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Treatment of lower urinary tract dysfunction facilitates awakening and affects the cure rate in patients with nonmonosymptomatic enuresis

Authors
  • Baek, Minki1
  • Im, Young Jae1
  • Lee, Jung Keun1
  • Kim, Hyun Kyu1
  • Park, Kwanjin1
  • 1 .
Type
Published Article
Journal
Investigative and Clinical Urology
Publisher
The Korean Urological Association
Publication Date
Aug 13, 2020
Volume
61
Issue
5
Pages
521–527
Identifiers
DOI: 10.4111/icu.20200074
PMID: 32869565
PMCID: PMC7458874
Source
PubMed Central
Keywords
License
Green

Abstract

Purpose Poor awakening in patients with enuresis has been assumed to be an adaptation to the chronic influence of arousal stimuli like lower urinary tract dysfunction (LUTD). This study aimed to examine the effect of controlling LUTD on improvement of awakening and cure of enuresis. Materials and Methods Data for 119 enuretic patients with overactive bladder were retrospectively analyzed. The patients received urotherapy, laxatives, and anticholinergic agents. LUTD symptoms and enuresis were regularly monitored every 3 months. History of waking up because of bedwetting (ability to awaken, AA) was used as a surrogate marker of arousal and was graded at baseline and every 3 months of treatment. Changing distribution of each grade of AA was associated with other LUTD symptoms. Multivariate analysis was applied to understand whether the lack of improvement in AA might harbor any prognostic implications regarding cure of enuresis. Results Decreasing number of LUTD with treatment corresponded to increasing number of better AA. Enuresis was resolved completely in 88 patients in a median time of 7 months. Failure to show even single episode of awakening before bedwetting within 6 months of treatment and persistent daytime incontinence were identified as risk factors for treatment resistance until 18 months of treatment. Conclusions Controlling LUTD symptoms in the management of nonmonosymptomatic enuresis was crucial for not only the treatment of enuresis but also for allowing the patients to obtain better arousal. AA tended to improve subsequent to bladder control and may contribute to the cure of enuresis.

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