The Application Of Urodynamics Examination In The Primary Children Nocturnal Enuresis

Objective To explore the bladder urodynamic changes in children with primary nocturnal enuresis(PCNE)and its clinical significance.Methods 40 patients(24 boys,16 girls,mean age 8.12 years,range 5-14)with PCNE(2-15 wet nights/week) were assessed using detailed recording of frequency-voiding diary(FVD) for one week,natural filling continous cystometry with simultaneous EEG monitoring during sleep at night.The most morning urinary volume was considered as functional bladder capacity(FBC)and FBC/CBC_norm(normal cystometry bladder capacity)was calculated.Functional bladder capacity(FBC),Enuretic volume,Bladder detrusor stability,Bladder compliance,the EMG of pelvic floor reflexes and function of detrusor-sphincter coordination were evaluated.30 healthy nonenuretic volunteers(19 boys,11 girls,mean age 8.08 years,range 5-13) underwent urodynamic study in the same period.The patients were divided into two groups according to the urodynamic result: groupⅠ,without detrusor instability(DI);and groupⅡ,with DI.All the patients were treated by dry bed training therapy which included psychological therapy,behavioral modification and clock waking training,nevertheless groupⅡwere given the oral anticholinergic medicine(oxybutynin) that inhibited selectively detrusor.At the same time 50 cases(31 boys,19 girls,mean age 8.20 years,range 5-15 )with PCNE who did not underwent urodynamic test were served as control and were treated only by dry bed training therapy.The therapeutic periods were 3 months.All patients were followed up at 3 and 6 months,the prevalance was compared with the curative effect.Results The FBC and FBC/CBCnorm(122.52±28.31ml and 45.42±5.01%),the enuretic volume(NV) and NV/CBCnorm(109.88±28.84ml and 40.45±5.39%) in the patients with PCNE were significantly lower than that in control group (259.21±55.47ml and 94.14±7.07%,253.5±54.96ml and 92.75±6.42%)(P＜0.01) The incidence of DI in patients was 70%(28/40) that was statistically different from the incidence of DI in control group(3/30)(p＜0.01).There were 4 patients with EMG decreasing when DI happening during filling period,36 with EMG increasing during voiding period,3 with low-compliance bladders;of 30 nonenuretic volunteers,there were 25 children with EMG increasing during voiding period,no low-compliance bladders or EMG decreasing when DI happening.But the differences were insignificant(p＞0.05). The effective rate of experimental group at 3 and 6 months were 87.5%(35/40) and 82.5%(33/40),and that of control group were 60%(30/50) and 52%(26/50);The cure rate of experimental group at 3 and 6 months were 80%(32/40) and 70%(28/40),while control group were 50%(25/50) and 44%(22/50),there were statistically significant differences between the two groups(p＜0.01)Conclusions Urodynamic studies play an important role in evaluation of bladder dysfunction of children with PCNE.The studies reveal that DI is the main urodynamic changes of PCNE,FBC decreasing was the basic character which follows after DI.The anticholinergic medicine which selectively inhibit vesical detrusor is effective to PCNE with DI.The treatment to the base of bladder urodynamic changes is better than traditional therapy without urodynamic assessment,it don't only avoid the side effects of traditional pharmacological therapy but also improve the cure rate.Therefore urodynamic analysis are needed in patients with PCNE.