| BackgroundEnuresis in children is often accompanied by anatomical or neurological abnormalities, such as vesicoureteral reflux(VUR), ectopic ureter, bladder exstrophy, spina bifida, congenital urethral stricture or urethral valves, etc. The study found the incidence of enuresis is up to 6-23% in children with VUR, significantly higher than other urinary tract abnormalities in enuresis.Children with vesicoureteral reflux(VUR) are vesicoureteral junction abnormalities caused by congenital anatomical abnormalities. In recent years, studies have shown that 40%-60% children with VUR have lower urinary tract symptoms, and many studies have shown that children with VUR may be related with voiding dysfunction. Correcting bladder and urethra function has become an important option for the treatment of VUR.However, the specific relationship between children with enuresis and VUR is unclear, this study will explore the specific relationship between children with enuresis and VUR, screen risk factors in children with VUR, and use urodynamic to understand voiding function in children with VUR and analyze the urodynamic predictors providing clinical reference for diagnosis and treatment of children with VUR.Materials and MethodsProtocol 1: This study included 83 neurologically normal children and adolescents(boys 36, girls 47, aged from 5 to 16 y, average 9.42±3.21 y) with a chief complaint of nocturnal enuresis, accompanied by renal ultrasound abnormalities, daytime incontinence, urodynamic abnormalities or siblings have a history of VUR, they were underwent voiding cystourethrography(VCUG) in order to assess the situation VUR.Protocol 2: This study included 87 cases(boys 58, girls 29, aged 6(4-12) who had diagnosed with VUR as VUR group(group I), and 60 children(boys 38, girls 22) aged 7(4-12) because of lower urinary tract symptoms to the hospital, urodynamic were normal, and without VUR as control group(group II). All children with VUR was classified into 3 categories, based on Voiding Cystourethrogram(VCUG), as mild(grade I, n=15), moderate(grades II, n=14 and III, n=19) and severe(grades IV, n=23 and V, n=16).The urodynamic parameters including maximum flow rate(MFR), post voiding residual urine volume(PVR), maximum detrusor pressure(Pdet.maxi), maximum bladder capacity(MBC) and bladder compliance(BC) are recorded.ResultsProtocol 1: Monosymptomatic nocturnal enuresis(MNE) 48(57.8%) cases, nonmonosymptomatic nocturnal enuresis(NMNE) 35(42.2%) cases. 13(15.7%) cases had VUR. The incidence of daytime urinary incontinence, girls with VUR and current urinary tract infections(UTI) in children was significantly higher(P=0.019, 0.006, 0.017, respectively). The types of enuresis(primary, secondary), enuresis frequency, a history of UTI and urinary tract symptoms except daytime incontinence during the daytime did not have significantly statistical difference(P> 0.05).Protocol 2: MFR and MBC in VUR group were significant lower than those in the control group[(6.8±6.3)ml/s vs.(16.1±6.7) ml/s,(138.5±73.9)ml vs.(285.5±107.5) ml,P<0.05], and PVR was higher than that in the control group [(95.9±103.4)ml vs.(9.6±13.9) ml,P<0.05]. There is no significant difference of Pdet.maxi between the two groups. The parameters between boys and girls in VUR group had no statistical significance(P>0.05). MBC in mild VUR group(15 cases), moderate VUR group(33 cases), and severe VUR group(39 cases)(121.83±69.94 ml vs. 163.73±80.81 ml vs. 123.58±68.70ml)had no statistical significance(P>0.05). BC less than 20ml/cm H2 O is defined with poor compliance. There are 12 cases(80% or 12/15) in mild VUR group with normal BC, but 12 cases(36.4% or 12/33) in moderate and 9 cases in severe VUR group(23.1% or 9/39), the difference is significant(P<0.05).ConclusionsVUR is relatively common in children with enuresis and daytime incontinence. We recommend that all children with enuresis and daytime incontinence conduct VCUG. UTI is a risk factor for the occurrence of VUR in children with enuresis, but it is recommended to conservative treatment as priority. MFR and MBC decrease, PVR increases and poor BC may contribute to VUR in children. |
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