enuresis
Introduction
Introduction to enuresis Enuresis is commonly known as bedwetting, which usually means that children involuntarily urinate when they are asleep. Generally, only 20% have enuresis when they are 4 years old, and 5% have enuresis when they are 10 years old. There are a few patients with enuresis that lasts into adulthood. Those with no obvious urinary tract or neurological organic lesions are called primary enuresis, accounting for 70% to 80%. Secondary to secondary urinary tract obstruction (such as urethral valve), cystitis, neurogenic bladder (neuropathic dysfunction caused by neuropathy) and other diseases called secondary enuresis, in addition to night bedwetting, children often have Frequent urination, urgency or difficulty urinating, fine urine flow and other symptoms. basic knowledge Probability ratio: Susceptible people: children Mode of infection: non-infectious Complications: recessive spina bifida, renal medullary cystic disease
Cause
Cause of enuresis
Genetic factors (25%):
Enuresis has obvious genetic predisposition, and the genetic gene is located on chromosome 22q11. The statistics show that the enuresis of enuresis, single parent enuresis, and enuresis of nobilis are 77%, 44%, and 15%, respectively.
Stunting (15%):
If the brain awakens the central developmental delay, the urinary pattern is completed by the low-level central reflex in infanthood. This child has other developmental delays, the development of the hypothalamus and pituitary gland in children, the nighttime secretion of vasopressin is reduced, and the amount of urine at night is increased. This functional bladder capacity reduction does not match the nocturnal urine volume is an important cause of enuresis.
Urodynamic factors (10%):
Urodynamic examination during sleep showed that 1 / 3 ~ 1/2 children with extremely active bladder, frequent autopsy and large amplitude, this unstable bladder can further reduce the functional bladder capacity of children.
Secondary factors (8%):
Secondary to urinary tract infections or obstructions such as posterior urethral valve disease and annular stenosis.
Nervous system factors (5%):
The development of the patient's body or disease leads to abnormal neurological function.
Psychological factors (3%):
Something that the patient encounters causes psychological stress.
Pathogenesis
At present, the pathogenesis of enuresis may be caused by the imbalance of neuromodulation between the bladder detrusor and the sphincter. When the detrusor strong contractile force exceeds the sphincter resistance, enuresis may occur, or the bladder sphincter hypoplasia or paralysis may occur. related.
Prevention
Enuresis prevention
Children should be established with a good work schedule and hygiene habits, master the rules of night urination, wake up regularly or use an alarm clock, so that children gradually form a time conditioning, and cultivate children's self-care ability. In addition, a good living environment should be provided to avoid enuresis caused by poor environmental stimuli. When children are facing setbacks and accidents, parents should be good at facilitating and helping children to eliminate psychological tension. When children have enuresis, they should not blame or corporal punishment. They should look for reasons and symptomatic treatment.
When training children to urinate, they must first understand the desire to urinate after "urine" and have an unpleasant feeling after urinating. Children's urination training should be coordinated with their developmental level to guide parents to pay attention to children's response to urination training. If the child refuses, parents should not intervene mandatoryly, and the training time should be postponed appropriately.
Complication
Enuresis complications Complications, recessive spina bifida, medullary cystic disease
Recessive spina bifida, renal medullary cystic disease.
Symptom
Enuresis symptoms Common symptoms Urinary urgency
Enuresis is a special type of urinary incontinence. It refers to the phenomenon of bedwetting caused by the involuntary contraction of the detrusor during sleep. The baby must establish a normal urination control mechanism, and the nervous system needs a certain development time. The length of this time varies from person to person. Statistics show that 5 years old can be used as a general time limit, that is, there are still bedwetting after 5 years old, and the diagnosis of enuresis can be considered. The urodynamic examination is used in the diagnosis and treatment of enuresis. It plays an important role.
Examine
Enuresis check
Generally, the urine routine is normal, and there is no bacterial growth in the urine culture. The content of arginine vasopressin (AVP) secreted by the pituitary gland in the urine during the daytime and nighttime periods is normal, which is increased at night compared with daytime, and its antidiuretic effect makes nighttime Reduced urine output, patients with enuresis due to delayed development of the thalamus and pituitary and no increase in nighttime AVP secretion, so that nighttime urine output increased.
1. B-ultrasound: IVU and urinary bladder urethra angiography, to understand the kidney, ureter and bladder, generally no abnormal findings, no congenital spina bifida and meningocele on the X-ray film.
2. Urodynamic examination: for all patients with suspected neurological diseases, daytime urinary incontinence without pathological changes, pubertal nocturnal enuresis, urinary excretion and defecation incontinence after routine treatment, persistent dysuria after infection control, although continuous Urinary tests should be performed in patients who have been treated with antibiotics but who are still urinary tract infections, and who have urinary bladder angiography showing trabecular ligament formation or sphincter spasm.
Diagnosis
Diagnosis of enuresis
Diagnostic criteria
1. History: To understand the urination during the day and night, age, enuresis (degree and relationship with sleep), urinary tract infection and family history of enuresis, etc., can be divided into three groups:
1 Asymptomatic nocturnal enuresis, no further examination is required.
2 There are infections or obvious neuropathy, which needs further examination.
3 no infection and neurological symptoms, no other urinary abnormalities, anatomical problems should be excluded.
2. Physical examination: whether there is phimosis, the foreskin is too long, the urethral opening is narrow; pay attention to whether there is hair or lipoma in the lumbosacral region, in order to detect the presence or absence of recessive sacral vertebrae, and the spinal canal is incomplete.
Differential diagnosis
1. Urinary incontinence: refers to the loss of control of urine, does not flow freely with subjective will, usually no significant difference between day and night.
2. Esophageal ectopic opening: When the female ureteral ectopic opening, in addition to the normal urinary tract urination, other parts of the urethra can also be found to leak urine, IVU and other tests can be seen urinary system deformity.
