UROLOGICAL APPROACH TO ENURESIS NOCTURNA II. Cystometric Findings Keiji Takatsuka, Shin-ichi Miyamoto and Takahiro Tamiya Department of Urology, Sunag

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1 UROLOGICAL APPROACH TO ENURESIS NOCTURNA II. Cystometric Findings Keiji Takatsuka, Shin-ichi Miyamoto and Takahiro Tamiya Department of Urology, Sunagawa Municipal Hospital Department of Urology, Sapporo Medical College* *(Director: Prof. Y. Kumamoto) Cystometric findings of 105 enuresis nocturna children, all cases primary and functional, were analyzed. 69% of the cases showed uninhibited contractions, that is, unstable bladders. In 11% of the cases unstable pattern was provocated by bethanecol injection. The remaining 20% were with stable bladders. Enuresis of nocturnal-diurnal type showed unstable patterns more frequently than that of nocturnal type. In older children, over 12 years, unstable bladders were less frequent than in younger. Bladder capacity in enuretic children increased with age, but was estimated to be smaller than in normal children of comparable ages. Bladder capacities were smaller in unstable bladders than in stable ones. Voiding pressure in boys was higher than that in girls. Voiding pressure in unstable bladders was higher than that in stable bladders. Based on the above data, we insisted that the cystometry was the important means for investigation of etiology and planning of treatment for nocturnal enuresis.

2 Table 1 Summary of clinical and cystometric findings in 105 enuretic children.

3 Fig. 1 Age and sex distribution of enuretic children. *Pattern I-III-b: see Fig. 2 **BC: Cystometric bladder capacity (ml) *** MVP: Maximum voiding pressure (mmhg) **** EN: Enuresis nocturna e, every night, n-e, not every night, dry at least once a week ***** ED: Enuresis diurna

Fig. 2 Type of cystometrogram in nocturnal enuresis. A, Type I Case 18, 14 years girl. Normal cystometrogram. No uninhibited contraction (UIC) and normal bladder capacity.

4 Fig. 2 Type of cystometrogram in nocturnal enuresis. A, Type I Case 18, 14 years girl. Normal cystometrogram. No uninhibited contraction (UIC) and normal bladder capacity. B, Type 11 Case 28, 10 years boy. Normal pattern at the first examination (1). UIC was provocated and capacity was reduced by Besacholin injection (2). C, Type 111-a Case 50, 9 years boy. bladder, mild. Mild UIC and rather small capacity (1). Marked reduction of capacity by Besacholin injection (2). D, Type III -b Case 102, 11 years girl. Unstable bladder, severe. Heavy UIC and considerably small capacity. E, Case 102. UIC was suppressed by Buscopan(R) injection.

6 Table 2 Structure of data analysis (Variance analysis) **: p<o. 01, *: 0. 01<p<0. 05, : p>0. 05 Fig. 3 Overall distribution of cystometric pattern in enuretic children. See the notation of Fig. 2.

7 Fig. 4-a Symptoms and age. Fig. 5-a Cystometric pattern and age. Fig. 4-b Enuresis diurna and age. Fig. 5-b Enuresis nocturna and cystometric patterns

8 Fig. 6-a Age and bladder capacity in enuretic children. 95% C. L.+16m1 Fig. 6-b Bladder capacity in two types of enuresis. 95% C. L. +10ml Fig. 7 Bladder capacities of enuretic children compared with voiding volumes of normal children. Fig. 6-c Cystometric patterns and bladder capacity. 95% C. L.+15ml

9 Fig. 8 Voiding pressure and cystometric pattern in enuretic children. O-e male, O-Ofemale. 95% C. L mmHg

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Fig. 1 Clinical findings and extent of inflammation area in female urethrocystitis Fig. 2 Classification and distribution of female patients with blad

Key words: Female with bladder irritability, Subjective symptoms, Pyuria, Bacteriuria Fig. 1 Clinical findings and extent of inflammation area in female urethrocystitis Fig. 2 Classification and distribution