Analysis Of Urine Flow Rate And Residual Urine In Children With Enuresis During First Desire To Void And Strong Desire To Void

BackgroundNocturnal enuresis(NE)is a relatively common urological disease in children and adolescents.NE not only causes a certain amount of psychological pressure on children,but also interferes with their sleep at night and affects the quality of life of children.The etiology and pathophysiological changes of NE are not fully understood,and abnormal bladder urodynamics is one of its causes.Therefore,more and more hospitals have used non-invasive urinary flow rate testing as one of the screening measures for evaluating bladder dysfunction in children with NE.Then,for children suspected of having bladder dysfunction,further invasive urodynamic tests are performed.At present,it is generally considered that if the urine output is too small,the result of the test will be affected when the free urine flow rate is checked.Before the examination,the urodynamics doctor will tell the parents to let the child drink a lot of water to hold back the urine.Many children undergo urinary flow rate examination when the bladder is overfilled.There is no difference in the results of urinary flow rate measurement in children with different urinary intentions.What is the effect of excessive urine holding on the urinary flow rate measurement and what kind of urinary intention state is to be tested?ObjectiveTo observe the differences in urine flow rate and residual urine test results of children with enuresis under the conditions of initial urine intensiveness and strong urine will provide a reference for clinical application of urine flow rate determination to determine bladder function in children with enuresis.MethodsFrom June 2017 to August 2019,180 children who were diagnosed with enuresis according to the diagnostic standards agreed by the experts on the management of children's enuresis in our hospital were selected from the outpatients of our pediatric urinary power center,aged 5 to 14 years,with an average of(7.84 ±3.68))year old.Among them,98 were male children,aged 5-13 years,with an average age of(7.93±3.64)years.The course of disease ranged from 3 months to 6 years,and the number of bedwetting was from 2-3 times/week to 3 times/night.There were 82 women.Age 6-14 years,mean age(8.52 ± 3.57)years,disease duration 3 months to 7 years,enuresis frequency from 2-3 times/week to 2 times/night.Explain the meaning of first desire to void(FD)and strong desire to void(SD)to patients and parents before the test.Then the children were instructed to drink plenty of water.When the children reported that they had FD,they were checked for the first free urine flow rate,and a post voiding residual(PVR)test was performed within 5 minutes after urination.After the first test,the child was asked to drink water again.When the child reported that he had SD,a second free urine flow rate test was performed,and a PVR test was performed within 5 minutes after urination.The results of the urine flow rate are evaluated by a professional urodynamics doctor.According to the ICS standard,we divide the urine flow curve into a normal bell-shaped urine flow curve and a non-bell-shaped urine flow curve.Then the urinary flow rate-residual urine test results(Qmax,Qave,VV,VT,PVR,and urinary flow curves)of children at FD were compared with the results of SD at FD.ResultsThe maximum urine flow rate(Qmax)of the child at FD was 17.64 ± 6.18mL/s,and the PVR was 3.84± 3.06mL;the Qmax at SD was 21.05 ± 7.59mL/s,and the PVR was 6.50 ± 7.32mL;The Qmax and PVR results were compared between FD and SD,and the differences were statistically significant(P<0.05).Qmax increased with the increase of urine output,but when the urine output increased to a certain extent,Qmax decreased.Analysis of urinary flow curves of 180 children at FD and SD.The incidence of non-bell-shaped urinary flow curves was 8.3%and 18.3%,respectively,and the difference was statistically significant(P<0.05).ConclusionUrine flow rate-residual urine test is prone to false residual urine volume increase and non-bell curve of urine flow rate in children with enuresis at the time of strong urine intention.The clinician should fully consider the influence of urine volume on the parameters when analyzing the results of urine flow rate examination in enuresis children.