Covid19 pandemisinin gölgesinde inkontinans ve enürezis hakkında retrospektif bir çalışma

Öz

Amaçlar: Üriner inkontinans idrarın istemsiz kaçışıyken enürezis ise uykuda idrar kaçırma anlamına gelmektedir. Enürezis ve/veya inkontinans, ailelerin bir hekimin yardımına ihtiyaç duydukları yaygın sorunlardan biridir. Bu çalışmada, Covid19 pandemisinin başlangıcından itibaren peditrik nefroloji polikliniğine enürezis ve/veya inkontinans nedeniyle başvuran hastaları değerlendirmeyi amaçladık. Yöntemler: “Organik olmayan enürezis” ve “Üriner inkontinans” ICD kodlarına sahip hastaları retrospektif olarak değerlendirdik. Hastanemizin tıbbi kayıt sisteminde kayıtlı detaylı anamnezi bulunan 204 hasta çalışma grubu olarak seçildi. Hastaların klinik verilerini, laboratuvar ve görüntüleme testlerini hastaları Grup A (primer enürezis nokturna) ve Grup B (disfonksiyonel işeme, sekonder enürezis, mesane ve barsak disfonksiyonu vb diğer enürezis ve inkontinans tipleri) olarak iki gruba ayırarak karşılaştırdık. Bulgular: 204 hastanın 97’si erkek(%47.5), 107’si kızdı (52.5%). Hastaların ortalama yaşı 9.1 (±3.05) idi. Ortalama tuvalet eğitimi yaşı 2.5 (±0.8) (min-max: 1,5-5) idi. 104 hasta primer enürezis nokturna (%51), 37 hasta (%18.1) disfonksiyonel işeme, 22 hasta (%10.8) sekonder enürezis, 14 hasta (%6.9) enürezis diürna, 12 hasta (5.9%) aşırı aktif mesane olarak tanı aldı. Hastaları Grup A (primer enürezis nokturna) ve Grup B (disfonksiyonel işeme, sekonder enürezis, mesane ve barsak disfonksiyonu vb diğer enürezis ve inkontinans tipleri) olarak iki gruba ayırdık. Grup A’nın ortalama yaşı Grup B ile karşılaştırıldığında anlamlı olarak daha yüksekti (9.57 (± 2.78) vs. 8.67 (±3.27), p=0.036). Grup A’da erkek/kız oranı 61/43 iken Grup B’de erkek/kız oranı 36/64 idi (p<0.001). Aile öyküsü Grup A’da daha belirgindi (%72 vs %31) ( p<0.001). Grup B’de hastaların %25’inde en az bir semptomatik idrar yolu enfeksiyonu öyküsü vardı ve bu oran Grup A’dan anlamlı olarak daha yüksekti (p=0.012). 204 hastanın 109’u kontrole geldi (%53). En az bir kontrol viziti olan hastalar arasında tedavi başarısı oranı Grup A ve B’de sırasıyla %82 ve %72 idi. Sonuç: İnkontinans ve enürezis çocuklarda yaygın görülen sorunlardandır. Nokturnal enürezis ve gündüz inkontinansı arasında özellikleri ve tedavileri açısından belirgin farklılıklar vardır. Enürezis ve inkontinans tedavisi yakın takip gerektirdiğinden genellikle kontrol vizitine ihtiyaç duyarız, ancak hastaların yalnızca %53’ü kontrole geldi. Hastaların ve ailelerinin önemli bir bulaşıcı hastalık ile karşılaştırıldığnda “daha az önemli” görünen bu şikayetler için hastaneye başvurmaktan çekinmiş olabileceği gerekçesiyle bu düşük kontrol oranının, Covid19 pandemisiyle ilişkili olabileceği düşünüldü.

Anahtar Kelimeler

• Covid19
• inkontinans
• enürezis
• alt ıslatma

A retrospective study about incontinence and enuresis in the shadow of Covid19 pandemic

Öz

Aim: Enuresis and/or incontinence are one of the most common problems that families seek professional help. In this study we wanted to evaluate the patients who applied to pediatric nephrology outpatient clinics with enuresis and/or urinary incontinence during Covid19 pandemic. Methods: We retrospectively evaluated the patients with the ICD diagnoses of “Non-organic enuresis” and “Urinary incontinence”. The data regarding two hundred and four patients were analyzed and compared via dividing them into two groups as Group A (Primary enuresis nocturna) and Group B (other enuresis and incontinence types such as dysfunctional voiding, secondary enuresis, bladder and bowel dysfunction etc.). Results: Mean age was significantly higher in Group A when compared with Group B (9.57 (± 2.78) vs. 8.67 (±3.27), p=0.036). In Group A male/female ratio was 61/43, in Group B male/female ratio was 36/64 (p<0.001). Family history was more prevalent in Group A (72% vs 31%) (p<0.001). In Group B, 25% of the patients had a history of at least one symptomatic urinary tract infection, and it is significantly higher than Group A (p=0.012). One-hundred and nine over 204 patients had applied for a control visit (53%). Overall treatment success rate in patients having at least one control visit was 82% and 72% in Group A and B respectively. Conclusions: Urinary incontinence and enuresis are common problems in children. There are certain differences between nocturnal enuresis and day time incontinence in terms of their characteristics and the treatments as well. We usually demand a control visit since the treatment of enuresis and incontinence requires close follow-up, however only 53% of the patients applied for a control visit. This low rate of control visit might be attributed to the Covid19 pandemic since patients and families might have avoided to apply to hospitals with this “less serious” complaints when compared with an important contagious disease.

Anahtar Kelimeler

• Covid19
• enuresis
• incontinence
• bed-wetting

Kaynakça

1. 1. Nieuwhof-Leppink AJ, Schroeder RPJ, van de Putte EM, de Jong TPVM, Schappin R. Daytime urinary incontinence in children and adolescents. Lancet Child Adolesc Health. 2019;3(7):492-501. doi:10.1016/S2352-4642(19)30113-0
2. 2. Austin PF, Bauer SB, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the International Children's Continence Society. Neurourol Urodyn. 2016;35(4):471-481. doi:10.1002/nau.22751.
3. 3. Nevéus T. Nocturnal enuresis-theoretic background and practical guidelines. Pediatr Nephrol. 2011;26(8):1207-1214. doi:10.1007/s00467-011-1762-8
4. 4. Swithinbank LV, Heron J, von Gontard A, Abrams P. The natural history of daytime urinary incontinence in children: a large British cohort. Acta Paediatr. 2010;99(7):1031-1036. doi:10.1111/j.1651-2227.2010.01739.x
5. 5. Yüksel S, Yurdakul AÇ, Zencir M, Çördük N. Evaluation of lower urinary tract dysfunction in Turkish primary schoolchildren: an epidemiological study. J Pediatr Urol.2014;10(6):1181-1186. doi:10.1016/j.jpurol.2014.05.008
6. 6. van Engelenburg-van Lonkhuyzen ML, Bols EM, Benninga MA, Verwijs WA, de Bie RA. Bladder and bowel dysfunctions in 1748 children referred to pelvic physiotherapy: clinical characteristics and locomotor problems in primary, secondary, and tertiary healthcare settings. Eur J Pediatr. 2017;176(2):207-216. doi:10.1007/s00431-016-2824-5
7. 7. Heron J, Grzeda MT, von Gontard A, Wright A, Joinson C. Trajectories of urinary incontinence in childhood and bladder and bowel symptoms in adolescence: prospective cohort study. BMJ Open. 2017;7(3):e014238. Published 2017 Mar 14. doi:10.1136/bmjopen-2016-014238
8. 8. Dahan P, de Bessa J Jr, de Oliveira DM, et al. Association between Asthma and Primary Nocturnal Enuresis in Children. J Urol. 2016;195(4 Pt 2):1221-1226. doi:10.1016/j.juro.2015.10.081

9. 9. Tai TT, Tai BT, Chang YJ, Huang KH. The Importance of Understanding Parental Perception When Treating Primary Nocturnal Enuresis: A Topic Review and an Institutional Experience. Res Rep Urol. 2021;13:679-690. Published 2021 Sep 7. doi:10.2147/RRU.S323926
10. 10. Franco I, von Gontard A, De Gennaro M; International Childrens's Continence Society. Evaluation and treatment of nonmonosymptomatic nocturnal enuresis: a standardization document from the International Children's Continence Society. J Pediatr Urol. 2013;9(2):234-243. doi:10.1016/j.jpurol.2012.10.026
11. 11. Nevéus T, Fonseca E, Franco I, et al. Management and treatment of nocturnal enuresis-an updated standardization document from the International Children's Continence Society. J Pediatr Urol. 2020;16(1):10-19. doi:10.1016/j.jpurol.2019.12.020
12. 12. Haid B, Tekgül S. Primary and Secondary Enuresis: Pathophysiology, Diagnosis, and Treatment. Eur Urol Focus. 2017;3(2-3):198-206. doi:10.1016/j.euf.2017.08.010
13. 13. De S, Teixeira-Pinto A, Sewell JR, Caldwell PHY. Prevalence, patient and consultation characteristics of enuresis in Australian paediatric practice. J Paediatr Child Health. 2018;54(6):620–624. doi:10.1111/jpc.13834
14. 14. Morais J, Soares S, Correia-Costa L, Santos AC, Barreira JL. Determinants of bedwetting trajectories between 4 and 7 years - A birth cohort analysis. J Pediatr Urol. 2021;17(5):647.e1-647.e10. doi:10.1016/j.jpurol.2021.07.031
15. 15. Sullivan S, Joinson C, Heron J. Factors Predicting Atypical Development of Nighttime Bladder Control. J Dev Behav Pediatr. 2015;36(9):724-733. doi:10.1097/DBP.0000000000000229
16. 16. Gkalonaki I, Patoulias I. Dysfunctional elimination syndrome: a short review of the literature. Folia Med Cracov. 2021;61(2):79-90. doi:10.24425/fmc.2021.137225
17. 17. von Gontard A, Mauer-Mucke K, Plück J, Berner W, Lehmkuhl G. Clinical behavioral problems in day-and night-wetting children. Pediatr Nephrol. 1999;13(8):662–667. doi:10.1007/s004670050677
18. 18. von Gontard A, Equit M. Comorbidity of ADHD and incontinence in children. Eur Child Adolesc Psychiatry. 2015;24(2):127-140. doi:10.1007/s00787-014-0577-0
19. 19. Van Herzeele C, De Bruyne P, De Bruyne E, Walle JV. Challenging factors for enuresis treatment: Psychological problems and non-adherence. J Pediatr Urol. 2015;11(6):308-313. doi:10.1016/j.jpurol.2015.04.035
20. 20. Kovacevic L, Wolfe-Christensen C, Rizwan A, Lu H, Lakshmanan Y. Children with nocturnal enuresis and attention deficit hyperactivity disorder: A separate entity?. J Pediatr Urol. 2018;14(1):47.e1-47.e6. doi:10.1016/j.jpurol.2017.07.002
21. 21. Nevéus T. Pathogenesis of enuresis: Towards a new understanding. Int J Urol. 2017;24(3):174-182. doi:10.1111/iju.13310
22. 22. Klausner AP, Steers WD. Corticotropin releasing factor: a mediator of emotional influences on bladder function. J Urol. 2004;172(6 Pt 2):2570-2573. doi:10.1097/01.ju.0000144142.26242.f3
23. 23. Hoebeke P, Van Laecke E, Van Camp C, Raes A, Van De Walle J. One thousand video-urodynamic studies in children with non-neurogenic bladder sphincter dysfunction. BJU Int. 2001;87(6):575-580. doi:10.1046/j.1464-410x.2001.00083.x
24. 24. Chandra M, Saharia R, Shi Q, Hill V. Giggle incontinence in children: a manifestation of detrusor instability. J Urol. 2002;168(5):2184-2187. doi:10.1097/01.ju.0000034703.53145.c3
25. 25. Alqannad EM, Alharbi AS, Almansour RA, Alghamdi MS. Alarm Therapy in the Treatment of Enuresis in Children: Types and Efficacy Review. Cureus. 2021;13(8):e17358. Published 2021 Aug 22. doi:10.7759/cureus.17358
26. 26. Yang S, Chua ME, Bauer S, et al. Diagnosis and management of bladder bowel dysfunction in children with urinary tract infections: a position statement from the International Children's Continence Society. Pediatr Nephrol. 2018;33(12):2207-2219. doi:10.1007/s00467-017-3799-9
27. 27. Borch L, Hagstroem S, Bower WF, Siggaard Rittig C, Rittig S. Bladder and bowel dysfunction and the resolution of urinary incontinence with successful management of bowel symptoms in children. Acta Paediatr. 2013;102(5):e215-e220. doi:10.1111/apa.12158
28. 28. Burgers R, de Jong TP, Visser M, Di Lorenzo C, Dijkgraaf MG, Benninga MA. Functional defecation disorders in children with lower urinary tract symptoms. J Urol. 2013;189(5):1886-1891. doi:10.1016/j.juro.2012.10.064