Enuresis: Prevalence, risk factors and urinary pathology among school children in Istanbul, Turkey
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Enuresis is a common problem among children and adolescents, and can lead to important social and psychological disturbances. The aim of the present study was to establish the prevalence of enuresis among school children and determine the risk factors associated with this disorder.A cross sectional population-based study was conducted in 1576 children. The pupils enrolled in the study were chosen randomly from 14 primary schools located in seven different regions of Istanbul. Data were collected via a questionnaire completed by parents. Enuretic children were invited to the pediatric nephrology outpatient clinic of Cerrahpasa Medical School, Istanbul, Turkey. A detailed history was taken, physical and ultrasonographic examinations, urinalysis and urine culture were performed. The relationship between the prevalence of enuresis and the patients' age, gender, region, the parental educational level and employment status, number of family members, and the family's monthly income were tested by means of chi(2 ) and logistic regression analysis. The comparison between the two enuretic groups (monosymptomatic nocturnal enuresis group vs diurnal enuresis only and diurnal-nocturnal enuresis group) regarding the sociodemographic factors were tested with the chi(2) test and P < 0.05 was accepted as statistically significant.The study group was composed of 1576 school children aged between 6 and 16 years. The overall prevalence of enuresis was 12.4%. When the chi(2) test was used, a significant relationship was found between the prevalence of enuresis and age, educational level of the father, the family's monthly income, and number of family members. However, when logistic regression analysis was applied, there was a statistically significant relationship only between enuresis, and age and number of family members. In the whole group, monosymptomatic enuresis nocturna was found to be more common in boys. When the two enuretic children groups (monosymptomatic nocturnal, diurnal only and nocturnal-diurnal enuretics) were compared with each other regarding gender, parental educational and employment status, and number of family members, statistically significant differences were found. Both maternal and the paternal low educational status were found to be associated with monosymptomatic enuresis nocturna. Likewise, monosymptomatic enuresis nocturna was found to be more common in the children of the unemployed mothers, while diurnal enuresis was more common in the children of unemployed fathers. Nocturnal enuresis was found to be associated with large families. No statistically significant difference was demonstrated between the two groups of enuretics regarding age and family income levels. The rate of urinary abnormalities in the whole group was 7.1%.Enuresis is a common problem among school children and associated urinary abnormalities are not uncommon. Identification of children at risk is an essential first step before choosing the individualized management for each enuretic child.Keywords:
Family income
Cross-sectional study
Nocturnal enuresis persists into adult life much more commonly than generally recognized. Although normal children are supposed to gain bladder control before age 3, 16. 1 per cent of a group of 1000 consecutive selectees questioned at an army induction station reported enuresis after age 5. Two and one half per cent did not gain control until age 18 or later and isolated cases continued bed-wetting to age 33. Associated nervous or mental conditions were noted in 63 per cent of the cases reporting enuresis. A study of 369 inmates of a state school for mental defectives revealed enuresis in 83.8 per cent of a group of 54 idiots, 12.8 per cent of 164 imbeciles and only 4 per cent in 125 morons. It is suggested that nocturnal enuresis may frequently be regarded as a developmental defect which disappears spontaneously when maturation within the central nervous system is completed. Since the incidence of enuresis tends to decline with increasing creasing age it follows that almost any method of treatment will be effective if instituted at the proper time.
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In a retrospective review of 32 consecutive patients (20 adults and 12 children) with acute appendicitis, we correlated abnormal urinalysis with the operative findings. Abnormal results on urinalysis were noted in 10 adults and 5 children. All urine specimens were collected by the clean-catch method. Abnormal findings were found more frequently in female patients. The majority of the patients with abnormal urinalysis had a ruptured or inflamed appendix in proximity to the urinary tract.
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We investigated bladder reservoir function in children with monosymptomatic nocturnal enuresis and in healthy controls.A total of 18 children with monosymptomatic nocturnal enuresis and 119 controls who were 7 to 13 years old were recruited. Children completed frequency volume charts and measurements of nocturnal urine production. Mean diuresis in the period preceding each voiding was calculated. Those with enuresis were grouped according to bladder capacity and hospitalized for 4 nights, including a baseline night and 3 with an oral water load. Enuresis volumes and post-void residual volume were estimated, allowing the calculation of bladder volume at the time of enuresis.Nine children with monosymptomatic nocturnal enuresis were characterized as having normal bladder capacity and 9 had decreased bladder capacity. We found large intra-individual variability in daytime voided volume in all 3 groups of participants. Children with enuresis and small bladder capacity generally voided with volumes close to maximal voided volume. A total of 93 enuresis episodes were recorded. Large intra-individual variability was seen in bladder volume at enuresis and it was lower than maximal voided volume in more than 50% of episodes. Variability in bladder volume at enuresis was greatest in the patient group with decreased bladder capacity. We found a significant correlation between diuresis and bladder capacity in all groups during the day and night.There is a great intra-individual diurnal variability in voided volume in children with enuresis and in healthy children. Enuresis seems to occur at bladder volumes that are smaller and larger than the maximal voided volume obtained from voiding charts.
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Urinalysis is a fundamental component of the holistic and symptom assessment of any individual in poor health. Urinalysis can disclose evidence of diseases, even some that have not caused significant signs or symptoms. Susan Foxley explains in this article how urine should best be collected so that test results can be used to screen, diagnose and manage diseases—including those affecting the kidneys.
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Complete urinalysis includes the evaluation of physical and chemical properties as well as a thorough examination of the urinary sediment. A complete urinalysis should be performed anytime that a complete blood count and routine serum biochemistry are submitted in order to be able to integrate and maximize the interpretation of findings. Urinalysis should be performed in febrile animals, because urinary tract infection can be a source of sepsis without obvious urinary tract clinical signs. Once urine is collected, the decision is made as to where and how the urinalysis will be performed. For urine samples being analyzed in-house, about two-third are run as complete urinalyses and one-third only undergo dipstrip chemical analysis. In-house automated methods of urinalysis allow the complete urinalysis to be performed, and a report generated within five minutes.
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Nocturnal enuresis was a symptom of childhood obstructive sleep apnoea, OSAS. We reported two children with secondary nocturnal enuresis which disappeared after tonsillectomy and adenoidectomy for proven OSAS. Pathogenesis of secondary nocturnal enuresis in OSAS was discussed.
Sleep
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Objective: To study the differences among the results of urinalysis at differences.Methods: MA_4210 urinalysis system was used to detect urine samples at 4 degrees C,35 degrees C and room temperature.Results: Each factor,such as pH、GLU、PRO、SG and URO in urinalysis at light temperarure(35 degrees C) were significantly higher than those at room temperature and lower temperature (4 degrees C).Conclusion: There are significant differences among the main results in urinalysis at different temperatures.More attentions should be paid to it.
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To examine the impact of routine urinalysis at admission on inpatient care at a hospital in Lebanon, where physicians perceive it to be a valuable diagnostic tool, in a country where preventive services are underdeveloped and where the epidemiology of kidney diseases possibly differs from that of the western world.American University Hospital, a tertiary teaching hospital in Beirut, Lebanon.A retrospective medical record review of all adult patients admitted over 2 weeks to the medicine and surgery wards of the American University Hospital. Outcomes measured were frequency of routine urinalysis versus urinalysis for a clinical indication, investigation of abnormal test results, and implications of test results on clinical management.367 (79%) of 462 study patients underwent urinalysis. 266 (73%) patients had routine urinalysis. Abnormal results were found in 97(37%) routine tests and 67 (66%) of those clinically indicated urinalysis (p<0.001). Abnormalities were investigated in 21 (22%) of the abnormal routine urinalyses and 45 (67%) of the abnormal clinically indicated urinalyses (p<0.001). Logistic regression analysis showed no factors to correlate positively with investigation of abnormal urinalysis. Treatment was given to two (1%) patients who had had routine urinalysis and 26 (26%) of all those tested because of a clinical indication (p<0.001).Clinical response to any abnormal urinalysis is more likely when a urine test is done for a clinical indication. In this study setting, impact of routine admission urinalysis on patient care was negligible. Despite physicians' perception of routine urinalysis being a valuable case finding tool, in this study its true value remains questionable.
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Fifteen per cent of 5-year-olds, 7% of
10-year-olds and 1% of 15-year-olds
wet their beds. The exact nature of a child's bedwetting
needs to be carefully elucidated,
making a clear distinction between
enuresis and incontinence. Enuresis can be defined as the persistent,
involuntary voiding of a normal
urine volume during sleep,
beyond the age of expected continence
(i.e. 5 years). The most common cause of bedwetting
is benign enuresis. Benign enuresis (monosymptomatic
nocturnal enuresis) is caused by a
combination of (i) inadequate arousal
response to bladder fullness; (ii) inadequate
increase in nocturnal ADH
production; and (iii) a small functional
bladder capacity. Benign enuresis is recognised by (i)
the absence of symptoms or signs of
any underlying disease; (ii) wetting
that occurs exclusively during sleep;
and (iii) normal urinalysis. Primary enuresis is almost never
caused by psychological problems. The most common causes of secondary
enuresis (relapse after 6 months
of dryness) are urinary tract infection
and psychological disturbance. The most effective treatment for
benign enuresis is alarm therapy. The most effective medication for
benign enuresis is DDAVP (desmopressin).
Desmopressin
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Nighttime incontinence, otherwise known as nocturnal enuresis, is a common condition that can cause substantial psychological distress in children with the condition. Nocturnal enuresis is defined as nighttime bedwetting in children five years of age or older.[1][1] The prevalence of bedwetting (≥
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