title: Impact of a multidisciplinary evaluation in pediatric patients with nocturnal monosymptomatic enuresis.
abstract: Enuresis (NE) is a clinical condition of multifactorial etiology that leads to difficulties in child/adolescent social interaction.
  
  
  
  This was a prospective study on the impact of multidisciplinary assessment of 6- to 17-year-old patients with monosymptomatic nocturnal enuresis (MNE), including a structured history, clinical/neurological examination, bladder and bowel diaries, sleep diary and questionnaires, psychological evaluation [Child Behavior Checklist (CBCL) and PedsQL 4.0 questionnaires], urinary sonography, blood and urine laboratory tests, polysonography (PSG), and balance evaluation.
  
  
  
  A total of 140 enuretic participants were evaluated, of whom 27 were diagnosed with NE complicated by urinary disorder, four with hypercalciuria, three with nephropathy and one with attention-deficit hyperactivity disorder. Among the 87 participants who underwent PSG, six were diagnosed with severe apnea. Of the 82 MNE patients who underwent full assessment, 62 were male (75.6 %), and the mean age was 9.5 (±2.6) years. A family history of NE was diagnosed in 91.1 % of first- and second-degree relatives, constipation in 89.3 % and mild/moderate apnea in 40.7 %. Balance control alteration was identified by physical therapy evaluation of MNE patients. Participants' quality of life evaluation scores were significantly lower than those of their parents.
  
  
  
  Enuresis is a multifactorial disorder that requires a structured diagnostic approach.
authors.affiliation: Pediatric Nephrology Unit, Instituto da Criança Hospital das Clinicas University of São Paulo Medical School, Rua Lydia Ferrari Magnoli, 300 ap 21 Jardim Avelino, São Paulo, 03227085, São Paulo, Brazil. simonenfagundess@gmail.com.
authors.forename: Simone
authors.initials: S
authors.lastname: Nascimento Fagundes
authors.affiliation: Pediatric Sleep Laboratory-Instituto da Criança Hospital das Clinicas, University of São Paulo Medical School, São Paulo, São Paulo, Brazil.
authors.forename: Leticia
authors.initials: L
authors.lastname: Azevedo Soster
authors.affiliation: Pediatric Nephrology Unit, Instituto da Criança Hospital das Clinicas, University of São Paulo Medical School, São Paulo, São Paulo, Brazil.
authors.forename: Adrienne Surri
authors.initials: AS
authors.lastname: Lebl
authors.affiliation: Department of Physical Therapy, Speech Therapy and Occupational Therapy, University of São Paulo Medical School, São Paulo, São Paulo, Brazil.
authors.forename: Rita Pavione
authors.initials: RP
authors.lastname: Rodrigues Pereira
authors.affiliation: Department of Physical Therapy, Speech Therapy and Occupational Therapy, University of São Paulo Medical School, São Paulo, São Paulo, Brazil.
authors.forename: Clarice
authors.initials: C
authors.lastname: Tanaka
authors.affiliation: Urology Department, ABC Medical School, São Paulo, São Paulo, Brazil.
authors.forename: Rodrigo Fernando
authors.initials: RF
authors.lastname: Pereira
authors.affiliation: Clinical Psychology Department, University of São Paulo, São Paulo, São Paulo, Brazil.|Psychology Department, University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Edwiges
authors.initials: E
authors.lastname: Ferreira de Mattos Silvares
authors.affiliation: Pediatric Nephrology Unit, Instituto da Criança Hospital das Clinicas, University of São Paulo Medical School, São Paulo, São Paulo, Brazil.|Department of Pediatrics, University of São Paulo Medical School, São Paulo, São Paulo, Brazil.
authors.forename: Vera H
authors.initials: VH
authors.lastname: Koch
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D009460:Neurologic Examination; D053206:Nocturnal Enuresis / Q000150:complications* / Q000175:diagnosis*; D017286:Polysomnography; D011446:Prospective Studies; D011795:Surveys and Questionnaires
keywords: Adolescents; Children; Monosymptomatic nocturnal enuresis; Multidisciplinary assessment; Physiotherapy; Psychology