Introduction and Objectives
To investigate the prevalence of nocturnal enuresis (NE) in children who diagnosed with obstructive sleep apnea syndrome (OSAS) and the rate of resolution or improvement in NE following adenotonsillectomy.
Material and Methods
Retrospective chart review of 541 patients who underwent adenotonsillectomy for OSAS secondary to adenotonsillar hyperplasia between January 2005 and January 2009 was performed. 398 patients between the ages of 5 and 18 years at the time of surgery were included into the study. After chart review, families were contacted by phone call. The parents of each child was asked about preoperative presence or absence of NE and postoperative symptoms, including the presence or absence of snoring, witnessed apnea, restless sleep, drooling, and mouthbreathing. Only patients diagnosed with primary enuresis were included in this study. The following questions were asked to the parents of the patients who had preoperative symptoms of enuresis:
- 1.How frequently did your child wet the bed before surgery?
- 2.Did your child improve after surgery in his/her enuretic episods? If yes was this:
- 2.1.A complete stop?
- 2.2.A partial stop?
We categorized the patients postoperatively into 3 groups:
- 1.Patients with complete resolution of nocturnal enuresis.
- 2.Patients with partial improvement.
- 3.Patients with no change in their complaints.
Partial improvement was defined as a minimum of 50% decrease in the frequency of bedwetting recorded preoperatively. All data were collected between November 2008 and May 2009. The chisquared test was used to compare the prevalence of NE before and after surgery.
Of the 398 patients 98 were excluded from the study because of incomplete records. The incidence of NE in the entire study group (n = 300) before adenotonsillectomy was 30.7% (92 patients). Among the 92 patients, 64 (69.6%) were male, and 28 (30.4%) were female (p = 0.001). In 46 patients who agreed to participate in the study 26 (56.5%) had complete resolution, 8 (17.4%) had a partial improvement and 12 (26.1%) had no change in NE following adenotonsillectomy. We observed a partial improvement or complete resolution of NE in 73.9%. To define whether the results related to enuresis were statistically significant, a chi-square test for equal proportions was performed. The chi-square value was found to be 13.131 resulting in p < 0.0001. Resolution of OSA symptoms was observed in 100% of these patients postoperatively.
Children with OSA symptoms have a high rate of NE. We have demonstrated that relief of OSA symptoms will also result in complete resolution or partial improvement of NE in more than two-thirds of patients. In the differential diagnosis of a child presenting with NE, OSAS should be kept in mind and the presence of NE should be investigated in a child presenting with OSA symptoms.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.