title: Enuretic children with obstructive sleep apnea syndrome: should they see otolaryngology first?
abstract: OBJECTIVE
  To study: (1) the prevalence of diurnal urinary incontinence (DI) and nocturnal enuresis (NE) in children with obstructive sleep apnea syndrome (OSAS) who underwent surgery for their upper airway symptoms, (2) the postoperative rate of enuresis resolution, and (3) factors that may predict lack of improvement post surgery.
  
  
  METHODS
  An observational, pilot study of children 5-18 years of age with OSAS and NE who underwent tonsillectomy and/or adenoidectomy (T&A) between 2008 and 2010 was performed. Study consisted of a phone interview and chart review. Severity of NE and DI, frequency, arousal and sleeping disturbances were assessed pre and post T&A. Factors associated with failure to respond were analyzed using a logistic regression model.
  
  
  RESULTS
  Among the 417 children who underwent T&A, 101 (24%) had NE (61 males, mean age 7.8 ± 2.5 years), and of these 24 had associated DI (6%). Mean postoperative follow-up was 11.7 months. Of the 49 whose NE responded to T&A (49%), 30 resolved within 1 month postoperatively. DI resolved in 4 children (17%). There was a statistically significant difference between responders and non-responders regarding the presence of prematurity, obesity, family history of NE, type of enuresis, enuresis severity, and ability to be easily aroused.
  
  
  CONCLUSIONS
  NE was present in about one fourth of children with OSAS undergoing surgery, and resolved in about half. Lower response rate was associated with prematurity, obesity, family history of NE, presence of non-monosymptomatic NE, severe NE preoperatively, and arousal difficulties.
authors.affiliation: Children's Hospital of Michigan, Pediatric Urology Department, Detroit, MI 48201, USA. lkovacev@dmc.org
authors.forename: Larisa
authors.initials: L
authors.lastname: Kovacevic
authors.forename: Michael
authors.initials: M
authors.lastname: Jurewicz
authors.forename: Ali
authors.initials: A
authors.lastname: Dabaja
authors.forename: Ronald
authors.initials: R
authors.lastname: Thomas
authors.forename: Mireya
authors.initials: M
authors.lastname: Diaz
authors.forename: David N
authors.initials: DN
authors.lastname: Madgy
authors.forename: Yegappan
authors.initials: Y
authors.lastname: Lakshmanan
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D053207:Diurnal Enuresis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D053206:Nocturnal Enuresis / Q000453:epidemiology*; D010038:Otorhinolaryngologic Diseases / Q000453:epidemiology / Q000601:surgery; D010865:Pilot Projects; D015995:Prevalence; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000601:surgery*; D014068:Tonsillectomy; D016896:Treatment Outcome