الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Nocturnal enuresis is a common presenting complaint. Although it is generally benign, nocturnal enuresis can cause significant frustration for parents and the affected child. More importantly, it can lead to diminished self-esteem of the affected child. The present study aimed to study the cystometric changes in children with primary monosymptomatic nocturnal enuresis in whom treatment had failed.
The study was carried on 30 children with primary monosymptomatic nocturnal enuresis attending and followed up in Enuresis Outpatient Clinic of Alexandria University Children’s Hospital. All children in this study had no evidence of neurological abnormalities or urinary tract infection. They were 17 males and 13 females. Their ages ranged between 7 and 12 years.
For every primary enuretic child the following were done:
1- History taking including number of bed wetting per week, history of snoring during sleep, urinary tract infection, constipation and family history.
2- Physical examination especially neurological examination (abnormalities in the gait, muscular strength and tone, deep tendon reflexes and sensations).
3- Urine analysis with specific gravity and urine culture if needed.
4- Abdominal ultrasound to assess the upper urinary system and the urinary bladder and its wall thickness.
5- Plain x ray lumbosacral region to detect the presence or absence of spina bifida occulta.
6- Uroflowmetry and cystomanometry .
from the results of the present study it was found that there was positive family history of enuresis in 14 cases (46.7%). Associated constipation in 11 cases (36.7%). All studied cases showed poor response to treatment (wet nights after treatment ranged between 4 and 7 wet nights per week, the mean was 4.72 wet nights per week) after both motivational therapy and pharmacological treatment for a duration ranging between 6 and 16 months with mean duration of 9.9 ±2.92 months. We found that 10 patients received tricyclic antidepressant drug (imipramine) only and 20 patients received imipramine and desmopressin. Urine analysis and culture were free from any abnormality in all cases. Spina bifida was absent in all cases. Increased bladder wall thickness was found in 7 cases (23.3%).
The cystometric study showed decreased maximum bladder capacity in all studied cases and bladder instability was found in 63.3% of cases. There was no statistically significant difference as regard results of cystomanometry in patients who received tricyclic antidepressant drug (imipramine) only and those who received both tricyclic antidepressant drug (imipramine) and desmopressin.
It appears that bladder dysfunction probably contributes significantly to the pathogenesis of primary nocturnal enuresis, particularly in patients with treatment failure and refractory symptoms. Most importantly nocturnal enuresis may be the only symptom, even in children with gross underlying bladder dysfunction. Our future management strategy for monosymptomatic primary nocturnal enuresis may need to be modified to consider these new findings.