| ObjectiveTwo types of pediatric incontinent, urgency incontinence (UI) and voiding postponement (VP) were evaluated by using urodynamic study.The purposes of present study were:1. To investigate the urodynamic manifestation in children with daytime wetting including UI and VP.2. To analyze the possible causes of pediatric UI and VP.Patients and methodsPatientsA total of 64 children who had the daytime incontinent were involved in present urodynamic study at the urodynamic center in the First Affiliated Hospital of Zhengzhou University from June 2007 to October 2009. The children were aged from 5 to 15 years old (10.7±3.7 years old). The children were divided into two groups, UI and VP, according to symptom. A total of 39 children (10.3±3.9 years old) were diagnosed as UI, the other 25 children (11.3±3.4 years old) were diagnosed as VP. Parameters were recorded in this study including physical examination, X ray, sonography, urodynamics evaluation (uroflowmetry, bladder pressure-volume, static urethral pressure) and urinalysis. Detailed history collections included micturition frequency, voided volume, leakage of urine condition, fecal retention and the family history of enuresis.Research CriteriaChildren under 7 years old with enuresis lasting at least 3-month and frequency at least once every 2 weeks, and children over 7 years old with enuresis frequency at least once a month were included.Children with congenital cerebral dysplasia, organic disease or dysfunctional voiding were excluded.The only child in one family was enrolled in the study when 2 sibs were affected.Group StandardUI was diagnosed as cases of high voiding frequency (greater than 7 per day), urgency and low voiding volume.VP was diagnosed as cases of low voiding frequency (less than 5 per day) and high voiding volume, in addition to a delayed voiding history.Urodynamic StudyThe urodynamic study was performed according to International Continence Society (ICS) standards by using DUTE Logic unit (Medtronic Corporation, Denmark). The urodynamic parameters were voiding volume, maximum flow rate, flow curve shape, bladder compliance and maximum urethral pressure.UltrasoundUsed the DP-8800 Doppler Ultrasound diagnostic (Mndary Corporation, China), with 3.5MHz endoprobe to measure bladder wall thickness. When filling up to 60% maximum bladder capacity, bladder wall thickness was measured by the Ultrasound.Diagnostic Criteria1. The diagnosis of bladder wall thickening:the bladder wall was greater than 2.5 mm or more which was considered pathological.2. Diagnostic criteria of residual urine volume:less than 5 ml which was considered normal.3. The maximum flow rate value:children under 10 years less than 15ml/s, and children over 10 years less than 20ml/s were considered as abnormal. Statistical analysisStatistical analysis was performed with SPSS version 10.0, using T test and ANOVA. Statistical significance was considered asp< 0.05.(A p value of less than 0.05 was considered statistically significant.)ResultsComparing to VP,UI had lower pathological uroflow curves (52%vs36%), higher urinary tract infection (16%vs21%),lower residual urine volume (60%vs41%) and bladder wall thicken (20%vs5%,p<0.05);.There are significantly more children with VP existing low clinical symptoms(p<0.05).The maximum flow rate in children with VP was higher than that in UI (20.20±9.02 vs 14.09±11.56, p<0.05). Maximum urethral pressure between VP and UI was significantly different (152.3±47.5 vs 107.7±40.3, P=0.003<0.05).Conclusion1. VP has the significantly high maximum urethral pressure and maximum flow rate. VP has more bladder wall thickening.2. Daytime wetting children with UI and VP have significantly behavioral symptoms and findings in urodynamic study especially children in VP who was at special risk.
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