Prevalence of Bladder Dysfunction in Children with Primary Nocturnal Enuresis Presenting to the Hospital
Date of Award
Master of Medicine (MMed)
Prof. Fred Were
Dr. Bashir Admani
Dr. Sudhir Vinayak
Paediatrics and Child Health (East Africa)
Introduction: Bladder dysfunction is thought to be a common cause of nocturnal enuresis. It can either be overactive, underactive or dysfunctional. Currently, there is a paucity of data on what proportions of children with nocturnal enuresis have bladder dysfunction. Studies have shown the prevalence of bladder dysfunction to be as high as 77-94.5% (28), and children with bladder dysfunction have poor response to treatment. There are currently no protocols for investigating and managing children with nocturnal enuresis. The decision for bladder ultrasound is usually made by the primary physician, and at times after the child has been on treatment for a long duration. Studies have shown boys are affected more than girls. Nocturnal Enuresis causes psychological stress and low self-esteem in the child (2). Diagnosis is made by history taking and examination of the child. Bladder ultrasounds and urodynamic studies are not routinely done to rule out bladder dysfunction, and therefore the prevalence of bladder dysfunction in children with NE is underreported.
Objectives: This study was designed to investigate the prevalence of bladder dysfunction in children with primary nocturnal enuresis presenting to Aga Khan University Hospital and Gertrude’s Children Hospital. In addition, the type of bladder dysfunction and the factors associated with bladder dysfunction
Methodology: It was a cross sectional study carried out in children between the age group five to eighteen years presenting with primary nocturnal enuresis to Aga Khan University Hospital and Gertrude’s Children Hospital. Fifty-six children with primary nocturnal enuresis were recruited for the study. A questionnaire was completed by the parent/caregiver/ child ≥ 18 years. Bladder ultrasound was done to determine the bladder volume and bladder wall thickness, which was used to calculate the bladder volume wall index, which was compared to normal bladder volume wall index (BVWI) for age. (27)
Results: the prevalence of bladder dysfunction using the BVWI in children between five to eighteen years presenting with primary nocturnal enuresis to Aga Khan University Hospital and Gertrude’s Children Hospital was 92.9% (52 children). The male to female ratio was 1:1. The prevalence of overactive bladder was 92.9% (95 % CI 82.7 – 98%) (52) and 7.1% (4) of children had normoactive bladder, there was no child with underactive bladder. The prevalence of bladder dysfunction was noted to be the similar to other studies. (28)
Conclusion: The prevalence of bladder dysfunction in enuretic children seen in Kenyan referral facilities is high. It is important for clinicians to consider the high likelihood of bladder dysfunction in enuretic children and incorporate this in the clinical management of these patients. There remains a need for high quality and properly designed studies to confirm the risk factors for bladder dysfunction in enuresis in low income countries.
Jethwa, N. P. (2016). Prevalence of Bladder Dysfunction in Children with Primary Nocturnal Enuresis Presenting to the Hospital (Unpublished master's dissertation). Aga Khan University, East Africa.