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Smooth muscle dysfunction in Duchenne muscular dystrophy (DMD) has been rarely studied. A cross-sectional study was conducted to estimate the prevalence of smooth muscle dysfunction (vascular, upper gastrointestinal, and bladder smooth muscle) in children with DMD using questionnaires (Pediatric Bleeding Questionnaire, Pediatric Gastroesophageal Symptom Questionnaire, and Dysfunctional Voiding Symptom Score). Investigations included bleeding time estimation, nuclear scintigraphy for gastroesophageal reflux, and uroflowmetry for urodynamic abnormalities. Ninety-nine subjects were included in the study. The prevalence of vascular, upper gastrointestinal, and bladder smooth muscle dysfunction was 27.2%. Mean bleeding time was prolonged by 117.5 seconds. The prevalence of gastroesophageal reflux was 21%. Voided volume/estimated bladder capacity over 15% and abnormal flow curves on uroflowmetry were seen in 18.2% and 9.7% of the subjects, respectively. Our study highlights the need for addressing issues related to smooth muscle dysfunction in the routine clinical care of patients with DMD., (© 2020 Wiley Periodicals LLC.)

Introduction: Evidence indicates an increase in the prevalence of enuresis in individuals with sickle cell disease. The present study aims to evaluate the prevalence and impact of enuresis on quality of life in individuals with sickle cell disease., Materials and Methods: This cross-sectional study evaluated individuals with sickle cell disease followed at a reference clinic, using a questionnaire designed to evaluate the age of complete toilet training, the presence of enuresis and lower urinary tract, and the impact on quality of life of these individuals., Results: Fifty children presenting SCD (52% females, mean age ten years) were included in the study. Of those, 34% (17/50) presented as HbSC, 56% with HbSS (28/50), 2% Sα-thalassemia (1/5) and 8% the type of SCD was not determined. The prevalence of enuresis was 42% (21/50), affecting 75% of subjects at fi ve years and about 15% of adolescents at 15 years of age. Enuresis was classifi ed as monosymptomatic in 33.3% (7/21) and nonmonosymptomatic in 66.6% (14/21) of the cases, being primary in all subjects. Nocturia was identifi ed in 24% (12/50), urgency in 20% (10/50) and daytime incontinence 10% (5/50) of the individuals. Enuresis had a signifi cant impact on the quality of life of 67% of the individuals., Conclusion: Enuresis was highly prevalent among children with SCD, and continues to be prevalent throughout early adulthood, being more common in males. Primary nonmonosymptomatic enuresis was the most common type, and 2/3 of the study population had a low quality of life., Competing Interests: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Introduction: Enuretic children wet their beds either because of nocturnal polyuria or nocturnal detrusor overactivity. Polyuric children often respond to desmopressin, whereas children with nocturnal detrusor overactivity are often therapy resistant and may have low daytime voided volumes. It is logical to assume that the enuretic event in children with nocturnal polyuria occurs with a full bladder, i.e. with the enuretic voided volume (EVV) close to the child's expected bladder capacity (EBC) for his/her age. However, the EVV has only rarely been studied, and little is known about how it relates to case history, polyuria, or daytime bladder function. The aim of this study was to look at EVV and relate it to voiding chart data and treatment response., Methods: Anamnestic data and voiding charts, including measurement of nocturnal urine production and EVV, in enuretic children with or without concomitant daytime incontinence attending a tertiary center were retrospectively reviewed. The EVV was analyzed and compared to anamnestic data, voiding chart data, and response to therapy in accordance with the guidelines of the International Children's Continence Society., Results: Data were available for 220 children (age 5-24, median 9), 40 of whom were girls. The prevalence of previous or present daytime incontinence was 42.4%, and 50.5% sometimes experienced urgency. The average EVV was 54.9 ± 32.8% of EBC. EVV correlated highly significantly to nocturnal urine production (p < 0.001). Still, EVV ≥ EBC was observed in only 16 children. EVV was slightly larger in girls (p = 0.013) and in children with urgency (p = 0.034), but there were no significant EVV differences between children responding or not responding to antidiuretic, anticholinergic, or antidepressant therapy. Relevant data are summarized in the Table below., Discussion: Case history and daytime voiding chart data give very little information about nocturnal bladder function. The EVV is strongly influenced by nocturnal urine production but only rarely reaches up to a level close to or exceeding the EBC. The enuretic event only very rarely represents the emptying of a full bladder. Thus, a component of nocturnal detrusor overactivity can be assumed to be present in almost all enuretic children, even in children with nocturnal polyuria. The value of the EVV is limited in predicting response to therapy., (Copyright © 2018 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Objectives: Detrusor overactivity and constipation often co-exist in children with enuresis. Constipation is known to be linked to detrusor overactivity. The voiding chart is the best non-invasive way to investigate bladder function, whereas the ultrasonographical detection of rectal dilatation is the best way to objectify constipation. We wanted to investigate a possible relationship between the rectal diameter and voiding chart data in enuretic children., Methods: Children with therapy-resistant enuresis were retrospectively evaluated. All had completed a voiding chart for at least 48 h. The rectal diameter was assessed ultrasonographically. The cutoff for rectal dilatation was set at 30 mm., Results: We evaluated 74 patients (12 girls) aged 10.2 ± 2.8 years, 35 of whom had rectal dilatation. No significant differences in voiding chart parameters were found between children with normal versus dilated rectum. Neither did urgency or a history of daytime incontinence differ between the groups. Boys were more likely to have rectal dilatation than girls (p = 0.02)., Conclusions: The absence of differences regarding voiding chart data may be explained as two mechanisms neutralizing each other: behavioral factors may make the constipated children void seldom and with large volumes, whereas detrusor overactivity caused by rectal compression of the bladder may have the opposite effect. Another option may be that the voiding chart is too blunt an instrument to detect detrusor overactivity. Constipation, and thus presumably bladder dysfunction, seems to be more important in enuretic boys than girls.

Background: Most urotherapy interventions are planned for children with daytime incontinence or symptoms, and are based on individual education. This study conducted a voiding school (VS) program with groups of 4-6 children with daytime incontinence or enuresis with or without daytime symptoms., Objective: The aim of this quasi-experimental study with a one-group pretest-posttest design was to assess the effectiveness of the VS intervention for treating children's daytime incontinence or enuresis., Materials and Methods: Sixty-nine 6-12-year-old children with incontinence classified as treatment resistant participated in the VS at an outpatient clinic. Based on a power analysis, a sample of 52 participants was required. The VS involved two whole-day group visits 2 months apart. The educational content of the intervention was based on the International Children's Continence Society's standards for urotherapy, and was delivered with child-oriented teaching methods, including group discussions with peers. The primary outcome measure was the number of dry days and nights. The amount of wetting was also estimated, and the frequency of voiding measured. Data were collected with 1-week voiding diaries before and after each visit. Changes in dependent variables between four measurement points was measured by using repeated measures variance analysis. The long-term effectiveness was evaluated from patient records concerning 3-month follow-up phone calls or other contacts 8-18 months after the VS., Results: Fifty-eight children, 34 girls and 24 boys, completed the study. Twelve children had daytime incontinence, 18 had enuresis, and 28 had both. The number of dry days increased from a mean of 3.5-5.3 (P < 0.001), and the number of dry nights increased from a mean of 2.4-3.9 (P < 0.001) (Summary table). Thirteen (22%) children became completely dry. Three of them had daytime incontinence, five enuresis, and five both. Twenty-four out of 40 (60%) children with daytime incontinence, and 23 out of 46 (50%) children with enuresis showed ≥50% decrease in wetting episodes. The amount of wetting reduced, but the voiding frequency remained unchanged based on the voiding diaries. Twenty-two (45%) of the children were completely dry (six had daytime incontinence, nine enuresis, and seven both), and 16 (39%) showed further improvement, but eight (16%) children remained unchanged 8-18 months after the VS., Conclusions: Voiding school (VS) was an effective intervention for treating both daytime incontinence and nocturnal enuresis in children who had not benefited from standard treatment and were classified as treatment resistant., (Copyright © 2018 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Purpose: We identify risk factors for daytime or combined urinary incontinence in children with cerebral palsy., Materials and Methods: A cross-sectional case-control study was conducted including children with cerebral palsy with or without daytime or combined urinary incontinence from the CP-Reference Center at Ghent University Hospital and 2 associated special education schools. Factors were subdivided in 3 clusters of demographic and general medical data, cerebral palsy classification, and bladder and bowel dysfunction. Data were obtained using uroflowmetry with electromyography testing, a nonvalidated questionnaire and bladder diaries. Univariate and multivariate analyses were performed for variables and clusters, respectively. A final associative logistic model including all clusters was developed., Results: The study included 34 incontinent children and 45 continent children. Daytime or combined urinary incontinence was associated with intellectual disability (OR 7.69), swallowing problems (OR 15.11), use of external aids (OR 27.50) and use of laxatives (OR 13.31). Daytime or combined urinary incontinence was positively associated with dyskinesia (OR 5.67) or combined spasticity and dystonia (OR 4.78), bilateral involvement (OR 4.25), Gross Motor Function Classification System level IV (OR 10.63) and V (OR 34.00), and severe impairment in manual (OR 24.27) or communication skills (OR 14.38). Lower maximum voided volume (OR 0.97) and oral fluid intake (OR 0.96) influenced daytime or combined urinary incontinence negatively. Pathological uroflow curves were not significantly associated with incontinence. The final model defined functional impairment, intellectual disability and oral fluid intake as predictive factors for daytime or combined urinary incontinence., Conclusions: Risk analysis revealed functional impairment, intellectual disability and fluid intake as important factors influencing continence in a child with cerebral palsy., (Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Aims: Frequency Volume Charts (FVC) are recommended for the evaluation of enuretic patients. Although this is a good instrument for the assessment of functional bladder capacity, it is known that patient compliance could introduce problems. Therefore, we assessed whether uroflowmetry and post-void residual volume could replace FVC recordings in specific cases, by comparing the bladder capacity as measured by FVC or uroflowmetry., Methods: We performed post-hoc analyses using data from a retrospective cohort study, in secondary/tertiary care. This included 907 patients between 2003 and 2013, aged ≥11 years, suffering from enuresis (≥1 wet night/fortnight). Data were collected from the medical files. Bland Altman plots were made to compare the two methods., Results: Agreement between uroflowmetry and FVC was reasonable only when uroflowmetry was between 200 and 450 ml., Conclusions: For individual clinical purposes, uroflowmetry can be used if values are in this range. For future research, we recommend to keep measuring bladder capacity with an FVC. Neurourol. Urodynam. 36:745-747, 2017. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Background: Mowat-Wilson Syndrome (MWS) is caused by deletion/mutation of the ZEB2 gene on chromosome 2q22. MWS is characterized by a distinctive facial appearance, severe intellectual disability and other anomalies, e.g. seizures and/or Hirschsprung disease (HSCR). Most individuals have a sociable demeanor, but one third show psychological problems., Aims: The aim was to investigate incontinence and psychological problems in MWS., Methods and Procedures: 26 children (4-12 years), 13 teens (13-17 years) and 8 adults (>18years) were recruited through a MWS support group. The Parental Questionnaire: Enuresis/Urinary Incontinence, as well as the Developmental Behaviour Checklist (DBC) were completed by parents or care-givers., Outcomes and Results: 97.7% of persons with MWS had incontinence (nocturnal enuresis 74.4%; daytime urinary incontinence 76.2%; fecal incontinence 81.4%). Incontinence remained high over age groups (children 95.8%, teens 100%, adults 100%). 46.2% of children, 25% of teens and 37.5% of adults exceeded the clinical cut-off on the DBC. The ability to use the toilet for micturition improved with age., Conclusions and Implications: MWS incontinence rates are very high. All had physical disabilities including anomalies of the genitourinary and gastrointestinal tract. Due to the high prevalence rates, a screening for incontinence and psychological problems in MWS is recommended., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Enuresis was historically viewed as a primarily psychiatric disorder, but this understanding has changed dramatically since the end of the last century, when it became clear that somatic factors, such as nocturnal polyuria as a result of vasopressin deficiency, nocturnal detrusor overactivity and high arousal thresholds, all play a crucial role in enuresis pathogenesis. It has also become clear that enuresis is inherited in the majority of cases, although the correlation between genotype and enuretic phenotype is not straightforward. The standard view of enuresis as being the result of either (i) nocturnal polyuria and high arousal thresholds; or (ii) nocturnal detrusor overactivity and high arousal thresholds has become well-established, but further research now complicates the picture. First, psychological/psychiatric problems are overrepresented in enuresis, and might in a minority of cases have a causal or aggravating role. Second, nocturnal polyuria is not always linked to vasopressin deficiency. Third, nocturnal detrusor overactivity is in itself pathogenetically heterogeneous, and could be linked to constipation. Fourth, the sleep of enuretic children might be "deep," but possibly also disturbed (by obstructed airways or a distended or contracting bladder). These children might have high arousal thresholds because of the enuresis instead of the other way around. The same might possibly be said about nocturnal polyuria. Taking these new insights into account, a new model of enuresis pathogenesis is presented, which is more complicated but hopefully also more true than the standard consensus., (© 2017 The Japanese Urological Association.)

Introduction: Although the relationship between enuresis and breastfeeding is still poorly documented in the literature, a possible association is speculated as both are strongly associated with children's development. Therefore, the main objective of this study was to evaluate whether there is an association between primary enuresis and the duration of exclusive breastfeeding., Material and Methods: This is an observational, case-control study, involving 200 children and adolescents from 6 to 14 years old, who were divided into two groups: the enuresis group (EG), composed of 100 children with primary enuresis; and the control group (CG) of 100 matched children without enuresis. The matching criteria were sex, age, and socioeconomic level. Adults responsible for each infant answered a structured questionnaire to identify biological and behavioral factor, as well as the duration of maternal breastfeeding. Children whose parents could not comprehend the questionnaire or children with neurological or psychiatric disorders or secondary enuresis were not included in the study., Results and Discussion: Evaluating the duration of exclusive breastfeeding, 72% of the subjects of the EG and 42% of the CG had been breastfed for less than 4 months (p < 0.001) (Figure). In bivariate analysis, there was a strong association between symptoms of enuresis with a positive family history of enuresis and duration of exclusive breastfeeding (p < 0.001), and also association with full breastfeeding duration (p = 0.044), number of children (p = 0.045), and parents' education (p = 0.045). After logistic regression, primary enuresis continued to be associated with duration of exclusive breastfeeding and family history of enuresis. The proportion of children that had been exclusively breastfed for more than 4 months was significantly higher in the CG 58% (58/100) than in the EG 28% (28/100) (p < 0.001, OR 4.35, 95% CI 1.99-9.50)., Conclusions: This study confirmed the association between primary enuresis and various factors that have already been studied, with the addition of a new factor, duration of exclusive breastfeeding for less than 4 months, which is strongly associated with primary enuresis., (Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Objective: The main objective was to compare children with frequent enuresis (FE) and children with infrequent enuresis (IE) using anamnestic data and variables related to bladder and kidney function. A secondary aim was to look at the group of children who wet their beds every single night, a phenomenon we chose to call constant enuresis (CE)., Subjects and Methods: The parents recorded the number of wet and dry nights for a period of 14 days, and measured the voided volumes as well as nocturnal urine production for 48 h. History data relevant to bladder and bowel function was also recorded., Results: The children could be grouped as follows: IE, n = 14; FE, n = 18; and CE, n = 22. The children with IE were slightly older than the other groups, IE mean 7.57; FE mean 6.22; CE, mean 6.56 (p = 0.004). When comparing the groups in terms of the measured parameters, only one significant difference was found: the FE group had larger average daytime voided volumes, but only when the first morning void was included. The only significantly differing anamnestic variable was previous daytime incontinence, which was more common among the children in the IE group., Conclusions: When comparing children with varying enuresis severity, no major differences regarding bladder function and urine production were found. Furthermore, children with infrequent enuresis tend to be slightly older when they seek medical help., (Copyright © 2014. Published by Elsevier Ltd.)

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.

Objective: To assess factors associated with detrusor overactivity in urinary incontinence patients with Alzheimer's disease, and to determine the correlation between the degree of Alzheimer's disease and the presence of detrusor overactivity., Methods: A total of 144 Alzheimer's disease patients (48 men, 96 women; aged 56-97 years) with urinary incontinence were enrolled in this protocol. Cognitive testing was carried out using the Mini-Mental State Examination, the Clinical Dementia Rating scale, the Global Deterioration Scale and Barthel's Activities of Daily Living. Urinary incontinence was assessed using a frequency-volume chart and the Incontinence Questionnaire on Urinary Incontinence Short Form. All study participants had a urodynamic study carried out., Results: Based on the Incontinence Questionnaire on Urinary Incontinence Short Form, the most common type of urinary incontinence was urge urinary incontinence followed by enuresis in men, whereas women most commonly complained of urge urinary incontinence followed by stress urinary incontinence. Detrusor overactivity was found in 57.6% of patients (25 men, 58 women) on urodynamic study. No statistical differences were found between those with and without detrusor overactivity in terms of age, sex or duration of education. No significant correlation was found between changes in Incontinence Questionnaire on Urinary Incontinence Short Form scores and those in the Mini-Mental State Examination, Clinical Dementia Rating and Barthel's Activities of Daily Living status. Multiple logistic regression analysis showed the presence of detrusor overactivity could be predicted using Clinical Dementia Rating and Barthel's Activities of Daily Living scores (P < 0.05)., Conclusions: The most common type of urinary incontinence in patients with Alzheimer's disease is urge urinary incontinence. Clinical Dementia Rating and Barthel's Activities of Daily Living predict the severity of detrusor overactivity in this patient population., (© 2014 The Japanese Urological Association.)

Objective: After failure of medical and behavioral therapy in enuresis, the usual next step is to investigate using urodynamics. The aim of this study was to determine the actual benefit and optimal method of urodynamics in the treatment of refractory enuresis., Methods: This prospective randomized study included 56 patients: 17 males and 39 females with an age range of 7-16 years. All had tried multiple courses of medical treatment for enuresis for at least 6 months without response. Thirty patients underwent investigation by cystometrogram, uroflowmetry and electromyogram (UFM/EMG), while 26 patients underwent pressure/flow/EMG (P/F/EMG) studies., Results: Bladder filling abnormalities were found in 25 out of the 56 patients (44.6%) and included low bladder capacity in 39%, hypocompliance in 32%, and detrusor overactivity in 45%. With regard to voiding dysfunction, 70% of the UFM/EMG group had detrusor‒sphincter dyssynergia and 67% of the P/F/EMG group had bladder outlet obstruction., Conclusions: Urodynamics can help in cases of refractory enuresis by detecting dysfunctional voiding, which is present in a large percentage of these patients. This can be diagnosed by UFM/EMG, rather than P/F/EMG, as a non-invasive test. UFM alone may be misleading. Alpha adrenergic blockers may be of benefit in treating these patients., (Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Aims and Objectives: To investigate how nurses can use children's ability to predict treatment outcomes as a possible feature contributing to successful therapeutic processes targeting enuresis., Background: Prediction of outcomes was viewed both as a self-efficacy component or belief (based on self-efficacy theory), and also as a skill for actually influencing change., Design: The study was conducted in a mental health community center, located in a large city in central Israel, which was well known for treatment of children with enuresis. For the purpose of the study, the children and their parents completed three questionnaires and underwent training to maintain bedwetting records., Methods: The study compared three groups of children aged 8-14 years who: made predictions only at baseline (n = 32), predicted progress every week during treatment (n = 38), or did not use prediction at all (n = 31)., Results: Findings pinpointed the role of practice in improving predictions. Children who predicted weekly showed the highest congruence with outcomes., Relevance to Clinical Practice: Based on self-efficacy, skills acquisition, and learning and training in the change process, nurses may help children overcome enuresis., (© 2012 Blackwell Publishing Ltd.)

This review aims to provide researchers and clinicians involved with the adult lower urinary tract with background knowledge regarding the early development of bladder function and its most common disturbances in childhood. Bladder development begins in weeks 4-6 and the detrusor muscle is formed during weeks 9-12 of gestation. Higher CNS centres are involved in micturition at birth, and the infant usually wakes up, at least briefly, to void. Voiding during the first years of life is often incomplete, owing to detrusor-sphincter dyscoordination, but this disappears when bladder control is attained. Approximately 5-10% of 7-year-old children suffer from daytime incontinence and/or nocturnal enuresis, and a few per cent of them will not outgrow it. Daytime incontinence in childhood is usually attributable to detrusor overactivity, although it is unclear to what extent it is the detrusor or the micturition reflex per se that is overactive. Enuresis - nocturnal incontinence - is caused by either nocturnal polyuria and/or nocturnal detrusor overactivity, in both cases combined with high arousal thresholds. Bladder problems in childhood constitute a risk factor for the development or persistence of bladder problems in adulthood., (© 2012 The Authors Acta Physiologica © 2012 Scandinavian Physiological Society.)

Evidence is growing that monosymptomatic enuresis (ME) is a maturational disorder of the central nervous system with a lack of arousal and lacking inhibition of the micturition reflex. Previous studies have shown a significant reduction of prepulse inhibition (PPI) of startle in children with enuresis. However, it is still unclear whether the abnormal PPI in enuresis is based on an inhibitory deficit at brainstem or cortical level. Nine children with ME and ten healthy children were investigated using simultaneous recording of EMG from the M. orbicularis oculi and functional MRI. The experimental paradigm consisted of acoustic startle stimulation, with startle-alone stimuli and prepulse-startle combinations. Functional MRI data were processed using multiple regression and parametric modulation with startle amplitudes as a parameter. Neither patients with enuresis nor healthy children revealed measurable PPI in the MRI scanner. Startle stimuli caused equal hemodynamic changes in the acoustic cortex, medial prefrontal and orbitofrontal cortex in both groups. The amplitude of startle correlated with more prominent BOLD signal changes in the anterior cingulate cortex in healthy subjects than in patients with ME. This pronounced frontal activation in healthy controls was related to the PPI condition, indicating that the prefrontal cortex of healthy children was activated more strongly to inhibit startle than in patients with ME. In conclusion, apart from the possibility that recordings of PPI inside the MRI scanner may be compromised by methodological problems, the results of this study suggest that high cortical control mechanisms at the prefrontal level are relevant for the pathogenesis of ME.

Unlabelled: The study of factors potentially associated with sleep bruxism (SB) may contribute to a better understanding of its nature and etiology., Objectives: In this way, this cross-sectional study aimed to evaluate the association between SB and salivary cortisol levels, heart rate, and other parafunctional habits., Design and Methods: Data were collected in 100 healthy caries-free children of both genders, aged 7.23 ± 0.60 years, with (n=27) and without (n=73) signs and symptoms of SB by interview with the parents and clinical and physical examination. Salivary cortisol was measured immediately after waking up and 30min after awakening for the determination of the area under the response curve (AURC). Data were analyzed by descriptive statistics, normality test, and Spearman correlation test; a stepwise logistic regression model was used to verify the association between SB, as the dependent variable, and age, gender, body mass index (BMI), heart rate, presence of sucking habit, nail biting, enuresis, and AURC (α=0.05)., Results: AURC did not correlate with BMI and heart rate. Only AURC showed a significant negative association with SB, while age, gender, BMI, heart rate and other parafunctional habits did not associate with SB., Conclusion: In the studied sample, children with SB were more likely to present low concentrations of awakening salivary cortisol., (Copyright © 2012 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.)

Purpose: This study was aimed to determine the effect of maximum voided volume (MVV) on the efficacy of desmopressin, which is commonly used to treat primary monosymptomatic nocturnal enuresis (PMNE) in children and adolescents., Materials and Methods: Bladder capacity was measured with different methods in 52 patients with PMNE, and the effect of bladder capacity on desmopressin therapy was investigated., Results: Patients with PMNE in whom MVV was 70% or less of estimated bladder capacity were found to be unresponsive to desmopressin therapy., Conclusion: The MVV can be measured before desmopressin therapy in patients with PMNE as a marker to predict treatment success. Our results suggest that desmopressin should not be used in patients with low MVV.

Human micturition is physiologically controlled via a complex and finely tuned network of cortical and subcortical regions, hitherto not fully understood. We report the case of a 42-year-old man with juvenile myoclonic epilepsy (JME) and post-traumatic epilepsy. Ictal enuresis was the only manifestation of the de novo post-traumatic simple autonomic seizures. Source analysis of the ictal epileptiform discharges showed activation of the cortical areas surrounding the right inferior frontal sulcus, adjacent to the lesional zone. The case depicted here further endorses recent neuroimaging studies which strongly implicate this cortical region in the regulation and the initiation of the micturition., (Copyright © 2011 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: The aim of this study was to assess risk factors for excessive autonomic activation during sleep (EAAS) and its association with sleep problems, impaired behavior, and poor academic performance in primary school children., Methods: Data from a community-based study on 997 primary school children were used. Based on nocturnal home pulse oximetry, autonomic activation during sleep was defined as a pulse rate increase by more than 20%. Children with ≥35.9 autonomic activations per hour (i.e., ≥ the 95(th) centile) were classified as suffering from EAAS and compared with controls. Sleep problems, impaired behavior, and academic performance were assessed by parental questionnaires and analysis of school reports., Results: According to the above-mentioned definition, EAAS was diagnosed in 52 children (67% male). Risk factors for EAAS were male gender (odds ratio [95% confidence interval]: 2.06 [1.14-3.72]) and presence of symptoms of sleep-disordered breathing (3.48 [1.29-9.43]). Children with EAAS had a higher prevalence of hyperactive behavior (39.2% vs. 26.0%; p = 0.05) and enuresis (5.8% vs. 0.8%; p = 0.017) but not of poor academic performance. The association with hyperactive behavior was confirmed in a subsample (n = 119) using the Strengths and Difficulties Questionnaire. Mean (SD) score of the hyperactive-inattentive scale was 4.5 (2.8) for EAAS and 3.4 (2.7) for non-EAAS (p = 0.04)., Conclusion: EAAS may be a marker of sleep disruption in children and may predict the occurrence of enuresis and hyperactive behavior.

Aims: We retrospectively investigated the efficacy of methylphenidate (MPH) in giggle incontinence (GI), and the relationship between GI and urodynamic parameters., Methods: Nine (n = 9) female GI patients underwent 1 year of treatment with 5 mg MPH. Three questionnaires, voiding diaries, and UDS were conducted before and after treatment. The severity of GI was classified into mild, moderate, and severe. Clinical success was characterized as: full response, response, partial response, and non-response., Results: The mean age of all patients was 16.2 ± 2.3 years. Five patients had mild, one had moderate, and three had severe grade incontinent. All patients reported complete cessation of wetting after MPH treatment. The mean duration of asymptomatic period was 7 ± 3.2 months. There were no statistically significant score changes in all three questionnaires: Urgency Perception Scale (UPS), Overactive Bladder Symptom Score (OABSS) and Primary Overactive Symptom Questionnaire (POSQ), and voiding diaries (P > 0.05). In UDS, there were no statistically significant altered parameters, except maximum urethral closure pressure (MUCP) and maximum urethral pressure (MUP). After treatment, the mean MUCP was increased from 52.2 ± 6.8 to 73.0 ± 5.4 cmH(2) O (P < 0.05), and the mean MUP was increased from 48.6 ± 7.3 to 70.2 ± 5.0 cmH(2) O (P < 0.05)., Conclusions: MPH can be a viable option for the primary treatment of GI, and it may be related to increasing urethral closure pressure. It was not possible to establish if a relationship between GI and detrusor overactivity exists., (Copyright © 2010 Wiley-Liss, Inc.)

Purpose of Review: The management of children with urinary incontinence and dysfunctional voiding problems can be very difficult at times. The present array of bladder-oriented treatments are marginally successful and for a long time patients were told that they would outgrow their symptoms. In this review, we look at the most recent findings in the urologic and psychiatric literature and try to piece together these two disparate fields and figure out how children who wet are best managed., Recent Findings: It became clear that children with attention deficit disorder were always more difficult to manage than those without neuropsychiatric problems. As the years have progressed and imaging technology has improved, we have begun to look into the active brain. This research has been conducted primarily in the fields of psychiatry and neuroscience, but there have been some seminal studies that point to a link between defects in the brain and functional urinary problems in children. In this review, we will attempt to outline the reasons why the traditional bowel program works and why there are such a large number of patients with neuropsychiatric problems who have functional urinary problems as children., Summary: Utilizing an approach that focuses on a treatment paradigm that is neurocentric instead of vesicocentric allows us to treat children who do not respond to the usual treatments and target the brain with centrally active medications such as tricyclics and serotonin reuptake inhibitors. Understanding that it is a problem in the central nervous system, and that in some cases it is necessary to treat the underlying neuropsychiatric problems to be able to get these children to remain dry is a very important step in the management of children with refractory wetting problems.

Objectives: To avoid the unphysiologic nature of cystometry, we searched a new tool for evaluating bladder perceptions., Methods: The study group consisted of 25 (14 girls and 11 boys) primary monosymptomatic enuretic children with a mean age of 11 (range 8-16). Four children were excluded due to neuromuscular dysfunctions of the bladder, which was demonstrated with the help of cystometry. All children filled a voiding chart 3 times daily to record the duration elapsed till normal desire (ND(daily)) and strong desire (SD(daily)). During cystometry, the amounts of infused medium (cystometric ND(ml) and cystometric SD(ml)) and the duration (cystometric ND(sec) and cystometric SD(sec)), till ND and SD were perceived and recorded., Results: Mean cystometric ND(ml) was 209.9 +/- 107.2 and ND(sec), 318.1 +/- 135.5, whereas mean cystometric SD(ml) was 273.0 +/- 103.1 and SD(sec), 415.7 +/- 136.8. To evaluate the reliability of elapsed time instead of milliliters, as a parameter, cystometric ND/SD values were calculated and a strong correlation was found between the 2 (ND/SD(sec) = 0.77 +/- 0.19 and ND/SD(ml) = 0.77 +/- 0.19, r = 0.9795, P = .000). Although there was a strong correlation between 3 ND(daily) (r = 0.9576, P = .000), between 3 SD(daily) (r = 0.9706, P = .000), and 3 ND/SD(daily) (r = 0.8706, P = .000), no significant correlation was determined between mean ND(daily) and cystometric ND(sec) (r = 0.3410, P = .2032), and also between mean SD(daily) and cystometric SD(sec) (r = 0.2740, P = .2402)., Conclusions: Daily durations of sensations do not correlate with those perceived during cystometry. However, as the results of 3 consecutive daily recordings have a strong correlation, comparison of the reliability of these methods is still needed., (2010 Elsevier Inc. All rights reserved.)

Although sleep disorders such as insomnia and obstructive sleep apnea are common in both children and adults, the clinical features and treatments for these conditions differ considerably between these two populations. Whereas an adult with obstructive sleep apnea typically presents with a history of obesity, snoring, and prominent daytime somnolence, a child with the condition is more likely to present with normal body weight, tonsillar hypertrophy, and inattentiveness during school classes. The adult with suspected sleep apnea almost always undergoes a baseline polysomnogram and proceeds to treatment only if this test confirms the diagnosis, while many children with suspected sleep apnea are treated empirically with adenotonsillectomy without ever receiving a sleep study to verify the diagnosis. This article reviews sleep disorders in children, with a particular focus on age-related changes in sleep, conditions that primarily affect children, and disorders for which clinical manifestations and treatment differ substantially from the adult population.

Purpose: The nature of voiding function and dysfunction associated with cerebral palsy is described in the literature without concurrence of opinion. We correlated urodynamic findings with voiding patterns to better understand and manage voiding dysfunction in children with cerebral palsy., Materials and Methods: Voiding patterns and urodynamic studies in our last 31 patients with cerebral palsy were reviewed. Patients and families were surveyed on the child ability to void spontaneously, clean intermittent catheterization requirement, daytime incontinence and enuresis. Urodynamics consisted of slow fill water cystometry and patch electromyography. Measured parameters were bladder capacity based on age, capacity pressure, compliance, uninhibited contractions, bladder sensation and external sphincter activity. Patients were stratified by voiding status and statistical analysis was performed with p <0.05 considered significant., Results: The 15 boys and 16 girls were 4.5 to 16.6 years old. Three children required clean intermittent catheterization for bladder drainage and 28 (90.3%) voided spontaneously. Diapers were worn by 24 patients (77.4%). There were daytime incontinence and enuresis in 12 patients (38.7%), daytime incontinence only in 11 (35.5%) and enuresis in 1 (3.2%). Seven patients (22.6%) were continent day and night. When correlated with urodynamic parameters, continent children tended to have a larger bladder, lower bladder capacity pressure, higher compliance, fewer uninhibited contractions and similar sphincter activity. The only statistically significant difference was in bladder sensation., Conclusions: There is a spectrum of clinical and urodynamic bladder function in children with cerebral palsy. Of these children 77.4% void spontaneously but are incontinent. Incontinence is more likely present during the day and rarely limited to enuresis. Urodynamically continent children have a similar storage profile and differ from children with daytime or nocturnal incontinence in the ability to sense bladder fullness.

Objective: Imipramine is the only evidence-based treatment available for enuretic children resistant to standard therapy. The drug's antienuretic effect is probably due to noradrenergic facilitation. The drug is, however, potentially cardiotoxic. In this study, the non-cardiotoxic noradrenergic antidepressant reboxetine was tested as an alternative to imipramine., Patients and Methods: 61 patients, aged 7-19 years, with enuresis-resistant to desmopressin, the alarm, urotherapy and anticholinergics, were given 4-8 mg reboxetine at bedtime, if necessary combined with desmopressin., Results: 32 patients became dry on reboxetine treatment, although 21 of them required combination treatment with desmopressin to achieve this. Eighteen children did not respond and eight children discontinued because of side-effects before treatment could be evaluated. No serious adverse events occurred., Conclusions: These results need to be confirmed with randomized controlled studies, but indicate that reboxetine will become a safe and efficient treatment alternative for enuretic children resistant to standard therapy.

Objective: There are no published nationally representative prevalence estimates of enuresis among children in the United States using standardized diagnostic criteria. This study sets out to describe the prevalence, demographic correlates, comorbidities, and service patterns for enuresis in a representative sample of U.S. children., Method: The diagnosis of enuresis was derived from parent-reported data for "enuresis, nocturnal" collected using the computerized version of the Diagnostic Interview Schedule for Children (C-DISC 4.0) from a nationally representative sample of 8- to 11-year-old children (n = 1,136) who participated in the 2001-2004 National Health and Nutrition Examination Surveys., Results: The overall 12-month prevalence of enuresis was 4.45%. The prevalence in boys (6.21%) was significantly greater than that in girls (2.51%). Enuresis was more common at younger ages and among black youth. Attention-deficit/hyperactivity disorder (ADHD) was strongly associated with enuresis (odds ratio 2.88; 95% confidence interval 1.26-6.57). Only 36% of the enuretic children had received health services for enuresis., Conclusions: Enuresis is a common condition among children in the United States. Few families seek treatment for enuresis despite the potential for adverse effects on emotional health. Child health care professionals should routinely screen for enuresis and its effects on the emotional health of the child and the family. Assessment of ADHD should routinely include evaluation for enuresis and vice versa. Research on the explanations for the association between enuresis and ADHD is indicated.

Aim: The aim of the study was to investigate the relationship between the clinical evidence of foot deformities in spina bifida occulta and the associated neurophysio-logical damage., Methods: The authors studied 47 patients with foot deformities (37 flat foot, 10 pes cavus) and vertebral cleft, variably associated with enuresis, midline cutaneous lesions, and further orthopaedic deformities. An electrophysiological evaluation was performed in an attempt to investigate the peripheral nervous system in greater detail, including conventional motor and sensory nerve conduction, F-wave recording and electromyogram (EMG) testing., Results: The peroneal nerve F wave latency was longer in patients with pes cavus than in those with flat foot (P<0.04). Conversely, the posterior tibial nerve F-wave latency was longer in patients with flat foot than in those with pes cavus (P<0.02). Needle EMG showed large amplitude motor unit potentials during voluntary recruitment in all patients, suggesting a neurogenic origin of these EMG changes. Neurophysiological study makes it possible to distinguish between myogenic and lower motor neuron involvement. The existence of some degree of spinal cord dysraphism may be pathophysiologically associated with foot deformities., Conclusion: Children with foot deformities and clinical evidence of occult spinal dysraphism should have a neuro-physiological assessment in order to obtain an early diagnosis and avoid ineffective foot surgery.

Purpose: Classification of pediatric enuresis into monosymptomatic nocturnal enuresis and nonmonosymptomatic nocturnal enuresis is crucial for management because these cases differ in many clinical respects. However, correct classification is frequently confused based on questionnaire and/or bladder diary. We tested the consistency of information obtained on lower urinary tract symptoms between our questionnaire and bladder diary., Materials and Methods: A total of 108 physically and neurologically normal patients (mean age 7.2 years) with enuresis were included in the study. All patients filled out the questionnaire and 3-day bladder diary completely. Our questionnaire included items on urinary frequency, daytime incontinence and voiding postponement. A total of 93 patients underwent uroflowmetry and residual urine measurements. We analyzed information on lower urinary tract symptoms from the questionnaire and the bladder diary, as well as the uroflowmetry results., Results: The percentage of children with nonmonosymptomatic nocturnal enuresis was 89.8% and 68.5% based on the questionnaire and bladder diary, respectively. In comparisons between the questionnaire and bladder diary we did not observe any significant consistency regarding urinary frequency (p = 0.912), daytime incontinence (p = 0.356) or voiding postponement (p = 0.505). Maximum voided volume, average voided volume and percent maximum voided volume/expected bladder capacity of children with monosymptomatic nocturnal enuresis were significantly higher than in those with nonmonosymptomatic nocturnal enuresis based on the bladder diary (p = 0.006, 0.001 and 0.041, respectively). By contrast, no significant difference was found between children with monosymptomatic and nonmonosymptomatic nocturnal enuresis based on the questionnaire (p = 0.559, 0.597 and 0.947, respectively)., Conclusions: Significant discrepancies in lower urinary tract symptoms were observed between the questionnaire and bladder diary. Therefore, a detailed history and discussion with the patient and family should be performed to correlate with the questionnaire and bladder diary for the proper treatment of children with enuresis. An updated questionnaire containing a detailed scoring system may be needed.

There is comparatively little information about premorbid maturational brain abnormalities in schizophrenia (SCZ). We investigated whether a history of childhood enuresis, a well-established marker of neurodevelopmental delay, is associated with SCZ and with measures of brain abnormalities also associated with SCZ. A Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) based history of enuresis, volumetric brain MRI scans and neuropsychological testing were obtained in patients with SCZ, their non-psychotic siblings (SIB) and non-psychiatric controls (NC). The subjects were 211 patients (79.6% male), 234 of their SIB (43.2% male) and 355 controls (39.2% male). Frequency of enuresis was compared across groups and correlated with cognitive measures. Total and regional brain volumes were determined using voxel-based morphometry on matched subsets of probands (n = 82) with or without enuresis (n = 16, n = 66, respectively) and controls (n = 102) with or without enuresis (n = 11, n = 91, respectively). Patients with SCZ had higher rates of childhood enuresis (21%) compared with SIB (11%; chi(2) = 6.42, P = 0.01) or controls (7%; chi(2) = 23.65, P < 0.0001) and relative risk for enuresis was increased in SIB (lambda(S) = 2.62). Patients with enuresis performed worse on two frontal lobe cognitive tests [Letter Fluency (t = 1.97, P = 0.05, df = 200) and Category Fluency (t = 2.15, P = 0.03, df = 200)] as compared with non-enuretic patients. Voxel-based morphometry analysis revealed grey matter volume reductions in several frontal regions (right BA 9, right BA 10 and bilateral BA 45) and right superior parietal cortex (BA 7) in patients with a history of enuresis as compared with non-enuretic patients (all t > 3.57, all P < 0.001). The high frequency of childhood enuresis associated with SCZ and abnormalities in prefrontal function and structure in patients with a childhood history of enuresis suggest that childhood enuresis may be a premorbid marker for neurodevelopmental abnormalities related to SCZ. These findings add to the evidence implicating prefrontal dysmaturation in this disorder, potentially related to genetic risk factors.

This study was carried out to determine the association of recurrent urinary tract infections with functional voiding disorders. Sixty eight children with suspected functional voiding disorders were prospectively evaluated clinically and by non-invasive urodynamics. Invasive urodynamics were carried out when indicated. Group I comprised 34 children with symptoms suggestive of functional voiding disorders and recurrent urinary tract infections (mean age 6.3+/-2 yr) and Group II comprised 34 children with symptoms suggestive of functional voiding disorders without recurrent urinary tract infections (mean age 6.7+/-2 yr). The underlying bladder abnormalities in Groups I and II were detrusor instability in 22 (64.7%) and 30 (88.2%), respectively (P>0.05) and dysynergic voiding in 10 (29.4%), and 1 (2.9%), respectively (P<0.05). Children with recurrent urinary tract infections are more likely to have a dysynergic voiding pattern than children presenting with other symptoms of functional voiding disorders.

In this prospective study, selected biochemical markers of glomerular and tubular function, proteinuria, and ultrasound findings in 62 pediatric patients who underwent surgery for obstructive uropathy were examined. Patients were younger than 12 months, normocreatininemic at the time of surgery, and examined at a mean age of 6.3+/-0.9 years. Out of the markers tested, serum concentration of cystatin C was significantly higher in patients when compared with the control group (p<0.001), and serum creatinine concentration was within reference interval in all patients. With respect to tubular function, 26% of patients had decreased concentration ability. Proteinuria was detected in 4.8% of patients. On ultrasound, 66.7% of kidneys after surgery had residual dilatation of the renal pelvis. The patients thrive well, and their somatic parameters do not differ from their peers. Half of the patients had one or more urinary tract infections from the date of surgery to the date of examination. Study results support the need for long-term nephrologic follow-up in patients after surgery for obstructive uropathy. The hypothesis that renal function in patients undergoing surgery aged younger than 3 or 6 months is better when compared with those aged 6 to 12 months has not been confirmed.

Objectives: Spinning top urethra (STU) deformity arises secondary to detrusor instability, leading to an increase in the intravesical pressure against a closed sphincter. We retrospectively analyzed the effect of biofeedback treatment on STU in children with dysfunctional voiding., Methods: A total of 121 patients with STU and voiding dysfunction were enrolled in this study. The patients divided into two groups. Group 1 (n = 49) were treated with simple bladder retraining with timed voiding, and group 2 (n = 72) were treated with biofeedback therapy. Voiding cystourethrography was performed 6 and 12 month later to determine the status of the STU after both therapies., Results: The patient age range was 5 to 13 years (mean 8.1 +/- 1.9) in group 1 and 5 to 13 years (mean 8.2 +/- 1.7) in group 2. Group 1 consisted of 41 girls and 8 boys; group 2 consisted of 63 girls and 9 boys. Voiding cystourethrography revealed vesicoureteral reflux in 39 and 59 children in groups 1 and 2, respectively. The improvement rates of the biofeedback therapy in children with STU and vesicoureteral reflux were significantly greater than the children treated with timed voiding at 6 months and 1-year of follow-up., Conclusions: For children admitted to urology clinics with urinary infection or complaints thought to be an unstable urinary bladder, proximal urethral dilation called STU is detected at a high frequency. It should be remembered that this situation can be related to vesicoureteral reflux and urinary bladder instability. Biofeedback training is a simple, effective, and well-tolerated treatment modality for these children.

To test the hypothesis that the presence of nocturnal enuresis is related to increased frequency of immature vesicoureteric function, which is further associated with detrusor overactivity, we compared the incidence of immature monophasic ureteric jet in children with and without nocturnal enuresis. The relationship between monophasic ureteric jet Doppler wave form and bladder wall thickness was further explored in the enuresis group. Ultrasound examinations were performed in 511 children suffering from nocturnal enuresis and 266 normal controls. Doppler wave forms of the ureteric jet on each side and the bladder wall thickness after voiding were recorded. Standard urodynamic studies were obtained in 203 enuretic children for correlations with ultrasound findings. There was a significant increase in the incidence of monophasic ureteric jet waveforms in enuretic children when compared with the controls (19.2% versus 6.4% on the right side, 19.2% versus 8.3% on the left side, all p < 0.01). Furthermore, immature monophasic waveforms were more commonly seen in the enuretic group with markedly thickened bladder wall. Enuretic children with bilateral immature ureteric jet waveforms and markedly thickened bladder wall showed multiple significant urodynamic abnormalities (p < 0.05). The above observations could be accounted for by immaturity of both vesicoureteric junction and detrusor muscle.

Purpose: Since nocturnal enuresis in adults and adolescents is rarely monosymptomatic, we identified the prevalence of childhood bladder and bowel dysfunction, and compared findings to those in a normative cohort., Materials and Methods: Childhood and current bladder and bowel dysfunction were investigated in 56 consecutive adolescents and adults attending a public nocturnal enuresis service and in 293 normative adults using a self-administered questionnaire. Analysis involved descriptive statistics, the chi-square and Kruskal-Wallis tests, and regression analysis with p <0.05 considered significant., Results: Adolescents and adults attending a public nocturnal enuresis service had significantly higher childhood scores than normative adults, and significantly more childhood urgency, frequency, urge incontinence, infrequent voiding and small volume, high urge voids. Infrequent bowel action and fecal soiling in childhood were also significantly more common in those with nocturnal enuresis than in controls. Adult symptoms of urge incontinence, general bowel symptoms and nocturnal enuresis were significantly more common in adults and adolescents with nocturnal enuresis. Significant associations were found between childhood symptoms and adult overactive bladder, and childhood emptying dysfunction and adult voiding dysfunction. Higher childhood scores in adults and adolescents with nocturnal enuresis correlated significantly with current adult symptoms of urge, urge leakage, stress incontinence, hesitancy, incomplete emptying and UTI within the last year., Conclusions: Significant childhood bladder and bowel symptoms along with more adult urge and bowel dysfunction were found in adults and adolescents with nocturnal enuresis. The association with adult urgency and urinary tract infection supports the likelihood of underlying bladder and or voiding dysfunction in unremitting nocturnal enuresis.

Objective: In this study we investigate the effects of carbamazepine (CBZ) on urinary volume, frequency of micturition, serum and urine osmolality, osmotic and creatinine clearance, and free water clearance in patients with primary nocturnal enuresis. This information might help in our understanding of the mechanism of action of CBZ in management of patients with enuresis., Patients and Methods: The study comprised eight patients with primary enuresis (age range, 8-14 yr) who wet at night on a daily basis. Enuretics were given, CBZ 200 mg each night; urine volume, urinary osmolality and electrolytes, serum osmolality and electrolytes, osmotic clearance, fractional excretion of sodium, and free water clearance were assayed before CBZ treatment and after 15 d of treatment. Frequencies of bed-wetting and dry nights were observed during treatment., Results: Mean number (+/-SD) of dry nights was increased from zero dry nights (daily bed-wetting) to 9.7 (2.8) per 15 d of treatment (65%). CBZ decreased the 24-h urinary volume by 41%, the night volume by 45%, the day volume by 38%, and frequency of micturition by 28%. CBZ increased the 24-h urinary osmolality by 43%. Serum osmolality changed significantly from 283.7 mOsm/l to 277.2 mOsm/l. CBZ decreased osmotic clearance by 37% and free water clearance by 34%. Creatinine clearance was decreased by 19% after CBZ treatment (p < 0.05)., Conclusion: CBZ reduced urine volume, increased urine osmolality, and decreased the free water clearance, the osmotic clearance, and the frequency of micturition in enuretics; this might help in understanding its mechanism of action.

In children with nocturnal enuresis, a higher rate of minor neurological dysfunction has been found. The aim of this study was to assess timed performance (a measure of motor performance speed) and associated movements using a standardized and reliable instrument. The motor function of 37 children with nocturnal enuresis (27 males, 10 females; mean age 10y 7mo [SD 1y 10mo]; age range 8y-14y 8mo) and 40 comparison children without enuresis (17 males, 23 females; mean age 10y 7mo [SD 1y 6mo]; age range 8y-14y 8mo) was assessed using the Zurich Neuromotor Assessment. Children with nocturnal enuresis showed a slower motor performance than comparison children, particularly for repetitive hand and finger movements. This study provides evidence for a maturational deficit in motor performance in children with nocturnal enuresis. In addition to a maturational deficit of the brainstem, it is proposed that there is a possible maturational deficit of the motor cortex circuitry and related cortical areas in children with nocturnal enuresis.

Purpose: In a subgroup of children with enuresis an increase in nighttime water and solute excretion has been documented. To investigate if modifications in renal function are involved in nocturnal enuresis, we assessed circadian variation in natriuresis and tubular sodium handling in polyuric hypercalciuric children., Materials and Methods: A total of 10 children with proved hypercalciuria and nocturnal polyuria and 10 age matched controls were included in the study. A 24-hour urine collection was performed in 8 sampling periods for measurement of urinary sodium excretion. Segmental tubular sodium transport was investigated during a daytime oral water load test and calculated according to standardized clearance methodology., Results: The children with enuresis showed a marked increase in the fractional excretion of sodium during the night (0.93% +/- 0.36%), while daytime sodium excretion was decreased (0.84% +/- 0.23%). Analysis of segmental tubular sodium transport revealed decreased delivery of sodium to distal tubule (C(H2O) + C(Na) = 10.7 ml/100 ml glomerular filtration rate), indicating increased proximal tubular sodium reabsorption but also stimulation of distal sodium reabsorption as demonstrated by increased fractional distal sodium reabsorption (92.9% +/- 2.2%, controls 90.5% +/- 2.9%). Increased distal reabsorption was associated with increased fractional potassium excretion (17.5% +/- 2.7%, controls 13.6% +/- 6.4%), indicating increased distal tubular sodium/potassium exchange., Conclusions: No intrinsic defect in renal tubular sodium transport was found, but during the day increased sodium reabsorption in proximal and distal tubules was observed, suggesting extrarenal factors to be involved in altered circadian variation in solute and water excretion by the kidney.

Purpose: We investigated bladder reservoir function in children with monosymptomatic nocturnal enuresis and in healthy controls., Materials and Methods: A total of 18 children with monosymptomatic nocturnal enuresis and 119 controls who were 7 to 13 years old were recruited. Children completed frequency volume charts and measurements of nocturnal urine production. Mean diuresis in the period preceding each voiding was calculated. Those with enuresis were grouped according to bladder capacity and hospitalized for 4 nights, including a baseline night and 3 with an oral water load. Enuresis volumes and post-void residual volume were estimated, allowing the calculation of bladder volume at the time of enuresis., Results: Nine children with monosymptomatic nocturnal enuresis were characterized as having normal bladder capacity and 9 had decreased bladder capacity. We found large intra-individual variability in daytime voided volume in all 3 groups of participants. Children with enuresis and small bladder capacity generally voided with volumes close to maximal voided volume. A total of 93 enuresis episodes were recorded. Large intra-individual variability was seen in bladder volume at enuresis and it was lower than maximal voided volume in more than 50% of episodes. Variability in bladder volume at enuresis was greatest in the patient group with decreased bladder capacity. We found a significant correlation between diuresis and bladder capacity in all groups during the day and night., Conclusions: There is a great intra-individual diurnal variability in voided volume in children with enuresis and in healthy children. Enuresis seems to occur at bladder volumes that are smaller and larger than the maximal voided volume obtained from voiding charts.