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Bladder wall thickness and urodynamic correlation in children with primary nocturnal enuresis.

By S. Charalampous, N. Printza, H. Hashim, M. Bantouraki, V. Rompis, E. Ioannidis, and F. Papacristou.

 Journal of Pediatric Urology, Volume 9, Issue 3, June 2013, Pages 334-338

Editor's comments:
Bladder wall thickness and urodynamic correlation in children with nocturnal enuresis.The title of this article suggests that there is a correlation between bladder wall thickness and bedwetting symptoms. However, the so-called increased bladder wall thickness in the so-called overactive bladder group is “only” 2.4mm, whereas in other published references, a threshold of 7mm is described. In addition, it should not be taken for granted that every child with (night-time) bedwetting symptoms should undergo a urodynamic investigation (during the day). And as in previous studies with “natural fill continuous night-time” urodynamic studies, 1/3 patients showed to have a night-time overactive bladder. The authors of this study suggest that bladder wall thickness should be considered as a screening tool for an overactive bladder [8].



To investigate the correlations between ultrasonographic bladder wall thickness (BWTh) and urodynamic study (UDS) findings and estimate the diagnostic value of BWTh for prediction of DO in children with monosymptomatic and non-monosymptomatic primary nocturnal enuresis (PNE).

Patients and methods
Ultrasound measurements (US) and UDS were performed on a total of 100 children, 50 consecutive boys and 50 consecutive girls, 6–14 years old, with monosymptomatic PNE (group 1, n = 75), and non-monosymptomatic PNE (group 2, n = 25). The US Protocol was specially designed for the evaluation of BWTh. All children underwent urodynamic studies for detailed assessment of any underlying bladder overactivity. Findings were compared between the two groups of patients.

The mean BWTh was increased in the group 2 compared to the group 1 (mean ± SD = 2.4 ± 0.41 mm, mean ± SD = 1.52 ± 0.18 mm respectively, p < 0.05). Detrusor overactivity (DO) occurred in 23/75 (30.5%) children of the group 1 and in 17/25 (68%) children of the group 2 (p < 0.05). Comparing the BWTh between the two groups of patients and the UDS findings, it was found that BWTh was significantly correlated with DO(r = 0.92 and p < 0.001), children with DO presented significantly increased BWTh compared to those without (mean ± SD = 2.1 ± 0.4 mm, mean ± SD = 1.5 ± 0.4 mm respectively, p < 0.05) and the maximum amplitude of DO occurred in 20 children who had non-monosymptomatic PNE.

We suggest that BWTh could be applied as a screening tool to identify the cases of DO between the children with PNE. Children with non-monosymptomatic PNE presented increased BWTh and higher percentages of DO.


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Consensus Guidelines

Practical consensus guidelines for the management of enuresis. 
Evaluation and management of enuresis, a common condition, is not a priority in training programs for medical doctors (MDs), despite being a common condition.