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Night-time diuresis pattern in children with and without primary monosymptomatic nocturnal enuresis.
J Pediatr Urol. 2019 May; 15(3):229.e1-229.e8.JP

Abstract

INTRODUCTION

Night-time polyuria as the dominating pathophysiological mechanism for primary monosymptomatic nocturnal enuresis (PMNE) has been put in question with nocturnal detrusor overactivity and high arousal thresholds as alternatives. An earlier finding of night-time polyuria in 12% of healthy non-enuretic schoolchildren underscores that excessive night-time diuresis per se is unlikely the major cause of PMNE.

OBJECTIVE

The objective of this study was to compare the night-time diuresis pattern in children with and without PMNE and to evaluate the role of night-time polyuria in provoking enuretic episodes in children with PMNE.

STUDY DESIGN

Night-time diuresis pattern was recorded in 27 children with PMNE, aged 6-15 years, and 29 non-enuretic children, aged 6-13 years. Using a portable ultrasound recorder, the bladder volume was estimated at 15-min intervals for at least three nights with the child sleeping in its own bed at home. The volume of enuretic episodes was controlled using preweighed diapers. All voids were registered by time and volume. Diuresis during night time was estimated from the slope of regression lines fitted to ultrasound recording points. Mean night-time diuresis was calculated from total urine production during the night and time interval from the last void before bedtime to the first morning void.

RESULTS

Night-time bladder filling pattern was recorded from 189 nights, giving 149 interpretable patterns for analysis (77 children with PMNE and 72 dry children). The night-time diuresis pattern was similar for children with or without PMNE, showing large variability between different nights of the same child. Most nights displayed a smooth bladder filling at constant low rate, whereas other nights showed an early phase with high diuresis followed by a longer period of low diuresis with no difference between the two groups.

DISCUSSION

Night-time diuresis has been non-invasively monitored in children while asleep in their own beds at home. The pattern of night-time diuresis varies considerably between different nights of the same child, with no obvious differences in any diuresis parameters between children with or without PMNE.

CONCLUSION

Non-enuretic children have similar diuresis pattern and maximal night-time diuresis values as children with PMNE, making it unlikely that PMNE is caused by night-time polyuria per se (Summary figure). Delayed maturation of sleep mechanisms such as decreased arousability or sleep inhibition of the micturition reflex is more likely to be the main etiology for enuresis.

Authors+Show Affiliations

H.K.H. Crown Princess Victoria´s Hospital for Children and Youth and Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, SE 58185 Linköping, Sweden. Electronic address: sven.mattsson@regionostergotland.se.H.K.H. Crown Princess Victoria´s Hospital for Children and Youth and Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, SE 58185 Linköping, Sweden. Electronic address: dorota.persson@regionostergotland.se.H.K.H. Crown Princess Victoria´s Hospital for Children and Youth and Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, SE 58185 Linköping, Sweden. Electronic address: gunilla.glad.mattsson@liu.se.H.K.H. Crown Princess Victoria´s Hospital for Children and Youth and Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, SE 58185 Linköping, Sweden. Electronic address: sivert.lindstrom@liu.se.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

30857839

Citation

Mattsson, S, et al. "Night-time Diuresis Pattern in Children With and Without Primary Monosymptomatic Nocturnal Enuresis." Journal of Pediatric Urology, vol. 15, no. 3, 2019, pp. 229.e1-229.e8.
Mattsson S, Persson D, Glad Mattsson G, et al. Night-time diuresis pattern in children with and without primary monosymptomatic nocturnal enuresis. J Pediatr Urol. 2019;15(3):229.e1-229.e8.
Mattsson, S., Persson, D., Glad Mattsson, G., & Lindström, S. (2019). Night-time diuresis pattern in children with and without primary monosymptomatic nocturnal enuresis. Journal of Pediatric Urology, 15(3), e1-e8. https://doi.org/10.1016/j.jpurol.2019.02.002
Mattsson S, et al. Night-time Diuresis Pattern in Children With and Without Primary Monosymptomatic Nocturnal Enuresis. J Pediatr Urol. 2019;15(3):229.e1-229.e8. PubMed PMID: 30857839.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Night-time diuresis pattern in children with and without primary monosymptomatic nocturnal enuresis. AU - Mattsson,S, AU - Persson,D, AU - Glad Mattsson,G, AU - Lindström,S, Y1 - 2019/02/13/ PY - 2018/10/23/received PY - 2019/02/02/accepted PY - 2019/3/13/pubmed PY - 2020/6/5/medline PY - 2019/3/13/entrez SP - 229.e1 EP - 229.e8 JF - Journal of pediatric urology JO - J Pediatr Urol VL - 15 IS - 3 N2 - INTRODUCTION: Night-time polyuria as the dominating pathophysiological mechanism for primary monosymptomatic nocturnal enuresis (PMNE) has been put in question with nocturnal detrusor overactivity and high arousal thresholds as alternatives. An earlier finding of night-time polyuria in 12% of healthy non-enuretic schoolchildren underscores that excessive night-time diuresis per se is unlikely the major cause of PMNE. OBJECTIVE: The objective of this study was to compare the night-time diuresis pattern in children with and without PMNE and to evaluate the role of night-time polyuria in provoking enuretic episodes in children with PMNE. STUDY DESIGN: Night-time diuresis pattern was recorded in 27 children with PMNE, aged 6-15 years, and 29 non-enuretic children, aged 6-13 years. Using a portable ultrasound recorder, the bladder volume was estimated at 15-min intervals for at least three nights with the child sleeping in its own bed at home. The volume of enuretic episodes was controlled using preweighed diapers. All voids were registered by time and volume. Diuresis during night time was estimated from the slope of regression lines fitted to ultrasound recording points. Mean night-time diuresis was calculated from total urine production during the night and time interval from the last void before bedtime to the first morning void. RESULTS: Night-time bladder filling pattern was recorded from 189 nights, giving 149 interpretable patterns for analysis (77 children with PMNE and 72 dry children). The night-time diuresis pattern was similar for children with or without PMNE, showing large variability between different nights of the same child. Most nights displayed a smooth bladder filling at constant low rate, whereas other nights showed an early phase with high diuresis followed by a longer period of low diuresis with no difference between the two groups. DISCUSSION: Night-time diuresis has been non-invasively monitored in children while asleep in their own beds at home. The pattern of night-time diuresis varies considerably between different nights of the same child, with no obvious differences in any diuresis parameters between children with or without PMNE. CONCLUSION: Non-enuretic children have similar diuresis pattern and maximal night-time diuresis values as children with PMNE, making it unlikely that PMNE is caused by night-time polyuria per se (Summary figure). Delayed maturation of sleep mechanisms such as decreased arousability or sleep inhibition of the micturition reflex is more likely to be the main etiology for enuresis. SN - 1873-4898 UR - https://www.unboundmedicine.com/medline/citation/30857839/Night_time_diuresis_pattern_in_children_with_and_without_primary_monosymptomatic_nocturnal_enuresis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1477-5131(19)30040-3 DB - PRIME DP - Unbound Medicine ER -