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Maffei HVL, Vidolin E, Reis JND, Freitas MD, Cabral BH, Trigo-Rocha F. OCCULT AND SEMI-OCCULT CONSTIPATION IN CHILDREN WITH MONOSYMPTOMATIC OR NON MONOSYMPTOMATIC ENURESIS. ARQUIVOS DE GASTROENTEROLOGIA 2023; 60:410-418. [PMID: 38018546 DOI: 10.1590/s0004-2803.230402023-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/04/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Functional constipation and enuresis frequently coexist. Constipation treatment often results in resolution or improvement of the enuresis. However, besides the classical presentation, patients can present with occult constipation (OC) diagnosed in complementary evaluation; in addition, semi-occult constipation (SOC) can be detected by means of a detailed questionnaire. OBJECTIVE To quantify OC and SOC frequency in children with monosymptomatic or non monosymptomatic enuresis (MNE or NMNE). METHODS Otherwise healthy children/adolescents, with enuresis refractory to behavioral therapy and denying constipation after simple questions, answered a structured bowel habit questionnaire and were submitted to a plain abdominal radiological exam. Constipation was classified considering the Boston diagnostic criteria (to allow diagnosis at initial stages), and fecal loading in the X-ray quantified ≥10 by the Barr score. Children with constipation received a standardized treatment (except 26 "pilot" children). RESULTS Out of 81 children, 80 aged 9.34±2.07 years, 52.5% male, were diagnosed with constipation: 30 OC, 50 SOC; 63.75% had MNE, 36.25% NMNE (six NMNE without behavioral therapy). Demographic data and the Barr score were similar for OC and SOC, but SOC children experienced significantly more constipation complications (retentive fecal incontinence and/or recurrent abdominal pain). Not showing the Bristol Stool Scale (BSS) to 24 "pilot" children, or absence of constipation symptoms accompanying BSS predominantly type 3, in 13 children, did not significantly impact the detection of constipation by the Barr score. Children identifying BSS 3 or ≤2 had similar results. Twenty-eight children, with adequate follow-up after treatment, improved or recovered from constipation at 44 of their 52 follow-up visits. CONCLUSION In patients with MNE or NMNE refractory to behavioral therapy, and who initially denied constipation after simple questions, a detailed questionnaire based on the Boston diagnostic criteria detected SOC in 61.7%, and the radiological Barr score revealed fecal loading (OC) in 37.0% of them.
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Affiliation(s)
- Helga Verena L Maffei
- Universidade Estadual Paulista, Faculdade de Medicina, Departamento de Pediatria, Botucatu, SP, Brasil
| | - Eliana Vidolin
- Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brasil
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, São Paulo, SP, Brasil
| | | | | | | | - Flavio Trigo-Rocha
- Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brasil
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Urologia, São Paulo, SP, Brasil
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Aral A, Usta MB, Erguner Aral A. Factors associated with response to simple behavioral intervention in primary enuresis nocturna. Bull Menninger Clin 2022; 86:67-89. [PMID: 35258343 DOI: 10.1521/bumc.2022.86.1.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This 8-week longitudinal study examined predictors of response to simple behavioral intervention in primary enuresis nocturna (PEN). A total of 154 children, aged 8-18 years, diagnosed with PEN were evaluated. The results indicated that lack of constipation, milder enuresis severity, and higher bladder capacity are the primary predictors of good treatment response, and lower family dysfunction is the most robust familial predictor. Lack of constipation is the main predictor with unique variance in multiple regression. Specialists should be aware of conditions that hinder the success of simple behavioral intervention before implementing costly treatments. In treatment-refractory cases, it is important to examine each child for constipation. Family-centered approaches can be helpful if used in parallel with behavioral treatments.
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Affiliation(s)
- Armagan Aral
- Staff physician in the Department of Child and Adolescent Psychiatry, Mental Health Hospital, Samsun, Turkey
| | - Mirac Baris Usta
- Department of Child and Adolescent Psychiatry, Medical Faculty, University of Ondokuz Mayis, Samsun, Turkey
| | - Ayse Erguner Aral
- Psychiatry resident in the Department of Mental Health and Diseases, Medical Faculty, University of Ondokuz Mayis, Samsun, Turkey
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Hsiao YC, Wang JH, Chang CL, Hsieh CJ, Chen MC. Association between constipation and childhood nocturnal enuresis in Taiwan: a population-based matched case-control study. BMC Pediatr 2020; 20:35. [PMID: 31992241 PMCID: PMC6986027 DOI: 10.1186/s12887-020-1939-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/22/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The relationship between constipation and childhood nocturnal enuresis (NE) has been previously reported; however, this relationship remains controversial. The present study aimed to evaluate the association between constipation and childhood NE. METHODS Data from the Longitudinal Health Insurance Database 2000 (LHID 2000) of Taiwan National Health Insurance Research Database from 2000 to 2013 were collected. A total of 2286 children were enrolled in this study: a case group of 1143 children aged 5-18 years who were diagnosed with NE (NE group) and an age- and sex-matched control group of 1143 children without NE. Conditional logistic regression and odds ratio (OR) for NE were used to examine the association between constipation and childhood NE. RESULTS The prevalence of NE in the case group (NE group, aged 5-18 years) was 1.03% from 2000 to 2013. The NE group had a higher percentage of constipation in 1 year before the diagnosis of NE. After stratification for sex, both boys and girls with constipation had higher OR for NE. With stratification for age, children aged 5-12 and 7-12 years had a higher OR for NE. CONCLUSIONS Constipation is associated with childhood NE in Taiwan, particularly in children aged 5-7 and 7-12 years.
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Affiliation(s)
- Yu-Chao Hsiao
- Department of Pediatrics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chia-Ling Chang
- Management Office for Health Data, Clinical Trial Research Center (CTC), China Medical University Hospital, Hongkong, China
| | - Chia-Jung Hsieh
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
| | - Ming-Chun Chen
- Department of Pediatrics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan. .,School of Medicine, Tzu Chi University, No. 707, Section 3, Chung Yang Road, Hualien City, Hualien, Taiwan.
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Ma Y, Shen Y, Liu X. Constipation in nocturnal enuresis may interfere desmopressin management success. J Pediatr Urol 2019; 15:177.e1-177.e6. [PMID: 30594475 DOI: 10.1016/j.jpurol.2018.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 11/26/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Previous studies indicated that the prevalence of constipation in enuretic patients is higher than that in the general population. Several studies have revealed that successful treatment of constipation may be helpful in resolving enuresis. However, constipation affecting the efficacy of desmopressin in treating enuresis remains to be clarified. OBJECTIVE This study aimed to determine whether the presence of constipation is associated with the efficacy of desmopressin in treating enuresis. STUDY DESIGN Patients diagnosed with nocturnal enuresis (NE) were studied prospectively. Treatment responses in different stratified groups of patients with NE were compared by Chi-squared tests or Wilcoxon rank sum test. A logistic regression model was performed to investigate the relationship between the possible factors and the effectiveness of desmopressin. RESULTS In children with severe enuresis, patients with constipation had significantly lower complete response rate compared with patients without constipation. The presence of constipation was always related to the effectiveness of desmopressin whether in monosymptomatic NE or non-monosymptomatic patients with NE. With stratification for dose of desmopressin, non-constipated patients who received 0.2 mg of desmopressin had significantly higher complete response rate than patients with constipation. However, in subgroups of mild to moderate NE and 0.4 mg desmopressin, constipation was not associated with treatment response of enuresis. Logistic regression analysis revealed that constipation was significantly related to the effectiveness of desmopressin. DISCUSSION This study confirmed the negative effects of constipation in response to desmopressin in patients with NE. To the best of authors knowledge, this work is the first study to evaluate the relationship of constipation in enuretic patients and the efficacy of desmopressin. CONCLUSIONS The presence of constipation negatively affects the response to desmopressin in patients with NE, especially in patients with severe enuresis and in patients prescribed with low dose of desmopressin.
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Affiliation(s)
- Y Ma
- The General Ward, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Chronic Kidney Disease and Blood Purification of Children, Xicheng District, Beijing, China.
| | - Y Shen
- The General Ward, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Chronic Kidney Disease and Blood Purification of Children, Xicheng District, Beijing, China.
| | - X Liu
- The General Ward, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Chronic Kidney Disease and Blood Purification of Children, Xicheng District, Beijing, China.
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Joinson C, Grzeda MT, von Gontard A, Heron J. A prospective cohort study of biopsychosocial factors associated with childhood urinary incontinence. Eur Child Adolesc Psychiatry 2019; 28:123-130. [PMID: 29980842 PMCID: PMC6349792 DOI: 10.1007/s00787-018-1193-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
The objective of the study was to examine the association between biopsychosocial factors and developmental trajectories of childhood urinary incontinence (UI). We used developmental trajectories (latent classes) of childhood UI from 4-9 years including bedwetting alone, daytime wetting alone, delayed (daytime and nighttime) bladder control, and persistent (day and night) wetting (n = 8751, 4507 boys, 4244 girls). We examined whether biopsychosocial factors (developmental level, gestational age, birth weight, parental UI, temperament, behaviour/emotional problems, stressful events, maternal depression, age at initiation of toilet training, constipation) are associated with the trajectories using multinomial logistic regression (reference category = normative development of bladder control). Maternal history of bedwetting was associated with almost a fourfold increase in odds of persistent wetting [odds ratio and 95% confidence interval: 3.60 (1.75-7.40)]. In general, difficult temperament and behaviour/emotional problems were most strongly associated with combined (day and night) wetting, e.g. children with behavioural difficulties had increased odds of delayed (daytime and nighttime) bladder control [1.80 (1.59-2.03)]. Maternal postnatal depression was associated with persistent (day and night) wetting [2.09 (1.48-2.95)] and daytime wetting alone [2.38 (1.46-3.88)]. Developmental delay, stressful events, and later initiation of toilet training were not associated with bedwetting alone, but were associated with the other UI trajectories. Constipation was only associated with delayed bladder control. We find evidence that different trajectories of childhood UI are differentially associated with biopsychosocial factors. Increased understanding of factors associated with different trajectories of childhood UI could help clinicians to identify children at risk of persistent incontinence.
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Affiliation(s)
- Carol Joinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 2BN, UK.
| | - Mariusz T. Grzeda
- 0000 0004 1936 7603grid.5337.2Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 2BN UK
| | - Alexander von Gontard
- grid.411937.9Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Jon Heron
- 0000 0004 1936 7603grid.5337.2Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 2BN UK
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Shah S, Jafri RZ, Mobin K, Mirza R, Nanji K, Jahangir F, Patel SJ, Ejaz MS, Qaiser I, Iftikhar H, Aziz K, Khan W, Maqbool HS, Ahmed H. Frequency and features of nocturnal enuresis in Pakistani children aged 5 to 16 years based on ICCS criteria: a multi-center cross-sectional study from Karachi, Pakistan. BMC FAMILY PRACTICE 2018; 19:198. [PMID: 30547752 PMCID: PMC6293541 DOI: 10.1186/s12875-018-0876-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 11/19/2018] [Indexed: 11/24/2022]
Abstract
Background Nocturnal enuresis (NE) is a common symptom in children worldwide. International Children’s Continence Society (ICCS) defines enuresis as either mono-symptomatic, NE with lower urinary tract symptoms and NE with co-morbid conditions. The objectives of this study were to determine the frequencies and types of NE and associated symptoms and conditions in children aged 5 to 16 years based on ICCS criteria. Methods A multi-center cross sectional study was conducted between November 2012 and December 2013 in the primary care clinics of four hospitals in Karachi. Children aged five to fifteen years were included through consecutive sampling. Informed consent was obtained from the parents and a pre-coded semi-structured questionnaire was used to obtain the information. Data was entered on SPSS version 20.0 and multivariable logistic regression analysis was used for data analysis. Results Out of 429 children aged between five and sixteen years, 243(56.9%) were boys and the remaining 186(43.1%) were girls. One hundred and eighty three children (43%) had nocturnal enuresis (NE). Forty four (10.3%), had mono-symptomatic NE, 57(31.1%) had associated lower urinary tract symptoms (NE-LUTS), whereas 30 (16.3%) had NE with a co-morbid condition. Fifty two (28.4%) NE’s had at least one of both LUTS and a co-morbid condition. Out of the 246(57%) non-enuretic’s, 31(12.6%) had a LUTS, 95(38.6%) had a co-morbid condition and 57(23.2%) had at least one of both LUTS and a co-morbid condition. The remaining 63 (25.6%) were symptom free. Increased voiding frequency, urgency, dysuria, suprapubic pain and daytime incontinence were the LUTS significantly associated with NE. Co-morbid conditions significantly associated with NE included constipation, congenital defects, developmental delay, and learning and sleep problems. Conclusion Although NE can be an only symptom, it is often associated with lower urinary tract symptoms like dysuria, urgency, suprapubic pain, and daytime incontinence. Children presenting with NE often have co-morbid conditions like constipation, urinary tract infection, sleep disorders, and developmental delay. Many children presenting with these conditions as the primary complaint may also have NE. It should be addressed as unrecognized and untreated NE can cause additional morbidity and distress.
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Affiliation(s)
- Sameena Shah
- Department of Family Medicine, Aga Khan University, Stadium Road, Karachi, Pakistan.
| | - Rabab Zehra Jafri
- Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA
| | - Khalil Mobin
- Community Health Sciences, Karachi Medical and Dental College, Karachi Metropolitan Corporation, Karachi, Pakistan
| | | | - Kashmira Nanji
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Fatima Jahangir
- Department of Family Medicine, Ziauddin University Hospital, Karachi, Pakistan
| | | | - Muzamil Shabana Ejaz
- Dow Medical College, DOW University of Health Sciences, Baba-e-Urdu Road, Karachi, Pakistan
| | | | | | - Komal Aziz
- Saint Louis University, St Louis, MO, USA
| | - Wajiha Khan
- Department of Pediatrics, Aga Khan University, Karachi., Pakistan
| | - Humza S Maqbool
- UC, San Francisco - Fresno medical education program, California, USA
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7
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Lai PH, Yang PS, Lai WY, Lin CL, Hsu CY, Wei CC. Allergic rhinitis and the associated risk of nocturnal enuresis in children: a population-based cohort study. Int Forum Allergy Rhinol 2018; 8:1260-1266. [PMID: 30281945 DOI: 10.1002/alr.22219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 08/28/2018] [Accepted: 09/09/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite controversy, an association between allergy and nocturnal enuresis (NE) has been reported for almost a century. Allergic rhinitis (AR)-associated sleep-disordered breathing frequently results in microarousals during sleep, decreased sleep efficiency, and change in sleep pattern and behavior. NE is a common sleep disorder in children. Hence, this study aimed to investigate the incidence and risk of NE in children with AR. METHODS A population-based cohort study was conducted among 327,928 children with AR and 327,601 non-AR controls between 2000 and 2012 in Taiwan. By the end of 2012, the incidence of NE in both cohorts, and the AR-to-non-AR cohort hazard ratios (HRs) were measured. RESULTS The adjusted HR of NE during the study period was 1.7-fold higher in the AR cohort compared to the non-AR cohort. The risk was greater for boys, children younger than 6 years old, those with comorbidities of asthma, atopic dermatitis, and attention deficit/hyperactivity disorder (ADHD), and those who had more than 5 AR-related medical visits per year. The risk of NE in the AR cohort decreased with follow-up time and was the highest within the first year after AR diagnosis. CONCLUSION Children with AR had a higher incidence and subsequent risk of NE. The risk of NE was greater for boys, younger children, and those with more frequent health utilization for AR symptoms.
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Affiliation(s)
- Pei-Hsuan Lai
- Children's Hospital, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Shan Yang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wan-Yu Lai
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,Institute of Biostatistics, China Medical University, Taichung, Taiwan
| | - Chung-Y Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Chang-Ching Wei
- Children's Hospital, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
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8
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Abstract
Constipation is one of the most common gastrointestinal symptoms in children. With a median reported prevalence of 12%, it accounts for about 25% of all pediatric gastroenterology consultations. The majority of children experiences functional constipation and do not usually require any diagnostic testing. For those children not responding to conventional medical treatment or in the presence of a more significant clinical picture, however, an accurate instrumental assessment is usually recommended to evaluate either the underlying pathophysiologic mechanisms or a possible organic etiology. The present review analyzes the possible diagnostic investigations for severely constipated children, focusing on their actual indications and their utility in clinical practice. During the last decade, there has been a remarkable increase in our knowledge of normal and abnormal colonic and anorectal motility in children, and a number of different techniques to measure transit and motility have been developed and are discussed in this narrative review.
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9
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Safaei-Asl A, Heydarzadeh A, Karimi A, Maleknejad S. Frequency of enuresis and related factors among
school children in Guilan province; a single center
investigation. J Nephropharmacol 2017. [DOI: 10.15171/npj.2017.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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10
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Benninga MA, Tabbers MM, van Rijn RR. How to use a plain abdominal radiograph in children with functional defecation disorders. Arch Dis Child Educ Pract Ed 2016; 101:187-93. [PMID: 27325615 DOI: 10.1136/archdischild-2015-309140] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2016] [Indexed: 12/29/2022]
Abstract
Defecation-related functional gastrointestinal disorders (FGIDs), such as infant dyschezia, functional constipation and functional non-retentive faecal incontinence, as defined by the Rome IV criteria, are common problems in childhood. The symptomatology varies from relatively mild, such as crying before passage of soft stools or infrequent defecation to severe problems with faecal impaction and the daily involuntary loss of faeces in the underwear. Conventional radiography is widely available, relatively cheap and is non-invasive. The drawback however, is radiation exposure. This review describes and evaluates the value of different existing scoring methods to assess faecal loading on an abdominal radiograph with or without the use of radio-opaque markers, to measure colonic transit time, in the diagnosis of these defecation-related FGIDs. Insufficient evidence exists for a diagnostic association between clinical symptoms of functional constipation or functional nonretentive faecal incontinence and faecal loading on an abdominal radiograph. Furthermore, evidence does not support the routine use of colonic transit studies to diagnose functional constipation. Colonic transit time measurement may be considered in discriminating between functional constipation and functional non-retentive faecal incontinence and in patients in which the diagnosis is not clear such as having an unreliable medical history. In children with the suspicion of defecation-related FGIDs, the diagnosis should be made based on the Rome IV criteria.
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Affiliation(s)
- M A Benninga
- Department of Paediatric Gastroenterology & Nutrition, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands
| | - M M Tabbers
- Department of Paediatric Gastroenterology & Nutrition, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands
| | - R R van Rijn
- Department of Paediatric Radiology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands
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Sarici H, Telli O, Ozgur BC, Demirbas A, Ozgur S, Karagoz MA. Prevalence of nocturnal enuresis and its influence on quality of life in school-aged children. J Pediatr Urol 2016; 12:159.e1-6. [PMID: 26778419 DOI: 10.1016/j.jpurol.2015.11.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE According to the ICCS definitions, enuresis is defined by an intermittent, wetting during sleep after organic causes have been ruled out with a minimum wetting frequency of once per month. Previous studies reported a prevalence rate of 9-12%. Eighty to 90% of enuresis cases are identified as primary enuresis and are based on genetic predisposition, biological and developmental factors. On the other hand, secondary enuresis frequently arises from psychological factors. In this study we aimed to determine the prevalence and associated factors of nocturnal enuresis (NE) among primary school children. METHOD We initiated a prospective cross-sectional epidemiological study from January 2013 to May 2013 by sending a questionnaire to parents of 4250 school children, aged 6-13 years. The questionnaire consisted of three parts. The first part investigated the demographic characteristics of the child and family, such as age, gender, number of siblings, and enuresis history of the parents and siblings. The second part consisted of questions about the presence and frequency of bedwetting, presence of constipation/fecal incontinence, and presence of daytime incontinence (DI). The last part surveyed school performance and the effect of enuresis on quality of life of parents and children. Logistic regression analyses were conducted to determine the significant predictive factors for NE. RESULTS The overall prevalence of enuresis was 9.52%. The prevalence of NE among boys and girls was 12.4% and 6.5%, respectively. Daytime incontinence was present in 18% of children. Of enuretic children, 59.2% had a positive family history of enuresis. Constipation was found in 13.2% of children with enuresis and there was no significant association between NE and the presence of constipation. In addition, 48% of enuretic children had poor school performance. CONCLUSIONS The current study demonstrated that age, male gender, parents' history of enuresis, and siblings' history of enuresis were significant predictive factors for NE. The majority of the parents did not have adequate interest in enuretic children and most of the children were not treated. Physicians should inform parents of enuretic children with the aim of solving this problem to prevent future issues and development of adulthood lower urinary tract symptoms (LUTS).
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Affiliation(s)
- Hasmet Sarici
- Department of Urology, Afyon Kocatepe University Faculty of Medicine, Afyon, Turkey
| | - Onur Telli
- Department of Pediatric Urology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Berat Cem Ozgur
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Arif Demirbas
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey.
| | - Senem Ozgur
- Department of Pediatrics, Sami Ulus Training and Research Hospital, Ankara, Turkey
| | - Mehmet Ali Karagoz
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
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12
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Gorbachinsky I, Sherertz R, Russell G, Krane LS, Hodges SJ. Altered perineal microbiome is associated with vulvovaginitis and urinary tract infection in preadolescent girls. Ther Adv Urol 2014; 6:224-9. [PMID: 25435916 DOI: 10.1177/1756287214542097] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Vulvovaginitis has a known association with urinary tract infections (UTIs) in girls. We hypothesize that vulvovaginitis is a major contributor to UTIs in prepubertal girls by increasing periurethral colonization with uropathogens. METHODS Periurethral swabs and urine specimens were obtained from a total of 101 girls (58 with vulvovaginitis and 43 without vulvovaginitis). Specimens were cultured for bacterial growth. The dominant organism in the periurethral swabs and urine cultures was recorded and antibiotic sensitivity profiles were compared. RESULTS Periurethral swabs from children with vulvovaginitis were associated with a statistically significant increase in uropathogenic bacteria (79% Enterococcus species or Escherichia coli) as the dominant culture compared with swabs from girls without vaginitis (18%) (p < 0.05). In children with vulvovaginitis, 52% of the urine cultures were positive for UTIs, and the dominant organism in the urine cultures matched the species and antibiotic sensitivity profile of the corresponding periurethral swab. Only 11% of the urine cultures from girls without vulvovaginitis were positive for UTIs. CONCLUSIONS Vulvovaginitis may cause UTIs by altering the perineal biome such that there is increased colonization of uropathogens.
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Affiliation(s)
- Ilya Gorbachinsky
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Robert Sherertz
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Gregory Russell
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - L Spencer Krane
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steve J Hodges
- Department of Urology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
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13
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Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014; 58:258-74. [PMID: 24345831 DOI: 10.1097/mpg.0000000000000266] [Citation(s) in RCA: 571] [Impact Index Per Article: 57.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Constipation is a pediatric problem commonly encountered by many health care workers in primary, secondary, and tertiary care. To assist medical care providers in the evaluation and management of children with functional constipation, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition were charged with the task of developing a uniform document of evidence-based guidelines. METHODS Nine clinical questions addressing diagnostic, therapeutic, and prognostic topics were formulated. A systematic literature search was performed from inception to October 2011 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials, and PsychInfo databases. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. For therapeutic questions, quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation system. Grading the quality of evidence for the other questions was performed according to the classification system of the Oxford Centre for Evidence-Based Medicine. During 3 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation, using the nominal voting technique. Expert opinion was used where no randomized controlled trials were available to support the recommendation. RESULTS This evidence-based guideline provides recommendations for the evaluation and treatment of children with functional constipation to standardize and improve their quality of care. In addition, 2 algorithms were developed, one for the infants <6 months of age and the other for older infants and children. CONCLUSIONS This document is intended to be used in daily practice and as a basis for further clinical research. Large well-designed clinical trials are necessary with regard to diagnostic evaluation and treatment.
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Bested AC, Logan AC, Selhub EM. Intestinal microbiota, probiotics and mental health: from Metchnikoff to modern advances: part III - convergence toward clinical trials. Gut Pathog 2013; 5:4. [PMID: 23497650 PMCID: PMC3605358 DOI: 10.1186/1757-4749-5-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 03/10/2013] [Indexed: 12/14/2022] Open
Abstract
Rapid scientific and technological advances have allowed for a more detailed understanding of the relevance of intestinal microbiota, and the entire body-wide microbiome, to human health and well-being. Rodent studies have provided suggestive evidence that probiotics (e.g. lactobacillus and bifidobacteria) can influence behavior. More importantly, emerging clinical studies indicate that the administration of beneficial microbes, via supplementation and/or fecal microbial transplant (FMT), can influence end-points related to mood state (glycemic control, oxidative status, uremic toxins), brain function (functional magnetic resonance imaging fMRI), and mental outlook (depression, anxiety). However, despite the advances in the area of gastro-biological psychiatry, it becomes clear that there remains an urgent need to explore the value of beneficial microbes in controlled clinical investigations. With the history explored in this series, it is fair to ask if we are now on the cusp of major clinical breakthroughs, or are we merely in the quicksand of Autointoxication II?
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Affiliation(s)
- Alison C Bested
- Complex Chronic Diseases Program, BC Women’s Hospital and Health Centre, B223A-4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Alan C Logan
- CAMNR, 775 Blithedale Avenue Suite 364, Mill Valley, CA 94941, USA
| | - Eva M Selhub
- Harvard Medical School and Massachusetts General Hospital, 40 Crescent St., Suite 201, Waltham, MA, 02453, USA
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Berger MY, Tabbers MM, Kurver MJ, Boluyt N, Benninga MA. Value of abdominal radiography, colonic transit time, and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children: a systematic review. J Pediatr 2012; 161:44-50.e1-2. [PMID: 22341242 DOI: 10.1016/j.jpeds.2011.12.045] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 11/21/2011] [Accepted: 12/28/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To perform a systematic review evaluating the value of abdominal radiography, colonic transit time (CTT), and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children. STUDY DESIGN Eligible studies were those assessing diagnostic accuracy of abdominal radiography, CTT, or rectal ultrasound scanning in children suspected for idiopathic constipation. Methodological quality of the included studies was assessed with the Quality Assessment of studies of Diagnostic Accuracy included in Systematic reviews checklist. RESULTS One systematic review summarized 6 studies on abdominal radiography until 2004. The additional 9 studies evaluated abdominal radiography (n = 2), CTT (n = 3), and ultrasound scanning (n = 4). All studies except two used a case-control study design, which will lead to overestimation of test accuracy. Furthermore, none of the studies interpreted the results of the abdominal radiography, ultrasound scanning, or CTT without knowledge of the clinical diagnosis of constipation. The sensitivity of abdominal radiography, as studied in 6 studies, ranged from 80% (95% CI, 65-90) to 60% (95% CI, 46-72), and its specificity ranged from 99% (95% CI, 95-100) to 43% (95% CI, 18-71). Only one study presented test characteristics of CTT, and two studies presented test characteristics of ultrasonography. CONCLUSION We found insufficient evidence for a diagnostic association between clinical symptoms of constipation and fecal loading on abdominal radiographs, CTT, and rectal diameter on ultrasound scanning in children.
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Affiliation(s)
- Marjolein Y Berger
- Department of General Practice, University of Groningen, University Medical Center, Groningen, The Netherlands.
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The prevalence and therapeutic effect of constipation in pediatric overactive bladder. Int Neurourol J 2011; 15:206-10. [PMID: 22259734 PMCID: PMC3256305 DOI: 10.5213/inj.2011.15.4.206] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 12/07/2011] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Overactive bladder (OAB) is a manifestation of urgency, regardless of urge incontinence, due to involuntary bladder contraction during the storage period. There is a close association between constipation and OAB, but constipation cannot be readily diagnosed. The aims of this study were to evaluate the prevalence of constipation in OAB and the consequent therapeutic effects according to the diagnostic criteria for constipation. METHODS We collected clinical data from 40 children (mean age, 71±22 months) with chief complaints of urgency, frequency, and incontinence. A voiding questionnaire and a 2-day voiding diary were collected, and urinalysis, the Bristol stool scale, and plain abdominal radiography were performed. Constipation was defined as conditions satisfying at least one of the following criteria: Rome III diagnostic criteria, Bristol stool scale types I/II, or a Leech score higher than 8 points as determined by plain radiography. Lower urinary tract symptoms, defecation symptoms, and the bladder volume of patients were examined, and the therapeutic outcomes by constipation diagnostic criteria were evaluated. RESULTS Of the 40 OAB patients, 25 had constipation. Among them, 6 had reduced functional bladder capacity (24%; P>0.05). Regarding treatment, in patients who satisfied only one diagnostic criterion, the symptoms improved in 76.9%, 76.9%, and 69.6% of patients meeting the Rome III criteria, Bristol stool scale, and Leech score, respectively (P<0.05). Among the 8 patients satisfying all three criteria, 75% responded to treatment (P<0.05). CONCLUSIONS The prevalence of constipation in OAB is high. Constipated patients recruited by use of the Rome III criteria, Bristol scale, and Leech score alone and together showed similar outcomes on OAB improvement after the treatment of constipation, which implies that each criterion has the same strength and can be applied comprehensively and generally.
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Chang JW, Yang LY, Chin TW, Tsai HL. Clinical characteristics, nocturnal antidiuretic hormone levels, and responsiveness to DDAVP of school children with primary nocturnal enuresis. World J Urol 2011; 30:567-71. [DOI: 10.1007/s00345-011-0753-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 08/16/2011] [Indexed: 11/29/2022] Open
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Effect of Rectal Distention on Lower Urinary Tract Function in Children. J Urol 2010; 184:1680-5. [DOI: 10.1016/j.juro.2010.03.120] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Indexed: 01/07/2023]
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Sureshkumar P, Jones M, Caldwell PHY, Craig JC. Risk factors for nocturnal enuresis in school-age children. J Urol 2009; 182:2893-9. [PMID: 19846154 DOI: 10.1016/j.juro.2009.08.060] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Indexed: 02/07/2023]
Abstract
PURPOSE Although nocturnal enuresis is common in children, its etiology is multifactorial and not fully understood. We evaluated potential risk factors for presence and severity of nocturnal enuresis. MATERIALS AND METHODS A validated, reproducible questionnaire was distributed to 8,230 school children in Sydney, Australia. Nocturnal enuresis was defined as any wetting in the previous month and categorized as mild (1 to 6 nights), moderate (7 or more nights but less than nightly) or severe (nightly). RESULTS Parents of 2,856 children (mean +/- SD age 7.3 +/- 1.3 years) completed the questionnaire (response rate 35%). Overall prevalence of nocturnal enuresis was 18.2%, with 12.3% of patients having mild, 2.5% moderate and 3.6% severe enuresis. Multivariate analysis showed that daytime incontinence (OR 4.8, 95% CI 2.9 to 7.9), encopresis (OR 2.7, 95% CI 1.6 to 4.4), bladder dysfunction (OR 3.6, 95% CI 2.4 to 5.3) and male gender (OR 2.0, 95% CI 1.3 to 3.1) were associated with severe nocturnal enuresis after adjustment for age. Emotional stressors (OR 2.3, 95% CI 1.2 to 4.2) and social concerns (OR 2.4, 95% CI 1.2 to 4.5) were associated with moderate nocturnal enuresis only. CONCLUSIONS Encopresis and daytime incontinence are significant modifiable risk factors for nocturnal enuresis. Expressed as population attributable risk, 23% of nocturnal enuresis is associated with encopresis and daytime incontinence. Psychosocial factors appear to contribute to moderate but not severe nocturnal enuresis.
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Quantifying demographic, urological and behavioral characteristics of children with lower urinary tract symptoms. J Pediatr Urol 2008; 4:127-33. [PMID: 18631908 DOI: 10.1016/j.jpurol.2007.10.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 10/22/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This project examines the voiding and behavioral characteristics of children referred to a specialty voiding clinic, including the impact of incontinence on the child and family. PATIENTS AND METHODS A total of 351 new patients (aged 5-17 years) referred to our specialty voiding clinic completed background information, including demographics and medical history, a standardized voiding questionnaire, school history, and questions about child and family quality of life, prior to their first appointment. RESULTS Patients are primarily female (53%) and Caucasian (70%) with a mean age of 9.5 years (range 5-17; SD=3.5). Of the patients, 25% were diagnosed with a mental or behavioral health problem. Mean urological symptom score was 12 (range 0-29). Higher symptom scores are associated with younger age, ethnic minority status, a mental health diagnosis, being on psychotropic medications, and a poor child and family quality of life. Families of children who are wet day and night reported a poorer quality of life as compared to the families of children who were daytime wetters or bedwetters only. CONCLUSION Symptom scores are associated with type of incontinence, social and quality of life variables. Collecting this baseline data will enable ongoing monitoring of progress for these complex patients.
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McGrath KH, Caldwell PHY, Jones MP. The frequency of constipation in children with nocturnal enuresis: a comparison with parental reporting. J Paediatr Child Health 2008; 44:19-27. [PMID: 17854414 DOI: 10.1111/j.1440-1754.2007.01207.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS To identify the prevalence of constipation in children with nocturnal enuresis presenting to a tertiary paediatric outpatient service and to assess parental and clinician recognition of constipation. METHODS A prospective cross-sectional study of children with nocturnal enuresis at presentation to a continence service. Data relating to the child's bowel habits, pattern of enuresis and other history items were obtained from parental questionnaires and paediatrician assessments. Presence and severity of constipation was assessed independently by parents and clinicians. Kappa was used to compare agreement between parental reporting and clinician assessment of constipation. RESULTS Of the 277 participants aged 4.8-17.5 years (median 8.6 years), 36.1% (n = 95) were identified as constipated by the clinician-based scoring method ('Constipation Score') compared with 14.1% from parental reporting (Kappa = 0.155, P = 0.003). Despite the poor overall recognition of constipation by parents, parental and clinician assessment of frequency of bowel motions (Kappa = 0.804) and soiling (Kappa = 0.384) were similar. Major factors influencing parental reporting of constipation were frequency of bowel motions and soiling with less emphasis on straining and stool consistency. CONCLUSIONS Prevalence of constipation was high among children with nocturnal enuresis as assessed by clinicians despite poor identification by parents. This may limit optimal diagnosis and management.
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Affiliation(s)
- Kathleen H McGrath
- Graduate Medical Program, University of Sydney, The Children's Hospital at Westmead Clinical School, Westmead, New South Wales, Australia
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Allen HA, Austin JC, Boyt MA, Hawtrey CE, Cooper CS. Evaluation of Constipation by Abdominal Radiographs Correlated with Treatment Outcome in Children with Dysfunctional Elimination. Urology 2007; 69:966-9. [PMID: 17482944 DOI: 10.1016/j.urology.2007.01.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Revised: 11/06/2006] [Accepted: 01/21/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To analyze the utility of assessing degree of constipation by abdominal radiograph (KUB) in relation to symptoms and urodynamic data in children with dysfunctional elimination. METHODS A retrospective review of children with concomitant constipation and daytime incontinence was performed. Inclusion required at least two consecutive visits with KUB and noninvasive uroflowmetry. Patients were excluded for anticholinergic medication use or neurogenic or anatomic abnormalities. Rectal fecal quantification and presence of stool throughout the colon was assessed on KUB and categorized as "empty," "normal amount of stool," or "fecal distention of rectum (FDR)." RESULTS Twenty-six patients met inclusion requirements (6 boys, 20 girls; average age, 7.7 +/- 2.2 years). The average time between the initial and subsequent visit was 12.5 +/- 7.8 weeks. Initial KUB revealed FDR in 17. No statistical significance was found between FDR on initial or final KUB and outcome of wetting symptoms, nor could a relationship between FDR uroflow parameters at either visit be demonstrated. CONCLUSIONS No correlation between any uroflowmetry parameter and the presence of FDR at the initial or final visits could be demonstrated. Similarly, no statistical significance between FDR on final or initial KUB and outcome of wetting symptoms was established.
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Affiliation(s)
- Heidi A Allen
- Division of Pediatric Urology, Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242-1089, USA
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Dunlop A. Meeting the needs of parents and pediatric patients: results of a survey on primary nocturnal enuresis. Clin Pediatr (Phila) 2005; 44:297-303. [PMID: 15864361 DOI: 10.1177/000992280504400403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary nocturnal enuresis (PNE) affects about 7 million children and adolescents in the United States. A telephone survey of 745 parents/guardians of children aged 3 to 14 years was conducted to determine their knowledge and attitudes about PNE. Most did not know that PNE is a physical problem. Although 82% would want healthcare providers to discuss PNE with them if their child older than 6 years wet the bed, most would be uncomfortable initiating the dialogue. According to parents, healthcare providers either never or rarely discuss PNE. For the benefit of their young patients, healthcare providers must initiate discussion about PNE.
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Affiliation(s)
- Amy Dunlop
- Buranakul Pediatrics-Provena United Samaritans Medical Center, Danville, IL 61832, USA
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Abstract
The involuntary passing of urine at age six and older is called enuresis. Wetting during the day is called diurnal enuresis and wetting at night while asleep is called nocturnal enuresis. Nocturnal enuresis is second only to allergy as the commonest chronic disorder in childhood. Many children (adolescents are included in the term 'children') who are nocturnal enuretics exhibit behaviours such as low self-esteem, withdrawal, less ambition and increased anxiety. These children are often low achievers within the school system and become a problem for their family and school. In this article the author discusses a child/adolescent-centred primary nocturnal enuresis program and service that is administered by a group of public health nurses in South Auckland, New Zealand.
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Affiliation(s)
- Linda S Nield
- Department of Pediatrics, West Virginia University, Morgantown, WV, USA
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Abstract
Sleep problems are common in many pediatric medical disorders and complicate management and patient outcomes. A wide range of conditions, including asthma, cystic fibrosis, sickle cell disease, gastroesophageal reflux, neuromuscular diseases, scoliosis, craniofacial abnormalities, obesity, and chromosomal disorders, have various sleep disturbances, including sleep-disordered breathing, ventilatory dysfunction, sleep-onset and sleep maintenance problems, and circadian rhythm disturbances. Given the adverse neurocognitive and physiologic outcomes associated with a deranged night's sleep, it is important for pediatricians to be able to anticipate, recognize, and appropriately manage these problems. This article reviews the known sleep-related problems of a few relatively common pediatric disorders.
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Affiliation(s)
- Hari Bandla
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
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