| RE:
PREVALENCE AND ASSOCIATED FACTORS OF ENURESIS IN TURKISH CHILDREN
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CUNEYT OZDEN, OZDEM
L. OZDAL, SERKAN ALTINOVA, IBRAHIM OGUZULGEN, GUVENC URGANCIOGLU, ALI
MEMIS
Department
of Urology, Numune Education and Research Hospital, Ankara, Turkey
Int
Braz J Urol, 33: 216-222, 2007
To the Editor:
In
this article, the authors aimed to determine the prevalence and associated
factors of enuresis in Turkish children and tried to identify common methods
of enuresis management. The sample was drawn using a short but detailed
and clear questionnaire distributed to the parents of 1,500 school children
aged 6-12 years, covering five schools selected randomly, with a high
response rate (89%).
Although their overall prevalence of nocturnal
enuresis is apparently comparable with previously published epidemiological
surveys, the importance of the study is that it demonstrates that enuresis
is a frequent disorder in childhood, also in Turkey, although many medical
doctors and parents still underestimate this issue. The traditional concept
is that most cases of enuresis are caused by a developmental immaturity
of voiding control, and most enuretic children will ultimately acquire
normal control with increasing age.
The authors stated that the prevalence of
enuresis decreased with age; of the 6-year-old children, 30.8% still wetted
their beds, while none of those aged 12 years did so. These results might
suggest a very high spontaneous resolution rate but the figures have to
be interpreted with caution since only a small number of children in the
age group 6 and 12 (n = 13 and 34 respectively) are a major limitation
of this study.
The authors refer to the classical study
of Forsythe et al. which dates from 1974 showing a spontaneous cure rate
of 14% annually between the ages of 5 and 9, and 16% between 10 and 19
years (1). Recently however, Yeung et al. reported no significant drop
in prevalence after the age of 10 (2). As age increases there are an increasing
proportion of enuretic patients with more severe bedwetting. Enuretic
children aged more than 10 years and adolescents, have significantly more
daytime urinary symptoms and incontinence compared to younger children
(3). Patients with severe symptoms are much more likely to have persistent
problems into adulthood. Consequently, it seems that spontaneous cure
only applies to patients with rather mild enuretic symptoms. This argues
against an expectant and conservative approach towards enuresis. Therefore
we are convinced that these recent findings have major clinical implications
for both primary and secondary care centers. First of all, enuresis in
children aged more than 10 years and adolescents is complex in nature
and also in treatment, and therefore these patients should be referred
instantly. Second, children with severe or not monosymptomatic nocturnal
enuresis have a much lower spontaneous cure rate than generally accepted,
making a policy of waiting with appropriate treatment not longer defendable.
References
1. Forsythe WI, Redmond A: Enuresis and spontaneous cure rate. Study of
1129 enuretis. Arch Dis Child. 1974; 49: 259-63.
2. Yeung CK, Sihoe JD, Sit FK, Bower W, Sreedhar B, Lau J: Characteristics
of primary nocturnal enuresis in adults: an epidemiological study. BJU
Int. 2004; 93: 341-5.
3. Yeung CK, Sreedhar B, Sihoe JD, Sit FK, Lau J: Differences in characteristics
of nocturnal enuresis between children and adolescents: a critical appraisal
from a large epidemiological study. BJU Int. 2006; 97: 1069-73.
Dr.
Jo L. Dehoorne
Pediatric Nephrology & Urology Department
University Hospital Gent
Gent, Belgium
E-mail: joke.dehoorne@uzgent.be
REPLY BY THE
AUTHORS
Previous
studies demonstrated that the prevalence of enuresis tends to decrease
with increasing age, and it was more common in boys than in girls. Similarly,
in the present study, 30.8% of the children were wetting their beds at
6-years-old whereas none of them was wetting their beds at 12-years-old.
However, as outlined in the discussion section, a small number of children
in the groups of 6-years-old (n = 13) and 12-years-old (n = 34) was the
limitation of our study.
Dr JL Dehoorne states that enuresis prevalence
did not decrease after 10-years-old and with the increasing age the prevalence
of severe enuresis increases, referring to the study of Yeung et al. On
the other hand, in our study, severe enuresis (bedwetting everyday) rate
was 33%, nevertheless, enuresis prevalence decreased with increasing age.
Similarly, Serel et al. (1) reported severe enuresis prevalence as 26%
and enuresis prevalence at age 7 and 12, as 15.1% and 4% respectively.
Kanaheswari et al. (2) demonstrated that the prevalence of bedwetting
2 or more times a week was 54.4%. In their study, they concluded that
the rate of enuretic children decreased significantly with increasing
age.
We believe that enuresis prevalence decreases
as the child grows, however, severe enuresis is a different situation
that could be managed separately.
References
1. Serel TA, Akhan G, Koyuncuoglu HR, Ozturk A, Dogruer K, Unal S, et
al.: Epidemiology of enuresis in Turkish children. Scand J Urol Nephrol.
1997; 31: 537-9.
2. Kanaheswari Y: Epidemiology of childhood nocturnal enuresis in Malaysia.
J Paediatr Child Health. 2003; 39: 118-23. |