Enuresis and urinary incontinence in children and adolescents with spinal muscular atrophy.
OBJECTIVE
To assess the rate and type of urinary incontinence in a large sample of children and adolescents with spinal muscular atrophy (SMA), a genetic disorder characterized by loss of motor function caused by anterior horn degeneration.


METHODS
The study included 96 severely incapacitated patients with SMA (aged 6.0-18.11 years) who were examined in detail, including a structured interview (Kinder-DIPS), the Child Behaviour Checklist (CBCL) and a specific questionnaire for urinary incontinence. They were compared with two control groups of unaffected siblings and normal children.


RESULTS
In all, 29% of the patients were wet at night and/or during the day; mostly younger children with SMA types I and II only were affected. The results of the interview were more reliable than the CBCL. The specific questionnaire revealed a variety of possible functional and neurogenic forms of wetting, including nocturnal enuresis, voiding postponement, dysfunctional voiding, stress, symptomatic (urinary tract infections, UTIs) and neurogenic incontinence. Many patients were constipated, soiled or had UTIs. The rate of behavioural problems was twice as high (32%) as normal (15%; CBCL).


CONCLUSIONS
Children with SMA have a high rate of urinary incontinence which is often overlooked, and not diagnosed and treated adequately. These problems should be addressed routinely by paediatricians in children referred to paediatric urological specialists.
von Gontard
A
A
Department of Child and Adolescent Psychiatry, University of Cologne, Germany. alexander.vongontard@medizin.uni-koeln.de
Laufersweiler-Plass
C
C
Backes
M
M
Zerres
K
K
Rudnik-Schöneborn
S
S
D000293:Adolescent; D002648:Child; D004775:Enuresis / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D009134:Muscular Atrophy, Spinal / Q000150:complications* / Q000503:physiopathology; D009410:Nerve Degeneration / Q000150:complications* / Q000503:physiopathology; D014549:Urinary Incontinence / Q000209:etiology* / Q000503:physiopathology