One year experience of a multidisciplinary investigation on Nocturnal Enuresis in a Brazilian Tertiary Care Facility

Abstract

Objective: To characterize a cohort of children, 6–16 yrs old, with nocturnal enuresis, defined by 2010 ICCS criteria on the basis of a multidisciplinary evaluation including renal, neurological, psychological and physical therapy approaches. Chronic clinical conditions and genetic disorders constituted exclusion criteria. Methods: After IRB approval, families were invited to participate in the project through press releases, 130 children completed quality of life evaluation through clinically validated questionnaires, followed by a one -day multidisciplinary clinical evaluation. Sleep, urinary and intestinal diaries were evaluated. Urinary sonography, nocturnal polysomnography, urinary and blood analysis were scheduled. Results: 96/130 participants (pts)were male (73,8%), mean age 8 ±1 yrs. Twenty two children were excluded due to noncompliance/chronic clinical conditions. 118/130 pts were evaluated. 93/130 parents of children/adolescents, answered the CBCL questionnaire, 25/93 (27%) of which resulted in scores compatible with clinical psychological conditions. Monosymptomatic enuresis (MoE) was diagnosed in 89/118 children (75.4%). In the MoE group, 67/89 pts were diagnosed with intestinal constipation; 7/89 pts with obstructive sleep apnea, 2/89 pts with hipercalciuria and 2/89 were characterized with ADHD. Area and velocity of center or pressure displacement (VM) were used for postural control evaluation and resulted in 3,67±2,95 cm 2 and 20,35±13,04 cm.s-1, respectively; 22/89 pts were also assessed for postural alignment exhibiting pelvic anteversion (10,27±3,71 grades) and head protusion (0,40±1,86 grades). These results corroborate with a smaller range of motion found for hip flexion (94,86±17,14 grades) and hip extension (2±3,89 grades) assessed using a goniometer. Conclusion: Multidisciplinary evaluation of enuretic children may be the key to optimize therapy on the basis of the underlying etiology of the process.