. 26 cases were shown to have no mismatch in DI+NE group, 27 cases were shown to have no mismatch in isolated NE group. There was no significant difference in uroflow parameters. The average of daytime urinary symptom in DVSS were 3.0±1.8 in DI+NE group and 1.0±1.2 in isolated NE group (p<0.001).
CONCLUSIONS: Between 2 groups there was objective proof showing significant difference in severity of daytime urinary symptoms. However there was no significant difference in both of flow shape pattern and uroflow parameters. Our results had discrepancy and may suggest two possible interpretations. First, the children with isolated NE may well have latent voiding dysfunction. Second, uroflowmetry is not necessarily suitable examination to detect the abnormal voiding in enuretic children.
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