Childhood enuresis is a risk factor for bladder dysfunction in adult life?

Primary enuresis in adults: pathogenesis, clinical course and modern approaches to treatment: A review

The review article presents current data on the epidemiology, classification, pathogenesis, risk factors, diagnosis, and features of the clinical course of primary enuresis in adults. The main methods of treatment of patients with primary enuresis are described in detail. It has been shown that in the treatment of this category of patients, the leading role is given to the use of a synthetic analogue of the antidiuretic hormone desmopressin. A detailed analysis of the pharmacological properties and clinical use of desmopressin in patients with primary enuresis is presented. The advantages of prescribing a sublingual form of desmopressin, which ensures its high efficiency and good tolerability of therapy.

Long-term functional and psychosocial outcome in adolescents and young adults treated for lower urinary tract dysfunction in childhood

BACKGROUND

Lower urinary tract dysfunction (LUTD) in childhood might affect lower urinary tract function and psychological wellbeing later in life. This study presents long-term functional outcome, psychological outcome and quality of life (QOL) of adolescents and young adults treated for childhood LUTD compared to healthy age-matched controls. In addition, association with past treatment outcomes is evaluated.

STUDY DESIGN

A single-centre cross-sectional study of former patients treated in childhood (currently 16-26 years old) was conducted. Participants completed a survey composed from validated questionnaires: the Overactive Bladder Questionnaire, the Hospital Anxiety and Depression Scale, the Pediatric Quality of Life Inventory and the Short Form 36 Health Survey.

RESULTS

Fifty-two former patients (out of 133) agreed to participate and returned the survey (mean age 21 ± 4.1 years). Sixty-nine control subjects were included (mean age 21 ± 2.9 years). Urinary tract symptoms were more common in former patients than controls. Storage symptoms more frequently reported were (urge) urinary incontinence, stress urinary incontinence (SUI) and nocturia. Voiding symptoms more frequently reported were intermittency and feeling of incomplete emptying, Fig. 1. There were no differences in urinary tract symptoms or urinary incontinence subdivided by childhood treatment outcome (complete response, partial response or no response), respectively p = 0.17 and p = 0.58. Results of the overactive bladder questionnaire revealed higher urinary symptom bother scores (score 14 versus 5 p < 0.01) and lower disease-specific QOL (score 95 versus 98 p = 0.02) in former patients compared to controls. General QOL and psychosocial wellbeing were not significantly different between the two groups. A childhood treatment duration extending 2,5 years was an independent prognostic factor for subsequent urinary tract symptoms later in life (OR = 1.5, 95% CI 1.1-2.0). Psychological comorbidity was more often present in former patients (35%) versus controls (10%), p < 0.01.

CONCLUSION

Adolescents and young adults treated for childhood LUTD are more prone to report urinary tract symptoms later in life, especially if treatment duration was extensive. However general QOL and psychosocial wellbeing later in life are not or only mildly affected.

Urinary incontinence in female university students

INTRODUCTION AND HYPOTHESIS

We aimed to determine the prevalence of urinary incontinence (UI) in nulliparous female university students and to provide an overview of risk factors associated with urinary continence.

METHODS

A total of 1,397 female university students aged 18-28 years were enrolled into this cross-sectional questionnaire study. The self-administered questionnaires, the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), Overactive Bladder V8 (OAB-V8), demographics, and general characteristics were recorded. The frequency, type, and severity of urinary incontinence and related factors were evaluated.

RESULTS

The mean age of the students was 20.27 ± 1.69 years. The prevalence of UI in female university students was 18.4% (n = 258). ICIQ-SF total score was 0.85 ± 2.11 (0-14). OAB-V8 total score was 5.97 ± 5.35 (0-40) and 27.0% of participants had scores of ≥8. Elevated BMI, childhood enuresis, constipation, exercising, positive family history for UI, accommodation in a dormitory, and holding urine at school are risk factors associated with UI in female university students.

CONCLUSION

We demonstrated that UI is a common condition among female university students. The identification of the associated risk factors will help to further raise the knowledge and awareness of the problem, and preventive strategies may be proposed to young women to improve the quality of life and psychological well-being.

Childhood nocturnal enuresis-a marker for pelvic floor disorders and urinary tract symptoms in women?

Introduction and hypothesis

A systematic survey on the association between childhood nocturnal enuresis (CNE) and adult pelvic floor disorders (PFDs) has not been presented previously. The aim was to describe the prevalence of PFDs and lower urinary tract symptoms in nulliparous women, with or without a history of CNE, at the age of ≥ 5 years.

Methods

This national survey of urinary (UI) and fecal incontinence (FI) and symptoms of pelvic organ prolapse (sPOP) was a random sample of 20,000 nulliparous women aged 25–64 years conducted in 2014. Women ≥ 5 years of age having CNE were compared with those without the condition. Fisher’s exact test and logistic regression adjusted for BMI and age were used to analyze differences between groups.

Results

The response rate was 52% and 10.2% of adult women reporting CNE. One or more PFDs occurred in 38.3% of women with CNE compared to 23.8% in those without CNE (p < 0.0001). Mixed UI had the strongest association with CNE, odds ratio (OR) 2.63 (95% CI 2.03–3.40). The rate of FI was 11.2% in the non-CNE group and 16.8% in those with CNE (p < 0.0001) and sPOP 2.6% in the non-CNE and 4.8% in the CNE group (p = 0.0004), respectively. The prevalence of lower urinary tract symptoms was consistently higher in women with a history of CNE: overactive bladder 32.6% versus 18.4% (OR 2.34 95% CI 2.03–3.40), daytime micturition ≥ 8/day 29.6% versus 24.0% (p < 0.0001), and nocturia ≥ 2/night 12.4% versus 7.8% (p < 0.0001) in the CNE group.

Conclusion

PFDs and lower urinary tract symptoms in nulliparous women were approximately doubled in women with a history of CNE and could therefore act as a strong confounding factor.

Electronic supplementary material

The online version of this article (10.1007/s00192-020-04345-x) contains supplementary material, which is available to authorized users.

Is nocturnal enuresis a predisposing factor for the overactive bladder?

Background/aim

This study aimed to perform a limited observational study to ascertain whether there is statistical support that nocturnal enuresis (NE) is a predisposing factor in the development of overactive bladder (OAB).

Materials and methods

The authors recruited patients diagnosed with OAB over a period of twelve months, and those who declared a history of NE were asked additional questions regarding the features of their NE.

Results

A total of 285 patients were diagnosed with overactive bladder, and 98 (34.38%) of them had previously displayed NE symptoms that had diminished before reaching the median age of 9.83. Separation of patients by sex revealed a male majority (58.16%). Additionally, most patients had urban origins (75.51%). The median time span from remission of NE to diagnosis of OAB was 24.79 years, and the median age at which patients began to suffer was 31.80 years. Behavioral factors (smoking, alcohol consumption) and psychological and infectious factors (past history of urinary tract infection) were identified at varying degrees.

Conclusion

The presence of NE in a third of the patients who developed over time OAB and the earlier onset of OAB for these patients suggests a causal physiopathological relationship between NE and OAB. The preponderance of urban patients confirms the existence of acquired urban triggering factors of OAB (nutritious, social, or professional).

A comprehensive review of adult enuresis

Nocturnal enuresis (NE) is a combined symptom of nocturia and urinary incontinence. In this review, we aim to summarize the current literature on NE in terms of its definition, diagnosis, and management. Recommended diagnostic evaluation of NE includes a focused history and physical examination, urinalysis, and when indicated, ultrasound examination, flow rate, urine volume chart, urodynamics, and cystoscopy. Therapeutic options include lifestyle modification and medications (i.e., desmopressin and anticholinergics).

The prevalence of urinary incontinence in nulliparous adolescent and middle-aged women and the associated risk factors: A systematic review

Urinary incontinence (UI) has been defined as the complaint of involuntary loss of urine. There is a general belief that UI is experienced almost exclusively by the elderly and women who have given birth. However, epidemiological studies report that young women who are nulliparous also experience UI. The aim of this study was to systematically review studies investigating the prevalence of UI in nulliparous adolescent and middle-aged women and to provide an overview of risk factors associated with UI. The electronic databases PubMed, EMBASE, CINAHL, and Cochrane Library were systematically searched for eligible studies. Inclusion and exclusion criteria were defined a priori. The selected studies were reviewed and data extraction was carried out by the reviewers. Two independent researchers assessed the quality of the included studies. Eighteen studies were included in this systematic review. UI prevalence estimates varied from 1% to 42.2%. Among the women with UI of any type, 12.5% to 79% had stress urinary incontinence. BMI, childhood enuresis, and high-impact exercising were found to be the main associated risk factors. Understanding the effect of the risk factors on the pelvic floor will enable us to implement preventive strategies and advise appropriately on the prevention of UI.

Trajectories of urinary incontinence in childhood and bladder and bowel symptoms in adolescence: prospective cohort study

OBJECTIVES

To identify different patterns (trajectories) of childhood urinary incontinence and examine which patterns are associated with bladder and bowel symptoms in adolescence.

DESIGN

Prospective cohort study.

SETTING

General community.

PARTICIPANTS

The starting sample included 8751 children (4507 men and 4244 women) with parent-reported data on frequency of bedwetting and daytime wetting for at least three of five time points (4½, 5½, 6½, 7½ and 9½ years-hereafter referred to as 4-9 years). Study children provided data on a range of bladder and bowel symptoms at age 14 (data available for 5899 participants).

OUTCOME MEASURES

Self-reported bladder and bowel symptoms at 14 years including daytime wetting, bedwetting, nocturia, urgency, frequent urination, low voided volume, voiding postponement, passing hard stools and low stool frequency.

RESULTS

We extracted 5 trajectories of urinary incontinence from 4 to 9 years using longitudinal latent class analysis: (1) normative development of daytime and night-time bladder control (63.0% of the sample), (2) delayed attainment of bladder control (8.6%), (3) bedwetting alone (no daytime wetting) (15.6%), (4) daytime wetting alone (no bedwetting) (5.8%) and (5) persistent wetting (bedwetting with daytime wetting to age 9) (7.0%). The persistent wetting class generally showed the strongest associations with the adolescent bladder and bowel symptoms: OR for bedwetting at 14 years=23.5, 95% CI (15.1 to 36.5), daytime wetting (6.98 (4.50 to 10.8)), nocturia (2.39 (1.79 to 3.20)), urgency (2.10 (1.44 to 3.07)) and passing hard stools (2.64 (1.63 to 4.27)) (reference category=normative development). The association with adolescent bedwetting was weaker for children with bedwetting alone (3.69 (2.21 to 6.17)).

CONCLUSIONS

Trajectories of childhood urinary incontinence are differentially associated with adolescent bladder and bowel symptoms. Children exhibiting persistent bedwetting with daytime wetting had the poorest outcomes in adolescence.

Pathophysiological and Therapeutic Considerations for Non-Neurogenic Lower Urinary Tract Dysfunction in Children

Non-neurogenic lower urinary tract dysfunction (LUTD) in children is very common in clinical practice and is important as an underlying cause of lower urinary tract symptoms, urinary tract infection and vesicoureteral reflux in affected children. LUTD in children is caused by multiple factors and might be related with a delay in functional maturation of the lower urinary tract. Behavioral and psychological problems often co-exist in children with LUTD and bowel dysfunction. Recent findings in functional brain imaging suggest that bladder bowel dysfunction and behavioral and psychiatric disorders in children might share common pathophysiological factors in the brain. Children with suspected LUTD should be evaluated properly by detailed history taking, validated questionnaire on voiding and defecation, voiding and bowel diary, urinalysis, screening ultrasound, uroflowmetry and post-void residual measurement. Invasive urodynamic study such as videourodynamics should be reserved for children in whom standard treatment fails. Initial treatment of non-neurogenic LUTD is standard urotherapy comprising education of the child and family, regular optimal voiding regimens and bowel programs. Pelvic floor muscle awareness, biofeedback and neuromodulation can be used as a supplementary purpose. Antimuscarinics and α-blockers are safely used for overactive bladder and dysfunctional voiding, respectively. For refractory cases, botulinum toxin A injection is a viable treatment option. Prudent use of urotherapy and pharmacotherapy for non-neurogenic LUTD should have a better chance to cure various problems and improve self-esteem and quality of life in affected children.

Attention deficit-hyperactivity disorder symptoms and daytime voiding symptoms in children with primary enuresis: an observational study to evaluate the effectiveness of desmopressin treatment

Purpose. To evaluate the effectiveness of presence of desmopressin in treating primary enuresis (PE) for children with attention deficit-hyperactivity disorder (ADHD) symptoms. Materials and Methods. Children aged from 5 to 12 years with the chief complaint of PE treated with desmopressin were enrolled in pediatric urology clinics. The parent-reported SNAP-IV questionnaire was used to evaluate ADHD symptoms (cut-off value: 90th percentile). Voiding symptoms were assessed by the Dysfunctional Voiding Scoring System (DVSS) questionnaire. The responses to desmopressin were analyzed in children with and without ADHD symptoms. Results. The study sample comprised 68 children; 27 (39.7%) presented with ADHD symptoms and 41 (60.3%) with non-ADHD symptoms. The children collected from a tertiary referral center may explain the high prevalence of ADHD symptoms in the present study. The total DVSS score in the ADHD symptoms group was significantly higher than in the non-ADHD symptoms group (7.72 versus 5.65, P = 0.05). In the ADHD symptoms group, there were significantly higher score in the “pee 1-2 times/day” and “can't wait” subscales of DVSS and lower sleep quality based on the Pediatric Sleep Quality questionnaire, as well as significantly lower peak flow rate and voided volume. The responses to desmopressin for enuresis were comparable between children with ADHD and non-ADHD symptoms. Conclusions. Approximately 39.7% of PE children presented with ADHD symptoms at urologic clinics. PE children with ADHD symptoms had higher risk of daytime LUTS and comparable response to desmopressin treatment for PE. To evaluate ADHD symptoms and daytime voiding symptoms is important in children with PE.

Advances in the management of enuresis

There are still many undiscovered facts about enuresis, even though it is a very old "symptom". It is a significant health problem with a high prevalence among children and a lower prevalence in adulthood. Many treatment guidelines have been proposed for the management of this problem. The improvement of diagnostic tools, and also treatment modalities, have had a significant impact on success rates; however, the long-term success rates need to be higher, especially in resistant cases. In this report, we summarize the advances made in the diagnosis and treatment of enuresis.

The impact of a history of childhood nocturnal enuresis on adult nocturia and urgency

AIM

This study examined the association between a childhood history of nocturnal enuresis and nocturia and urgency as an adult.

METHODS

A questionnaire was completed by 3649 parents and grandparents of children with nocturnal enuresis. The age range of the respondents was 30-89, and 54% were female. The questionnaire included the respondent's age, underlying disease, the age at which nocturnal enuresis was resolved and any current nocturia and urgency.

RESULTS

The responses enabled us to analyse the risk factors for nocturia and urgency for the total sample, the history of nocturnal eneurisis for 2555 adults aged from 30 to 79 years and the age when nocturnal enuresis resolved for 1300 adults aged from 30 to 49 years. Respondents were significantly more likely to have nocturia and urgency as adults if they had a history of nocturnal enuresis and were aged ≥12 years when their nocturnal enuresis resolved.

CONCLUSIONS

A childhood history of nocturnal enuresis, particularly nocturnal enuresis that resolved at ≥12 years old, was associated with an increased frequency of adult nocturia and urgency. The impact of previous nocturnal enuresis on adult nocturia and urgency presents a risk that is comparable to ageing and prostatic disease.

A 20-year study of persistence of lower urinary tract symptoms and urinary incontinence in young women treated in childhood

OBJECTIVE

To determine whether urinary incontinence (UI) and lower urinary tract symptoms (LUTS) persist over years, patients treated for UI and LUTS in childhood were re-evaluated in adulthood.

MATERIALS AND METHODS

Forty-seven women (cases) treated in childhood for daytime UI/LUTS (group A) and nocturnal enuresis (group B) self-completed (average age: 24.89 ± 3.5 years) the International Consultation on Incontinence Questionnaire for Female with LUTS (ICIQ-FLUTS). ICIQ-FLUTS was self-administered to 111 healthy women (average age: 23 ± 5.1 years) from a nursing school as a control group. Data obtained from ICIQ-FLUTS and quality of life (QoL) score (0-10) were compared (Fisher's exact test) between patients and controls, and between group A (n = 28) and group B (n = 19).

RESULTS

Prevalence of LUTS was higher in patients than in controls. The difference between patients and controls was statistically significant (p = 0.0001) for UI (34% vs. 7%) and feeling of incomplete bladder emptying (49% vs. 28%). QoL score was >5 in 59% of patients and 1% of controls (p = 0.0001). No significant differences were found between groups A and B.

CONCLUSIONS

UI and LUTS are confirmed in young women who suffered for the same condition in childhood. Longitudinal studies are needed to assess if these symptoms persist or are newly onset.

Management of mixed urinary incontinence

Mixed urinary incontinence accounts for 33% of all incontinence and is the involuntary loss of urine associated with the sensation of urgency; it is also associated with exertion, sneezing or coughing. Risk factors include vaginal delivery, obesity, age and possible genetic factors. Treatment includes lifestyle changes, behavioral therapies, medication and nerve modulation. Surgery with midurethral slings can cure both stress and urge components in 40-50% of cases. Future therapies may include new medications adapting potassium and calcium channels and more widespread use of sacral neuromodulation. This review focuses on the investigation and optimal management of mixed urinary incontinence.