Monosemptomatik ve Monosemptomatik Olmayan Enürezis Arasındaki Klinik ve Laboratuvar Farklılıklar

Öz

Amaç: Bu çalışmada monosemptomatik ve monosemptomatik olmayan enürezis arasındaki farkların klinik ve laboratuvar değişkenleri ışığında belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Bu çalışmada monosemptomatik ve monosemptomatik olmayan enürezis arasındaki farkların klinik ve laboratuvar değişkenleri ışığında belirlenmesi amaçlanmıştır. Bulgular: Bu çalışmaya monosemptomatik enürezisli (MNE) 161 hasta ve monosemptomatik olmayan enürezisli (NMNE) 86 hasta dahil edildi. MNE'li hastalar NMNE'li hastalardan anlamlı olarak daha yaşlıydı (9,0±2,5 ve 7,6±2,4 yıl; p=<0,001). Kızların sayısı hem MNE hem de NMNE grubunda anlamlı olarak daha yüksekti (sırasıyla %32.2'ye karşı %17.4; p=0.046; %54,7'ye karşı %40.4; p=0,032). Hemoglobin düzeyi NMNE grubunda anlamlı olarak daha düşüktü (12.8±0.8 vs 13.4±1.0 g/dl; p=0.05). NMNE grubunda kabızlık ve fekal inkontinans oranı anlamlı olarak daha fazlaydı(sırasıyla %27.9'a karşı %14.2; p=0.009 ve %11.6'ya karşı %1,2; p=0.002). Yukarıda tanımlanan parametreleri kullanan tek değişkenli analizler, nispeten düşük bir ortalama hemoglobin seviyesinin NMNE için bir risk faktörü olduğunu göstermiştir (OR=-0.603, %95 CI 0.346-0.867; p= 0.01). Sonuç: MNE ve NMNE ayırıcı tanısını yapmak ve hastalık seyrinde risk faktörlerini daha erken belirlemek, enürezisli hastaların ilk değerlendirmesinde yapılması gereken temel görevlerdir. Nispeten düşük Hb seviyeleri, NMNE için yeni bir risk faktörü olabilir.

Anahtar Kelimeler

• Monosemptomatik enürezis
• monosemp-tomatik olmayan enürezis
• hemoglobin
• risk faktörü

THE CLINICAL AND LABORATORY DIFFERENCES BETWEEN MONOSYMPTOMATIC AND NONMONOSYMPTOMATIC ENURESIS

Öz

Objective: The present study aimed to determine the differences between monosymptomatic and non-monosymptomatic enuresis in light of clinical and laboratory variables. Material and Methods: We retrospectively reviewed the medical records of pediatric patients with enuresis who were followed up between 2010 and 2021 at XX University Hospital. Results: One hundred and sixty-one patients with monosymptomatic nocturnal enuresis (MNE) and 86 patients with non-monosymptomatic enuresis (NMNE) were enrolled in this study. The patients with MNE were significantly older than the patients with NMNE (9.0±2.5 vs 7.6±2.4 years; p=<0.001). The proportion of females was significantly higher both in the MNE and NMNE groups (32.2% vs 17.4%; p=0.046; 54.7% vs 40.4%; p=0.032 respectively). The hemoglobin level was significantly lower in the NMNE group (12.8±0.8 vs 13.4±1.0 g/dl; p=0.05). The rate of constipation and fecal incontinence were significantly higher in NMNE group (27.9% vs 14.2%; p=0.009, and 11.6% vs 1.2%; p=0.002, respectively.) The univariable analyses using the above-identified parameters showed that a relatively low mean hemoglobin level was a risk factor for NMNE (OR=-0.603, 95% CI 0.346-0.867; p=0.01). Conclusion: Making the differential diagnosis of MNE and NMNE and determining the risk factors earlier in the disease course are essential tasks to be accomplished in the initial evaluation of patients with enuresis. Relatively low Hb levels may be a novel risk factor for NMNE.

Anahtar Kelimeler

• Monosymptomatic enuresis
• non-monosymptomatic enuresis
• hemoglobin
• risk factor

Kaynakça

1. Neveus T, Eggert P, Evans J, Macedo A, Rittig S, Tekgül S et al., International Children’s Continence Society. Evaluation of and treatment for monosymptomatic enuresis: a standardization document from the international children’s continence society. J Urol 2010;183(2):441–7.
2. Nevéus T, von Gontard A, Hoebeke P, Hjälmås K, Bauer S, Bower W et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. J Urol 2006;176(1):314–24.
3. 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(3):341–5.
4. Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P 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. J Urol. 2014;191(6):1863-65.
5. Tekgül S, Stein R, Bogaert G, Nijman RJM, Quaedackers J, 't Hoen L et al. European Association of Urology and European Society for Paediatric Urology Guidelines on Paediatric Urinary Stone Disease. Eur Urol Focus. 2021;26:S2405-4569.
6. Butler RJ, Golding J, Northstone K. Nocturnal enuresis at 7.5 years old: prevalence and analysis of clinical signs. BJU Int. 2005;96(3):404–10.
7. Girisgen I, Avcı E, Yüksel S. Assessment of serum levels of copeptin and corticotropin-releasing factor in children with monosymptomatic and non-monosymptomatic nocturnal enuresis. J Pediatr Urol. 2019.15(4):393-8.
8. Prgomet S, Saraga M, Benzon S, Turudić D, Ledina D, Milošević D. Uroflowmetry in Non-Monosymptomatic Nocturnal Enuresis in Children of Coastal Region of Croatia. Acta Medica (Hradec Kralove). 2020;63(3):113-8.

9. Bakker E, van Sprundel M, van der Auwera JC, van Gool JD,Wyndaele JJ. Voiding habits and in a population of 4332 Belgian schoolchildren aged between 10 and 14 years. Scand J Urol Nephrol 2002;36(5):354–62.
10. Vaz GT, Vasconcelos MM, Oliveira EA, Ferreira AL, Magalhães PG, Silva FM et al. Prevalence of lower urinary tract symptoms in school-age children. Pediatr Nephrol. 2012;27(4):597-603.
11. Motta DM, Victoria CG, Hallal PC. Investigação de disfunção miccional em uma amostra populacional de crianças de 3 a 9 anos. J Pediatr (Rio J) 2005;81(3):225–32.
12. Robinson D, Toozs-Hobson P, Cardozo L. The effect of hormones on the lower urinary tract. Menopause Int. 2013;19(4):155-62.
13. Fritz G, Rockney R, Bernet W, Arnold V, Beitchman J, Benson RS, et al. Work Group on Quality Issues; AACAP. Practice parameter for the assessment and treatment of children and adolescents with enuresis. J Am Acad Child Adolesc Psychiatry. 2004;43(12):1540-50.
14. Loening-Baucke V. Prevalence rates for constipation and faecaland urinary incontinence. Arch Dis Child. 2007;92(6):486-9.
15. Malykhina AP, Brodie KE, Wilcox DT. Genitourinary and gastroin-testinal co-morbidities in children: the role of neural circuits inregulation of visceral function. J Pediatr Urol. 2017;13(2):177-82.
16. Combs AJ, Van Batavia JP, Chan J, Glassberg KI. Dysfunctional elimination syndromes – how closely linked are constipation and encopresis with specific lower urinary tract conditions? J Urol, 2013;190(3):1015-20.
17. Wolfe-Christensen C, Manolis A, Guy WC, Kovacevic N, Zoubi N, El-Baba M et al. Bladder and bowel dysfunction: evidence for multidisciplinary care. J Urol. 2013;190(5):1864-8.
18. Rodríguez-Ruiz M, Mendez-Gallart R, García Mérida M, Somoza-Argibay I. Influence of constipation on enuresis. An Pediatr (Engl Ed). 2021;95(2):108-15.
19. Eneh CI, Ikefuna AN, Okafor HU, Uwaezuoke SN. Nocturnal enuresis in school-aged children with sickle-cell anemia: Any relationship with hyposthenuria? Niger J Clin Pract. 2017;20(2):215-20.
20. Galassi C, De Sario M, Biggeri A, Bisanti L, Chellini E, Ciccone G et al. Changes in prevalence of asthma and allergies among children and adolescents in Italy: 1994–2002. Pediatrics 2006;117(1):34–42.
21. Ripabelli G, Tamburro M, Sammarco ML, de Laurentiis G, Bianco A.. Asthma prevalence and risk factors among children and adolescents living around an industrial area: a cross-sectional study. BMC Public Health. 2013;13:1038.
22. Camfield P, Camfield C. Incidence, prevalence and aetiology of seizures and epilepsy in children. Epileptic Disord. 2015;17(2):117-23.
23. Mabiala Babela JR, Loumingou R, Pemba‑Loufoua A, Londjongo W, Nzingoula S, Senga P. Enuresis in children with sickle cell disease. Arch Pediatr 2004;11(10):1168-72.
24. Jordan SS, Hilker KA, Stoppelbein L, Elkin TD, Applegate H, Iyer R. Nocturnal enuresis and psychosocial problems in pediatric sickle cell disease and sibling controls. J Dev Behav Pediatr 2005;26(6):404-11.
25. Readett DR, Morris J, Serjeant GR. Determinants of nocturnal enuresis in homozygous sickle cell disease. Arch Dis Child 1990;65(6):615‑8.
26. Macnab AJ, Stothers LS, Shadgan B.. Monitoring Detrusor Oxygenation and Hemodynamics Noninvasively during Dysfunctional Voiding. Adv Urol. 2012:676303.
27. Nomiya M, Andersson KE, Yamaguchi O. Chronic bladder ischemia and oxidative stress: new pharmacotherapeutic targets for lower urinary tract