title: Overactive bladder in children should be strictly differentiated from monosymptomatic nocturnal enuresis.
abstract: BACKGROUND
  To elucidate the prevalence of concomitant overactive bladder in children with a chief compliant of primary enuresis, and to evaluate the pathogenetic difference between monosymptomatic and non-monosymptomatic enuresis.
  
  
  METHODS
  All patients had evidence of primary enuresis. Neurogenic bladder was excluded. Urinary symptoms were evaluated by taking a history from the affected children and parents, and using a questionnaire and bladder diary. Voiding cystourethrography was performed for non-responders to exclude urinary abnormalities.
  
  
  RESULTS
  Eighty-eight patients (9.8 +/- 3.1 years old) were enrolled. Initial assessment demonstrated that 24% had undervalued overactive bladders and 9% had constipation. Voiding cystourethrography was performed in 25%, demonstrating mechanical urethral obstructions in 8% and vesicoureteral reflux in 4.5%. Constipation, a history of urinary tract infections, mechanical obstructions and vesicoureteral reflux were strongly associated with non-monosymptomatic enuresis.
  
  
  CONCLUSIONS
  Patients with non-monosymptomatic enuresis had a different clinical background, therapeutic response and pathogenetic abnormalities. In children an overactive bladder should be strictly differentiated from monosymptomatic enuresis.
authors.affiliation: Department of Urology, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. urokajiwara@yahoo.co.jp
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kajiwara
authors.forename: Masao
authors.initials: M
authors.lastname: Kato
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mutaguchi
authors.forename: Tsuguru
authors.initials: T
authors.lastname: Usui
mesh_terms: D000293:Adolescent; D002648:Child; D003248:Constipation / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D053206:Nocturnal Enuresis / Q000175:diagnosis*; D013997:Time Factors; D053201:Urinary Bladder, Overactive / Q000175:diagnosis*; D014549:Urinary Incontinence / Q000175:diagnosis; D014572:Urology / Q000379:methods; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis