Re: Prevalence and associated factors of enuresis in Turkish children

LETTER TO THE EDITOR

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: [e-mail]

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.

Re: Prevalence and associated factors of enuresis in Turkish children

Cuneyt Ozden; Ozdem L. Ozdal; Serkan Altinova; Ibrahim Oguzulgen; Guvenc Urgancioglu; Ali Memis

Publication Dates

• Publication in this collection
  29 Aug 2007
• Date of issue
  June 2007