Not only enuresis: do not disregard organic disorders
Keywords:
Enuresis, encopresis, synovial cyst, hydrosyringomyelia, lipoma.Abstract
Nocturnal enuresis (NE) is a common condition in the pediatric age. NE is defined as an intermittent bedwetting with any frequency while sleeping in children. NE is classified into primary form (patient never had achieved nocturnal urinary control) or secondary form (children with a period of 6 consecutive months of night-time urinary control before incontinence, which is generally associated with organic or psychological causes). Moreover, NE could be monosymptomatic (MNE) or non-monosymptomatic (NMNE), depending on the presence of daytime incontinence or any other lower urinary tract symptoms (LUTS).
We report a 7-year- old female with a history of recent onset of sphincter troubles and recurrent low urinary tract infections. She presented urinary urgency associated to daytime incontinence, bedwetting almost every night in the previous 3 months and sometimes encopresis. The physical and neurological examination was silent, no psychological or social problem intercurred. As first approach, she was treated with deamino-delta-D-arginine vasopressin (dDAVP) 120 mcg associated with oxybutynin 5 mg and educational therapy, for 3 months without benefits. So, she underwent a magnetic resonance imaging (MRI) of the spinal cord, that highlighted the presence of hydrosyringomyelia from D6 to D10, lipoma of the terminal filum and the presence of synovial cyst between L5-S1.
This case remarks that in secondary NMNE, any possible organic cause must be investigated.
References
Ferrara P, Franceschini G, Bianchi Di Castelbianco F, Bombace R, Villani A, Corsello G. Epidemiology of enuresis: a large number of children at risk of low regard. Ital J Pediatr. 2020 Sep 11;46(1):128. doi: 10.1186/s13052-020-00896-3.
Ferrara P, Ianniello F, Romani L, Fabrizio GC, Gatto A, Chiaretti A. Five years of experience in nocturnal enuresis and urinary incontinence in children: where we are and where we are going. Urol Int. 2014; 92:223-229. doi: 10.1159/000354388.
Ferrara P, Romano V, Cortina I, Ianniello F, Fabrizio GC, Chiaretti A. Oral desmopressin lyophilisate (MELT) for monosymptomatic enuresis: structured versus abrupt withdrawal. J Pediatr Urol. 2014 Feb;10(1):52-55. doi: 10.1016/j.jpurol.2013.05.021.
Ferrara P, Del Volgo V, Romano V, Scarpelli V, De Gara L, Miggiano GA. Combined dietary recommendations, desmopressin, and behavioral interventions may be effective first-line treatment in resolution of enuresis. Urol J. 2015 Sep 4;12(4):2228-2232. PMID: 26341763
Ferrara P, Costa S, Rigante D, et al. Intramedullary epidermoid cyst presenting with abnormal urological manifestations. Spinal Cord. 2003 Nov;41(11):645-6488. doi: 10.1038/sj.sc.3101482.
Brown BJ, Habelt S, Koral K, Sacco D, Herman JH, Baker LA. Secondary nocturnal enuresis caused by central sleep apnea from Chiari malformation type 1. J Pediatr Urol. 2010 Jun;6(3):265-269. doi: 10.1016/j.jpurol.2009.08.009.
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Copyright (c) 2023 Pietro Ferrara, Giovanna Magli, Elena Malavolta, Emidio Procaccini, Luca Massimi, Antonio Gatto
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