Refractory enuresis in children and adolescents: how can urodynamics affect management and what is the optimum test?
OBJECTIVE
After failure of medical and behavioral therapy in enuresis, the usual next step is to investigate using urodynamics. The aim of this study was to determine the actual benefit and optimal method of urodynamics in the treatment of refractory enuresis.


METHODS
This prospective randomized study included 56 patients: 17 males and 39 females with an age range of 7-16 years. All had tried multiple courses of medical treatment for enuresis for at least 6 months without response. Thirty patients underwent investigation by cystometrogram, uroflowmetry and electromyogram (UFM/EMG), while 26 patients underwent pressure/flow/EMG (P/F/EMG) studies.


RESULTS
Bladder filling abnormalities were found in 25 out of the 56 patients (44.6%) and included low bladder capacity in 39%, hypocompliance in 32%, and detrusor overactivity in 45%. With regard to voiding dysfunction, 70% of the UFM/EMG group had detrusor‒sphincter dyssynergia and 67% of the P/F/EMG group had bladder outlet obstruction.


CONCLUSIONS
Urodynamics can help in cases of refractory enuresis by detecting dysfunctional voiding, which is present in a large percentage of these patients. This can be diagnosed by UFM/EMG, rather than P/F/EMG, as a non-invasive test. UFM alone may be misleading. Alpha adrenergic blockers may be of benefit in treating these patients.
Section of Voiding Dysfunction and Urodynamics, Urology Department, Faculty of Medicine, Alexandria University, Azarita, 21113 Alexandria, Egypt. mostafa_elmissiry@yahoo.com
Mostafa
M
Elmissiry
Ali
A
Abdelkarim
Haitham
H
Badawy
Salah
S
Elsalmy
Gaber Abdelfattah
GA
Ali
D000293:Adolescent; D002648:Child; D004576:Electromyography; D004775:Enuresis / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D014563:Urodynamics