Behavioral Comorbidity Differs In Subtypes Of Enuresis And Urinary Incontinence

Main Category: Urology / Nephrology
Article Date: 25 Feb 2008 - 0:00 PDT

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UroToday.com - A study out of Saarland, Germany in the January 2008 issue of The Journal of Urology by Zink, et al on behavioral comorbidity found in enuresis was performed in a prospective manner. The groups aim was to assess the rates of psychiatric comorbidities in children with enuresis. Their hypothesis was stated that even in a highly selected group of children referred to tertiary centers, those with monosymptomatic nocturnal enuresis would be the group with the lowest rate of comorbid psychiatric disorders and behavioral problems.

Over a two year period a total of 166 consecutive children between the ages of 5.1 to 16.4 years old were evaluated with a detailed history, pediatric examination, 24 to 48-hour voiding protocols, sonography, and uroflow. Parents reviewed and filled out the Child Behavior Checklist, a standardized parental questionnaire consisting of 113 problem items. The sample consisted of 111 boys and 55 girls. 97 children (58%) wetted at night, of whom 45 (46%) had monosymptomatic nocturnal enuresis. The remaining of these children had non-monosymptomatic nocturnal enuresis. A total of 69 children were wet during the day and of these 69 children, 86% had daytime incontinence and noctural enuresis with another 14% having daytime incontinence only. A total of 23 children had urinary incontinence and 36 had urinary hesitancy. The Child Behavior Checklist questionnaires were obtained in 141 children which is 85% of the sample size. A total of 56 children (40%) had total T values in the clinical range.

The group found that in the full sample externalizing disorders were more than twice as common as internalizing disorders. Children with monosymptomatic nocturnal enuresis showed fewer internalizing disorders and lower rates of at least 1 ICD-10 psychiatric diagnosis and comorbid encopresis compared to those with non-monosymptomatic nocturnal enuresis, urge incontinence, and holding maneuvers. The results of sonography and uroflow measures also differed between groups with the non-monosymptomatic children showing worse results.

The group concluded and did answer their hypothesis that different subtypes of enuresis and urinary incontinence demonstrates differences in behavioral problems and psychiatric comorbidities. They found the highest rates of psychiatric comorbidity in the group of children with what they called voiding postponement and the lowest were in children with monosymptomatic nocturnal enuresis. They go on to further recommend screening for comorbid psychiatric disorders with children who have enuresis and urinary incontinence if they were not diagnosed previously.

Zink S, Freitaga CM, von Gontarda A.

J Urol. 179(1): 295-298, January 2008
doi: 10.1016/j.juro.2007.09.007

Reported by UroToday.com Medical Editor Pasquale Casale, MD

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