Hypothesis / aims of study
Objective: PE is a common disease in pediatrics, which has a high incidence and affects the quality of life of children. However, the etiology of PE is still unclear, including genetic genes, dysrhythmia of antidiuretic hormone secretion, excessive sleep, dysfunction of bladder, psychological factors and delayed maturation of central nervous system function. The bladder dysfunction is one of the important reasons. However, there are few regional bladder function tests for PE children and insufficient urodynamic data. So analyze the urodynamics result of children with PE in our center, and to explore the significance and value of urodynamics in the determination and clinical diagnosis of bladder function in children with PE. Epidemiological data of PE children in southwestern China are also provided.
Study design, materials and methods
Methods: According to the diagnostic criteria of ICCS, 832 children were diagnosed with PE by parallel urodynamics in our center from January 2017 to September 2019, including 524 males and 308 females, aged 6-15 years, averaged (8.8±2.6) years. All cases were subjected to detailed inquiry of medical history, physical examination, urine routine and ultrasonic examination of urogenital system to exclude organic lesions and infections. Urodynamic examination was performed according to the ICS standard method, and the maximum urinary flow rate, residual urine, maximum bladder function capacity, compliance, and filling period detrusor stability were recorded.
non-monosymptomatic nocturnal enuresis 525 (63.1%) cases with daytime urinary urgency and urinary incontinence, and monosymptomatic nocturnal enuresis 307 (36.9%) cases, wherein, in non-monosymptomatic nocturnal enuresis proup, females accounted for a higher proportion of 68.4% (359/525). The maximum urinary flow rate was 18.2±2.5 ml/s in women and 15.1±2.1 ml/s in men. Urodynamics showed a reduction in bladder function capacity in 766 (92.0%) cases, detrusor instability in 573 (68.9%) cases, and decreased bladder compliance in 38 (4.6%) cases. All the three were significantly higher in the non-monosymptomatic nocturnal enuresis group than in the monosymptomatic nocturnal enuresis group and there was a statistically significant difference between the two groups (P<0.01). The residual urine volume was increased by 5 (0.6%) cases, all being in the non-monosymptomatic nocturnal enuresis group.
Interpretation of results
Discussion: In PE children, the incidence of male is higher than that of female, and the incidence of children with daytime urinary tract symptoms is also significantly higher than that of monosymptomatic nocturnal enuresis, which illustrates the important role of bladder dysfunction in PE. The urethral anatomical characteristics and urination mode of female children also affect bladder function, so women account for a larger proportion in non-monosymptomatic nocturnal enuresis. The reduction of bladder function capacity, unstable contraction of detrusor and the decrease of bladder compliance were the three main manifestations in the urodynamic results of PE children. The majority of PE children had the performance of insufficient bladder function capacity. Insufficient bladder function capacity could also be one of the causes of PE, and PE could lead to the reduction of bladder capacity, both of which were mutually causal. The unstable contraction of detrusor is one of the important reasons for PE. Children who have not detected unstable contraction during awakening may have unstable contraction of detrusor during sleep. Decreased bladder functional capacity and unstable contraction of detrusor may lead to decreased bladder compliance and further aggravate the symptoms of PE.