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PubMed2003

Enuresis in children with sleep apnea.

OBJECTIVES: To test the hypothesis that the presence of nocturnal enuresis is related to the severity of sleep apnea, we examined the relation between the Respiratory Disturbance Index (RDI, apneas plus hypopneas per hour of sleep) and the presence and severity of enuresis. STUDY DESIGN: All children 4 years of age and older who were referred to our sleep center for suspected sleep disordered breathing (SDB) were asked whether and how frequently they currently wet the bed. All patients underwent full overnight polysomnography (PSG). The relation between RDI and enuresis was examined by chi(2) analysis. A value of P <.05 was considered statistically significant. RESULTS: Ninety boys and 70 girls were studied; 66 children (41%) described current enuresis. At all ages, enuresis was more prevalent in our patients than control patients in the literature. Children with an RDI of < or =1 had a significantly lower prevalence of enuresis (17%) than did children with an RDI >1 (47%) (P <.05). Fourteen percent of children with an RDI < or =1 had frequent enuresis, compared with 32% of children with an RDI >1 (P <.05). There was no significant difference in the prevalence of enuresis in children with an RDI 1 to 5, 5 to 15, or >15 (P =.92). CONCLUSIONS: There is a high prevalence of enuresis in children with suspected sleep-disordered breathing. Children with an RDI >1 were at higher risk for enuresis than children with an RDI < or =1. This may be due to the effects of obstructive sleep apnea on arousal response, bladder pressure, or urinary hormone secretion.

Adolescent↗
PubMed2000

Prepulse inhibition of startle, intelligence and familial primary nocturnal enuresis.

UNLABELLED: Previous studies have shown a significant reduction of prepulse inhibition of startle in boys with primary nocturnal enuresis. Those enuretic boys who had higher IQs showed less prepulse inhibition. This study evaluates the association of prepulse inhibition and IQ in primary nocturnal enuresis in respect to family history of primary nocturnal enuresis. Prepulse inhibition of startle was studied in 83 boys with primary nocturnal enuresis and 57 non-enuretic boys using an interval of 120 ms between the onset of a 75 dB 1000 Hz tone and a 104 dB noise burst. Of the boys with primary nocturnal enuresis, 56 had a family history of primary nocturnal enuresis and 27 had no family history (no first-degree relative). Of the 57 non-enuretic boys, 42 also had no family history (no first-degree relative) of primary nocturnal enuresis, while 15 did have a positive family history. Associations between prepulse inhibition and IQ scores were compared among these four groups. Strong and significant associations between prepulse inhibition deficit and higher IQ scores in the enuretic group with familial primary nocturnal enuresis were unique in comparison to the other groups. CONCLUSIONS: The strong heritabilities of primary nocturnal enuresis, intelligence and prepulse inhibition suggest genetic mediation of the association of prepulse inhibition with intelligence in familial primary nocturnal enuresis.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

Epidemiology of enuresis among school-age children in Thailand.

Enuresis is a very common developmental problem in young children. The aims of this study were to estimate the prevalence of enuresis in school-age children, to determine the factors associated with nocturnal enuresis, and to evaluate the parental strategies for managing enuresis. A randomly selected cross-sectional population-based study was conducted in eight elementary schools in Bangkok, Thailand. A total of 3453 parents of children aged 5 through 15 years completed the questionnaires. The overall response rate to the questionnaire was 70%. The prevalence of enuresis was 4.2% and that of nocturnal enuresis was 3.9%. The prevalence declined with increasing age from 10%, 5.3%, 3%, and 1.2% at ages 5, 7, 10, and 12 years, respectively. There was no enuretic child at ages 13 through 15 years. The prevalence of bed-wetting was slightly more frequent in females than males. Nocturnal enuresis was also found to be significantly associated with the history of encopresis and positive family history of enuresis. There was no significant associated with parental education, birth order, socioeconomic status, diaper use, toilet training, and behavioral and school problems. Behavioral techniques mostly used by parents for management of their children with bed-wetting were ensuring that the child voids before bedtime (72.9%), waking the child up at night to void (61.8%), and evening water intake restriction (28.5%). The overall prevalence rate of nocturnal enuresis in Bangkok school-age children is lower than that of many previous studies reported from other countries. The significant differences in the prevalence reported by other countries' studies attributed to the criteria selection for ranges of age, definition of enuresis, genetic predisposition, and traditional and cultural background.

Adolescent↗
PubMed2001

The genetics of enuresis: a review.

PURPOSE: Formal studies of the genetics of enuresis have been performed since the 1930s and molecular genetics since 1995, both highlighting the importance of hereditary factors in the etiology of nocturnal enuresis. We summarize the current state of knowledge with respect to the genetics of nocturnal enuresis and its genotype-phenotype interactions. MATERIALS AND METHODS: A comprehensive review of the published data available on the genetic basis of enuresis was performed. RESULTS: Genetic factors are the most important in the etiology of nocturnal enuresis but somatic and psychosocial environmental factors have a major modulatory effect. Most commonly, nocturnal enuresis is inherited via an autosomal dominant mode of transmission with high penetrance (90%). However, a third of all cases are sporadic, and the difference between sporadic and familial forms is not known. Four gene loci associated with nocturnal enuresis have been identified but the existence of others is presumed (locus heterogeneity). All likely candidate genes have been excluded so far. There is no specific association among the different loci, type of wetting and other aspects of the phenotype. All subtypes of nocturnal enuresis (primary, secondary, combined day/night wetting) are susceptible to comparable genetic influences. Certain syndromes of day wetting follow their own genetic mechanisms but this association with the genetics of nocturnal enuresis is not known. CONCLUSIONS: Nocturnal enuresis is a common, genetic and heterogeneous disorder. The associations between genotype and phenotype are complex and are susceptible to environmental influences. Therefore, exact assessment of the clinical phenotype and identification of intermediary phenotypes or traits are needed. Future research will focus on the identification of genes, gene products and their interaction with environmental factors.

Child↗
PubMed2004

Monosymptomatic nocturnal enuresis is associated with abnormal nocturnal bladder emptying.

PURPOSE: We investigate the nature of enuresis episodes in monosymptomatic nocturnal enuresis using a fluid provocation model. MATERIALS AND METHODS: The study included 18 children 7 to 13 years old with monosymptomatic nocturnal enuresis. Based on basal home recordings patients were subgrouped into those with a normal nocturnal urine output and those with nocturnal polyuria (mean nocturnal urine production on wet nights exceeding 130% of functional bladder capacity, normal functional bladder capacity for age provided). Children were admitted to the hospital for 4 consecutive nights. After an adaptation night all children received orally 25 ml/kg water, 30 minutes before bedtime on the remaining 3 nights. A cordless alarm device enabled registration of enuretic episodes from another room and diapers allowed the measurement of enuresis volumes. Post-void residual volumes were measured by ultrasound. Pelvic floor electromyography was continuously recorded throughout the night, and its association to bladder emptying was investigated. RESULTS: A total of 95 enuresis and 14 nocturia episodes were recorded. Significantly more enuresis episodes were registered on nights with oral fluid load, whereas no increase in number of nocturia episodes was seen. Of the enuresis episodes 46 were associated with incomplete bladder emptying (post-void residual volume greater than 10% of total bladder volume at time of enuresis). No difference between patient groups regarding post-void residual volume was seen. Abnormal bursts of electromyography activity were associated with incomplete micturitions. CONCLUSIONS: Enuresis nocturna episodes in polyuric and nonpolyuric patients are frequently incomplete micturitions. The present findings question the definition of nocturnal enuresis episode as normal complete voiding.

Adolescent↗
PubMed1990

A 6 year follow-up of childhood enuresis: prevalence in adolescence and consequences for mental health.

Recent studies have shown an association between enuresis and behavioural or emotional problems. The direction or causality of the association and its duration, however, remain unclear. This study followed a large group of children from ages 11 to 15 years and reported the prevalence of enuresis to age 13 years. The enuretic status of the sample at age 11 years was established relative to the history of enuresis at age 9 years. At age 11 years a significant association was found between enuresis and measures of psychopathology. This association was particularly evident for those children with secondary enuresis, and those who had a history of enuresis but had ceased to wet the bed. Current primary enuresis was not significantly associated with disorder. Similar associations were found between enuresis at age 11 and later disorder at age 13. At age 15 years no significant associations between enuresis and disorder were found. These findings have implications for parents of children with enuresis and for clinicians dealing with the disorder.

Adolescent↗
PubMed1991

[Congenital lower urinary tract obstruction and enuresis in children].

We reviewed enuretic children among patients with congenital lower urinary tract obstructions experienced in the Department of Urology, Hyogo College of Medicine during 16 years from 1974 to 1989. Among 612 patients with congenital lower urinary tract obstructions, 139 (22.7%) had enuresis nocturna and/or diurna. The incidence of enuresis was 24.7% with posterior urethral valve (77 cases), 50.0% with anterior urethral valve (6 cases), 23.8% with congenital bulbar urethral stenosis in boys (303 cases) and 19.9% with congenital distal urethral stenosis in girls (226 cases). Diurnal enuresis was more common in enuresis associated with congenital lower urinary tract obstructions than in usual enuresis. In urodynamic examinations, more than half of enuretic children with congenital lower urinary obstructions showed hyperactive detrusor activity. Treatment of congenital lower urinary tract obstructions through operation resulted in cure or amelioration of enuresis in about 80% of the patients. Enuresis associated with lower urinary tract obstruction or neurogenic bladder is sometimes called complicated enuresis and it is an important role of a urologist to differentiate complicated enuresis from simple enuresis.

Adolescent↗
PubMedDate not supplied

Relationship between parental attitude towards the emotionally disturbed child and nocturnal enuresis.

In a study of children with nocturnal enuresis a close relationship was found between disturbed family environment and the frequency of enuresis. It will appear that negative parental attitudes in contrast to positive ones, as defined in this paper, are predisposing factors for the appearance of nocturnal enuresis. It is well known that nocturnal enuresis is one of the most serious problems encountered in children. It is estimated that over 25 percent of the children examined in Child Guidance Clinics suffer from nocturnal enuresis. In fact enuresis is considered the most common reason for referral of children to such Clinics. Much has been said about the etiology of nocturnal enuresis, and the organic factor was considered to be of primary importance by physicians of past generations. Spina bifida, local infections, small cyst, adenoids, epilepsy and mental retardation were at times considered as the main causes. Today the organic factor is accepted as an important one in a percentage not exceeding that of five percent. As a psychological psychosomatic phenomenon, nocturnal enuresis is considered to be the result of many interacting factors. One of the psychological factors is known to be the child-parent relationship and the influence of the family environment as a whole. The purpose of this paper is the study of the influence of the family environment on the frequency of nocturnal enuresis regardless of the parents' reactions to the enuresis itself.

Adolescent↗
PubMed2001

No relationship between family history of enuresis and response to desmopressin.

PURPOSE: We determined the prevalence of positive family history of nocturnal enuresis in relation to response to desmopressin. MATERIALS AND METHODS: A total of 328 children with nocturnal enuresis and 53 normal children were interviewed to determine the presence of family history of nocturnal enuresis. Response to desmopressin was confirmed in some cases by home recordings of enuresis episodes during 2 baseline weeks and 2 weeks of 20 to 40 microg. desmopressin intranasally. RESULTS: Significantly more patients than normal children (75% versus 38%, p <0.001) reported a positive family history of enuresis (any relative). The high prevalence of a positive family history of nocturnal enuresis was present in severe/nonsevere or primary/secondary types of enuresis. Of the patients 141 completed 4 weeks of home recordings including 20 with a complete response (greater than 90% reduction in wet nights week), 25 with a partial response (50% to 90% reduction) and 96 with no response (less than 50% reduction). The prevalence of a positive family history (any relative) was no different among the response groups (80%, 84% and 78%, respectively). Similarly, family history, as defined by first order relatives only, showed no relation to treatment response. CONCLUSIONS: A positive family history of nocturnal enuresis is more prevalent in patients with enuresis than in normal children regardless of the nature of the nocturnal enuresis. In contrast to previous reports, a positive family history failed to predict a good response to desmopressin treatment. Hereditary factors are important to consider in desmopressin responding and desmopressin resistant cases.

Adolescent↗
PubMedDate not supplied

[Videourodynamic findings in the child with enuresis].

Videourodynamic investigation was carried on 62 patients with enuresis (34 females, 28 males). Patients were all grouped in four different clinical types according to the International Continence Society: (Type I) monosymptomatic enuresis nocturnal (24 cases); (Type II) nocturnal and diurnal enuresis without daytime frequency (8 cases); Type III) nocturnal enuresis with daytime frequency (22 cases); (Type IV) nocturnal and diurnal enuresis with daytime frequency and/or urgency (8 cases). In children with monosymptomatic enuresis nocturnal the videourodynamic study revealed, in 85% of cases, a normal bladder; in only 17% of cases was observed a detrusor instability. In patients with Type II enuresis a normal bladder was observed in 6 cases, whereas in two a detrusor instability was present. Among the 22 patients with Type III enuresis, 13 cases (59%) had a detrusor instability, 3 cases (14%) had a vesicosfinteric dyssinergia and 6 (27%) had a normal activity. In this group of patients it was documented in 10 cases a trabeculated bladder together with a vesicoureteral reflux in 4 patients, meatal stenosis and bladder diverticula in other two cases. All patients with Type IV enuresis documented pathological data: detrusor instability in 4 patients, vesico-sfinteric dyssinergia in two and neurogenic non-neurogenic bladder in the other two cases. A severe trabeculated bladder was present in all this cases, with vesico-ureteral reflux in two patient. Maximum cystometric capacity was low in 41 cases (66%), normal in 20 (32%), high in 1 (2%), independently of the types of enuresis.

Adolescent↗
PubMed2006

Nocturnal enuresis in adolescents and adults is associated with childhood elimination symptoms.

PURPOSE: Since nocturnal enuresis in adults and adolescents is rarely monosymptomatic, we identified the prevalence of childhood bladder and bowel dysfunction, and compared findings to those in a normative cohort. MATERIALS AND METHODS: Childhood and current bladder and bowel dysfunction were investigated in 56 consecutive adolescents and adults attending a public nocturnal enuresis service and in 293 normative adults using a self-administered questionnaire. Analysis involved descriptive statistics, the chi-square and Kruskal-Wallis tests, and regression analysis with p <0.05 considered significant. RESULTS: Adolescents and adults attending a public nocturnal enuresis service had significantly higher childhood scores than normative adults, and significantly more childhood urgency, frequency, urge incontinence, infrequent voiding and small volume, high urge voids. Infrequent bowel action and fecal soiling in childhood were also significantly more common in those with nocturnal enuresis than in controls. Adult symptoms of urge incontinence, general bowel symptoms and nocturnal enuresis were significantly more common in adults and adolescents with nocturnal enuresis. Significant associations were found between childhood symptoms and adult overactive bladder, and childhood emptying dysfunction and adult voiding dysfunction. Higher childhood scores in adults and adolescents with nocturnal enuresis correlated significantly with current adult symptoms of urge, urge leakage, stress incontinence, hesitancy, incomplete emptying and UTI within the last year. CONCLUSIONS: Significant childhood bladder and bowel symptoms along with more adult urge and bowel dysfunction were found in adults and adolescents with nocturnal enuresis. The association with adult urgency and urinary tract infection supports the likelihood of underlying bladder and or voiding dysfunction in unremitting nocturnal enuresis.

Adolescent↗
PubMed2002

Self-image and performance in children with nocturnal enuresis.

OBJECTIVE: To study the self-image of children between 8 and 12 years with nocturnal enuresis, and to correlate the findings with age, sex, clinical symptoms, primary versus secondary enuresis and treatment failures. METHODS: The study-group embraced 50 university hospital, and therefore selected therapy-resistant nocturnal enuresis-children, 27 boys and 23 girls. The mean age was 9.8, which means children aged between 8 and 12 years. Children were classified into two age groups: I=8-9 years and II=9-12 years. A total of 41 out of 50 had primary nocturnal enuresis. The mean number of treatments before intake was 5.6, A=1-4, B=5-8, C=9-12. Seventy-seven children without nocturnal enuresis were included in the control group, 31 boys and 46 girls. The method we used to measure the perceived competence of the children on specific domains of their life was the Dutch translation and also validation of the "Self-Perception Profile for Children" by Harter. The testing was performed before and after therapy. RESULTS: Children with nocturnal enuresis have a significantly lower perceived competence than children without nocturnal enuresis, concerning physical appearance (p<0.05) and global self-esteem (p<0.01). There is a main effect of gender (p<0.01) and age (p<0.05) concerning scholastic skills. There is a correlation with the number of treatment failures. The more treatment failures, the lower the self-esteem. After successful treatment, there is an improvement of 'athletic competence' and 'global self-esteem', but it is not significant. CONCLUSION: Nocturnal enuresis has important negative effects on the self-image and performance of children. Perceived competence was lower in girls than in boys with enuresis, and it was significantly lower in the higher age than in the lower. Children with day-time and night-time incontinence have a significantly decreased perceived competence on scholastic skills compared to children with nocturnal problems only. Successful treatment tended to increase athletic competence and global self-esteem.

Age Factors↗
PubMed1998

An Italian epidemiological multicentre study of nocturnal enuresis.

OBJECTIVE: To estimate the prevalence of enuresis in schoolchildren in Italy. SUBJECTS AND METHODS: The Italian Club of Nocturnal Enuresis promoted a prevalence study of nocturnal enuresis using a self-administered questionnaire in seven cities in Northern, Central and Southern Italy. The association between enuresis and potential risk factors, e.g. a family history of enuresis, stress, socio-economic status and abnormal diurnal voiding habits, was investigated. The perceived impact on the child and on the family was also evaluated. A random-cluster sampling scheme was used to obtain a sample of primary and secondary schoolchildren from each city. One primary school and one secondary school for each socio-economic level was sampled in each city, giving a total of 42 schools surveyed; 9086 children were covered by the survey. In a cluster sampling method, the variance of prevalence is divided into two components, binomial and extra-binomial variability. Both the DSM III and DSM IV definitions of enuresis were used because at present, there is no consensus on the diagnostic criteria. RESULTS: Completed questionnaires were received from 7012 children, an overall response rate of 77.2%. Those aged 6-14 years were analysed, restricting the sample to 6892 children. There were 250 enuretic children using the DSM III definition of enuresis and 112 using the DSM IV definition. The overall prevalence was 3.88% and showed a decreasing trend with increasing age. Bedwetting was more frequent in boys than in girls. The prevalence of enuresis was higher when the child was from a family of low socio-economic status despite the child's age group. The logistic analysis showed that familiality, stress, birthweight, age of attaining diurnal continence, soiling and, for girls, menstruation, were statistically significant variables and thus contributed to predicting the probability of bedwetting, confirming the findings of previous studies. There was a large difference in prevalence using the two DSM definitions; a high percentage of DSM III enuretic children had more than two wet nights per week. CONCLUSION: It is important that a consensus about the 'working definitions' of enuresis is reached to avoid bias in the recruitment step, to carry out comparable epidemiological studies and to obtain adequate therapeutic responses.

Adolescent↗
PubMed2001

Evaluation of the autonomic nervous system function in children with primary monosymptomatic nocturnal enuresis--power spectrum analysis of heart rate variability using 24-hour Holter electrocardiograms.

OBJECTIVE: The purpose of this study was to evaluate the circadian rhythm of the autonomic nervous system functions of children with primary monosymptomatic nocturnal enuresis. MATERIAL AND METHODS: The subjects were allocated to three groups--enuresis group (n = 72), normal control group (n = 26), post-treated and cured enuresis group (n = 13). In the three groups. we evaluated the autonomic nervous system function by the power spectrum analysis of heart rate variability (HRV) using 24-hour Holter electrocardiograms. Frequency components of the power spectra of HRV (% power) were divided into three factors; the very low frequency (VLF), the low frequency (LF) and the high frequency (HF) by computer analysis using Fast Fourier Transformation (FFT). RESULTS: In the three groups, the HF component reflecting parasympathetic activity was significantly higher, compared with the LF during sleep. The HF in the enuresis group was significantly higher, compared with the HF in the control group during sleep. The HF in the control group was significantly lower, compared with the LF during waking. However, the HF in the enuresis group was significantly higher, compared with the LF during waking. It showed more increased parasympathetic tone in the enuresis group, compared with that of the control group during sleep and waking. In the post-treated enuresis group, the HF during sleep and waking were significantly decreased, compared with those before treatment. CONCLUSION: These findings suggest the parasympathetic hyperfunction through 24 hours and abnormal circadian rhythm of autonomic nervous system functions in the enuresis group. The post-treated enuresis group showed normal autonomic nervous system functions.

Autonomic Nervous System↗
PubMed2002

An investigation of the impact of nocturnal enuresis on children's self-concept.

OBJECTIVE: This study sought to evaluate the relationship between the self-esteem and the self-image of children with nocturnal enuresis and to examine these in relation to various aspects of clinical and demographic variables. Previous studies investigating the self-esteem of bedwetting children have had mixed findings. Some studies report that children with nocturnal enuresis have a lower self-esteem than their non-bedwetting peers, but other studies report that children with nocturnal enuresis perceive themselves similarly to non-bedwetting children. However, what have not been studied to date are the self-perceptions of bedwetting children treated in community clinics. MATERIAL AND METHODS: A total of 114 bedwetting children treated in community clinics provided the sample. School nurses conducted a routine first-visit assessment, collected baseline demographic and social information and invited children to complete the Butler Self-Image Profile and the Coopersmith Self-Esteem Inventory. RESULTS: Age and extent of wetting were not significantly related to self-concept measures. Girls had significantly (p = 0.008) higher scores on positive self-image compared with boys. Children with secondary enuresis also scored higher on positive self-image compared with those with primary nocturnal enuresis (p = 0.02). The Butler self-image scores indicated a number of significant links between positive self-image and enuresis variables, whereas the Coopersmith self-esteem scores generally failed to distinguish between the enuresis variables and closely reflected those of the negative self-image scores. CONCLUSIONS: These findings suggest that amongst children with nocturnal enuresis, the most vulnerable in terms of self-image are male, those with primary enuresis and those with a greater number of wet nights a week.

Adolescent↗
PubMed1999

Prevalence of nocturnal enuresis and accompanying factors in children aged 7-11 years in Turkey.

There has been limited epidemiological research about nocturnal enuresis in Turkey. The objectives of this study were to ascertain the prevalence of nocturnal enuresis and the epidemiological factors associated with this in Turkish children aged 7-11 y, living in Manisa. Included in the study were 2000 children from various primary schools in Manisa. Parents were asked to fill out our specially designed questionnaire. In all, questionnaires for 1703 children were completed and returned to the department (871F, 51.1%; 832M, 48.9%). The prevalence of nocturnal enuresis for females was 10.6%, for males it was 16.9% and the overall prevalence was 13.7%. The prevalence of nocturnal enuresis decreased with age. Enuresis nocturna was found to be more common in children with a family history of bedwetting (76.5%). Deep sleeping, poor toilet habits and low educational level of the family were associated with enuresis. Consanguineous marriage did not influence the incidence of enuresis nocturna. There was no difference between enuretics and nonenuretics with reference to breastfeeding, being firstborn or being right- or left-handed. In our opinion, enuresis is an important problem for both families and children in Turkey for which specific guidelines should be developed. Various methods have been tried in the treatment of enuresis because of its multi-factorial aetiology. Child, family and physician co-operating together achieve the best help to both child and family.

Child↗
PubMed2004

Enuresis prevalence and accompanying factors in schoolchildren: a questionnaire study from southeast Anatolia.

INTRODUCTION: The aims of this study were to establish the prevalence of enuresis, to determine accompanying factors, and to identify common methods in the management of enuresis in Turkish children aged between 6 and 11 years living in eastern Anatolia. METHODS: The parents of 3,527 schoolchildren aged between 6 and 11 years completed a self-administered questionnaire. The questionnaire asked about sociodemographic data, enuresis data, physical or psychological disorders, and family stressors. Descriptive statistics and chi2 test were used for data analysis. RESULTS: The response rate was 88%. The overall prevalence of reported enuresis was 12.96%, and the prevalence of marked enuresis (at least weekly) was 9.8%. Enuresis was notably more common in boys (male:female ratio 1.6), and the prevalence rates decreased by age without gender bias. Of all enuretic children, 21% had also daytime bed-wetting. The rate of a positive family history was 42% for siblings only and 66% for the other family members. Significantly more of the dry children woke up spontaneously at night to void as compared with the enuretic children (p < 0.001). The parental concern level was not high, and only 15% of the children visited a physician for the management of enuresis. Low socioeconomic status, unfavorable perinatal or postnatal history, and unsatisfactory familial characteristics were significantly more frequent in the enuretic group (p < 0.05). The enuretic children had also higher rates of poor school performance and poor social adaptation as compared with nonenuretic children (p < 0.001). CONCLUSIONS: These results suggest that the prevalence of enuresis in eastern Anatolia is similar to that reported from western Anatolia and from most other countries. Turkish families did not report a high-level concern about enuresis, and the problem was managed primarily within the family.

Child↗
PubMedDate not supplied

[Psychiatric morbidity associated to enuresis in children].

AIMS: The objective of the study was to know the clinical and epidemiological features, including associated psychiatric morbidity, of the children seeking help for enuresis in a public child and adolescent mental health unit. SUBJECTS AND METHOD: Within an exploratory, retrospective, and observational study, we reviewed the clinical charts of all the children (N= 2,315) attending the unit during a five-year period (January 1992-December 1997), collecting information on gender, age, type of enuresis, associated psychiatric morbidity, and social and family characteristics. Both the enuresis and the associated psychiatric disorders were diagnosed according to the DSM-IV criteria. RESULTS: Enuresis was the reason for admission in 230 children (9.9%), whose mean (+/- SD) age was 9.0 (+/- 2.9) years (range: 5-18). The condition of single-parent family, the perception of economic difficulties, and a poor academic achievement were not associated to any type of enuresis. A 19.5 per cent of the patients with enuresis presented a co-morbid psychiatric disorder, which was significantly associated to both male gender in subjects younger than 9 and enuresis of the type secondary or mixed. DISCUSSION: Most children with enuresis referred for psychiatric consultation do not present an associated psychiatric disorder. Our results on children with enuresis, in a clinical sample, are similar to those of previous studies conducted in the general population. This may mean that these patients are sent to child psychiatry services for reasons of traditional health delivery uses rather than for their psychopathological characteristics.

Child↗