The paediatric urology division has remained at the forefront of urological care by performing extensive endourology and also reconstructive surgery, especially with children born with extrophy of the bladder. Short hospital stay, good post-operative analgesia and care, and excellent results have made our hospital one of the institutions of choice for this speciality.
There could be several causes for MNE in children:
Urodynamic Findings: Bladder instability does not occur in children with MNE at a higher rate than in normal subjects, and in most enuretics, unstable contractions are not the cause for bed-wetting. Consequently, therapy for eliminating uninhabited contractions is generally ineffective. However, the single most important observation in MNE is a reduced bladder capacity. This reduction is functional and not anatomic. It is not the cause for enuresis, although it often increases coincidentally with cure. Those children who have diurnal symptoms of frequency, urgency or even incontinence, will have bladder instability.
Sleep Factors: Sleep patterns of enuretics are not different from those of normal children. Most enuretics neither have a disorder of arousal nor wet as a consequence of sleeping too deeply. Instead, findings support the concept that enuresis is related to a delay in CNS development, or more accurately, a dual delay in the development of perception and inhibition of filling and contraction of the bladder by the CNF.
Alteration in Vasopressin Secretions: About 50% less urine is normally excreted during the night than during the day. In many children with enuresis, the circadian rhythm of plasma vasopressin secretion is altered, with no decrease in AVP during the night. This causes them to produce larger amounts of dilute urine at night. Administration of vasopressin will be helpful only in those children in whom this increased nocturnal urine output has been documented. Studies indicate that the circadian rhythm of AVP matures over time, and it indicates that enuresis associated with AVP-induced nocturnal polyuria may simply represent another manifestation of developmental delay.
Developmental Delay: All the seemingly unrelated alterations in urodynamic function, sleep, AVP secretion, etc., that have been mentioned above, all occur normally in infants and young children and actually represent a varied expression of neurophysiological immaturity. In most children, MNE represents a delay in development, and each of these physiological alterations tends to improve with time, and to resolve spontaneously.
Organic Urinary Tract Disease: Most children with MNE do not have an organic urinary tract cause for their wetting. The incidence of an organic urinary tract cause is less than 0.4%. MNE should be distinguished from enuresis associated with daytime symptoms. Such children, especially boys, should undergo urinary tract imaging with an ultrasound to search for signs of possible obstruction.
A detailed history, physical examination and a urine analysis are sufficient for most children with primary MNE. The goal is to identify those children who require further study. History of urinary tract infection, diurnal symptoms, obstructive symptoms or certain signs of neuropathy must be pursued. In their absence, there is generally no indication for radiographic study or cystoscopy.
Vesicoureteral Reflux (VUR) in Children: About 1% of children in the world have VUR. It results when the connection between the bladder and the ureter is not normal. The lower part of the ureter tunnels through the muscle of the bladder (valve mechanism). If this tunnel is too short, VUR occurs. Behaviors such as infrequent or incomplete urination and related constipation are also associated with VUR.
Urine is made in the kidneys. Normally, it only flows one way - down the ureters and into the bladder. VUR occurs when urine flows back to a kidney from the bladder, through the ureters. This can happen on either or both sides.
Your doctor can tell you how serious your child's VUR is, with a grading scale obtained by conducting an MCU. This scale ranges from Grade 1 (mild) to Grade 5 (severe). Most of the time, mild VUR will go away by itself. However, the more severe the VUR, the less likely is the possibility that it will go away on its own.
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