Introduction: Enuresis is one of the most common medical complaints in pediatric urology. In non-monosymptomatic (NME) enuresis, lower urinary tract dysfunction (LUTD) needs further investigation, as daytime symptom control is crucial for enuresis therapy. Although NME corresponds to 50%-80% of all enuresis cases, the relationship between daytime and nighttime symptoms is poorly understood. NME is highly heterogenous and may not be the cause, but only overlap with enuresis. Therefore, a better description of lower urinary tract symptoms (LUTS) in patients with enuresis is of paramount importance. The aim of this study is to estimate the prevalence and impact of LUTS enuresis and characterize the determining factors of this clinical condition.
Methods: This is an observational, cross-sectional, descriptive and analytical study, which included individuals aged 5-17 years who answered yes to the presence of enuresis. To assess LUTS, the Disfunctional Voiding Scoring System (DVSS) was used. Participants with at least 1 symptom according to the DVSS were considered to have NME. NME group was further divided into Overactive Bladder (OAB), Voiding Postponement (VP) and Dysfunctional Voiding/Hypoactive Bladder (DV/HB) for intragroup analysis.
Results: 84 participants were included, with a median age of 7.00 (Interquartile Range 6.00-10.00) and 47 (56.0%) male participants, with no difference between the MNE and NME groups. There was no difference between the two groups also regarding the rate of constipation (p=0.369) and the whether the enuresis was primary or secondary (p=0.148). 71.4% presented NME. Daytime symptoms included holding maneuvers (71.7%), urgency (68.3%), incontinence (26.7%), increased urinary frequency (10%), effort to urinate (1,7%) and dysuria (1,7%). Enuresis was more severe in patients with holding maneuvers (p=0.029) and urgency (p=0.045). According to the type of LUTD, OAB was present in 63.3%, VP in 13.3% and DV/HB in 23.3%. Primary NME was associated with OAB and the secondary NME had more VP and DV/HB. An association was found between the severity of enuresis and the type of LUTD (p=0.002), with a higher prevalence of patients with Overactive Bladder in the frequency > 3 times a week. No Voiding Postponement had >3x enuresis in a week.
Conclusions: To our knowledge, this is the first study that evaluate the relationship of enuresis and the LUTD subtypes and the severity of enuresis and daytime symptoms. The presence of urgency and holding maneuvers is associated to a more severe enuresis. Of interest, no VP patient has more than 3 times per week enuresis episodes. Most of non-monosymptomatic enuretic patients have OAB. We expect that patients with primary NME have more OAB and those with secondary NME have more VP and DV/HB.