Epidemiology of Enuresis among Children in Diyala Governorate

Background: Nocturnal enuresis, is intermittent involuntary voiding in a child aged five years or more. One time a month for three months is required for the diagnosis. It is a common problem in children. It is the cause of stress for them and for their families. Enuresis can be classified into two types to understand its causes and treatment. These types are primary and secondary enuresis, monosymptomatic and polysymptomatic. Primary enuresis always associated with a familial history of delayed control of the urinary bladder. Secondary enuresis may cause by urinary tract or neurogenic causes like the spinal cord and urinary tract infection. Most of the cases were of the primary type. Objective: To evaluate the associated factor of nocturnal enuresis, study the various types of nocturnal enuresis, and evaluate the associated factors that affect the types of nocturnal enuresis. Patients and Methods: A cross-sectional study conducted in outpatient clinic of Albatool hospital in Diyala province, Iraq, 150 children was eligible in the study, which started from 1st Febreuary to 30th June 2020. Collection of the data was done by interview parents’ or the children's caregiver by a questionnaire that was used before for study enuresis. Analysis was carried out using statistical package for social sciences SPSS version 24. Results: The present study included 150 patients with enuresis, their mean age was 7.51±1.34 years (range:= 5-10 years), there were (59.3%) males and (40.7%) females. Most of the patients (61.3%) had 2-3 sibling, second in their birth order (52%), reside in the urban area (56%), a majority of the mothers 38% had primary school as their highest educational attainment, a majority of the fathers (32.7%) had secondary school as their highest educational attainment, most of the mothers 62.7% were housewives and 57.3% of fathers were employees. Regarding clinical features of the patients, 32% had a family history of enuresis, 52% had a history of fluid consumption other than water, 7.3% had a history of punishment, 8% had history of constipation, 27.3% had a history of emotional stress, 5.3% had a history of DM, 30.7% had a history of drug intake, 61.3% reveal UTI in their urinalysis, 78% reveal abnormal US findings. Secondary enuresis was found in 65.3% of the patients, while primary enuresis found in 34.7% of the patients, 7.3% of the patients complaining of diurnal enuresis. All studied factors not significantly associated with types of enuresis except constipation was found more in patients with secondary enuresis 91.7%. Conclusion: According to the previous study many risk factors were associated with nocturnal enuresis, in the current study these risk factors, except constipation which was associated with secondary enuresis, were not associated with nocturnal enuresis.

Biofeedback as single first-line treatment for non-neuropathic dysfunctional voiding in children with diurnal enuresis

Introduction: Non-neurogenic dysfunctional voiding (NDV) accounts for a significant portion of pediatric urology outpatient clinic visits. Biofeedback (BF) is a promising, non-invasive modality for treating children with DV and daytime wetting. Our objective was to investigate BF’s efficacy as a single first-line treatment for children with NDV and diurnal enuresis. Methods: A retrospective cohort study was conducted with a total of 61 consecutive patient records from January 2009 to March 2016. All children with NDV who had BF as first-line treatment were included. Full urological histories, physical examinations, dysfunctional voiding symptom score (DVSS), urine analysis, ultrasound (US), and uroflowmetry (UFM), and electromyogram (EMG) were performed and recorded for all patients before and after finishing the last BF cycle. The patient’s satisfaction scale was also obtained. Results: The mean age was 10±2.6 years. Most patients (80.3%) were females. The presenting symptoms were diurnal enuresis, urinary tract infections, and voiding discomfort in 52 (85.2%), 16 (26.2%), and 38 (62.3%) patients, respectively. Six months after the last BF cycle, there was a statistically significant objective improvement in US and UFM+EMG findings, with the disappearance of EMG signals in 40 of 61 (65.5%) patients. There was also a significant subjective symptomatic improvement, as the mean DVSS had decreased from 14 to 7.9 (p=0.003). Forty-seven patients (77%) were satisfied, while only eight (13.1%) were not. Conclusions: BF is considered a potentially effective, single firstline treatment modality for children with DV and diurnal enuresis. Long-term outcome assessments are needed to assess the children’s compliance and symptom recurrence.

Hubungan enuresis dengan kejadian leukosituria pada siswa sekolah dasar

Enuresis refers to the involuntary excretion of urine that occurs during urination which is expected to have already been attained. Enuresis is divided into nocturnal enuresis and diurnal enuresis. Nocturnal enuresis (sleep wetting) is enuresis which occurs at night while enuresis diurnal (awake wetting) is enuresis which occurs during the day. The presence of leukocytes in urine that exceeds the normal value is called leukocyturia which is a sign of inflammation of the urinary tract (kidneys, ureter, bladder, and urethra). This study aimed to obtain the relationship between leukocyturia and enuresis among primary school students aged 5-10 years in SDN 4 and SDN 8 Wawalintouan Tondano. This was an observational analytical study with a cross sectional approach. Samples were obtained by using purposive sampling method. There were 60 urine samples of children of SDN 4 and SDN 8 Wawalintouan, Tondano. The results showed that of the 60 students, there were 34 males (56.7%) and 26 females (43.3%). Based on gender, there were 29 males (61.7%) with negative leukocyturia and 5 males (38.5%) with positive leukocyturia; among females there were 18 females (38.3%) with negative leukocyturia and 8 females (61,5%) with positive leukocyturia Based on enuresis, the distribution of leukocyturia showed 7 students (53,8%) with enuresis and positive leukocyturia, meanwhile of those without enuresis there were 6 students (46,2%) with positive leukocyturia. Conclusion: There was no relationship between the incidence of enuresis and leukocyturia among primary school students aged 5-10 years in SDN 4 and SDN 8 Wawalintouan Tondano.Keywords: enuresis,leukosituria,urinalysis. Abstrak: Enuresis merupakan pengeluaran air kemih yang tidak disadari yang terjadi pada saat proses berkemih diharapkan sudah tercapai. Enuresis di bagi atas enuresis nokturnal dan enuresis diurnal. Enuresis nokturnal (sleep wetting) merupakan enuresis yang terjadi pada malam hari sedangkan enuresis diurnal (awake wetting) adalah enuresis yang terjadi pada siang hari. Terdapatnya leukosit dalam urin melebihi nilai normal disebut leukosituri yang merupakan salah satu tanda adanya peradangan pada saluran kemih (mencakup ginjal, ureter, kandung kemih, dan uretra). Penelitian ini bertujuan untuk mengetahui hubungan antara enuresis dengan kejadian leukosituria pada siswa sekolah dasar usia 5-10 tahun di SDN 4 dan SDN 8 Wawalintouan Tondano. Jenis penelitian ini analitik observasional dengan desain potong lintang. Sampel diperoleh dengan metode purposive sampling yang dilaksanakan dengan mengambil sampel urin anak-anak sekolah dasar di SDN 4 dan SDN 8 Wawalintouan Tondano. Hasil penelitian memperlihatkan dari 60 sampel terdapat 34 anak laki-laki (56,7%) dan 26 anak perempuan (43,3%). Dari distribusi leukosituria berdasarkan jenis kelamin didapatkan anak laki-laki dengan leukosituria negatif berjumlah 29 anak (61,7%) dan dengan leukosituria positif 5 anak (38,5%), sedangkan anak perempuan dengan leukosituria negatif berjumlah 18 anak (38,3%) dan yang leukosituria positif 8 anak (61,5%). Distribusi leukosituria berdasarkan enuresis didapatkan 7 anak (53,8%) yang enuresis dengan leukosituria positif, sedangkan yang tidak enuresis didapatkan 6 anak (46,2%) dengan leukosituria positif. Simpulan: Tidak terdapat hubungan antara enuresis dengan kejadian leukosituria pada siswa sekolah sekolah dasar usia 5-10 tahun di SDN 4 dan SDN 8 Wawalintouan Tondano. Kata kunci: enuresis, leukosituria, urinalisis

The Efficacy of a Transurethral Incision for Diurnal and Nocturnal Enuresis in Young Males

Introduction: In this study, we investigated the effects of treatment with a transurethral incision (TUI) for congenital urethral stenosis, which was accompanied by diurnal and nocturnal enuresis. Methods: We recruited 21 young males who presented to our department for the treatment of diurnal and nocturnal enuresis from January 2010 to March 2014. All patients underwent TUI due to urethral stricture found by a close investigation. We surveyed each case to evaluate the improvement of diurnal and/or nocturnal enuresis after TUI. Results: One and a half years after TUI, an improvement in diurnal enuresis was observed in 17 of 21 cases (80.9%), whereas that of nocturnal enuresis was observe in only 7 of 21 cases (33.3%), showing the significant contribution of TUI to the improvement of diurnal enuresis (p = 0.001). In the case of diurnal enuresis, continual improvement was observed more than a year after surgery, whereas no improvement was observed in nocturnal enuresis at more than 6 months after surgery. Conclusion: TUI is more effective for diurnal enuresis than nocturnal enuresis. At postoperative 6 months, clinicians should thus consider other etiologies for unresponsive cases and start other treatment options.