Improvement of night time bedwetting after adenotonsillectomy in children
Thursday, 24 September 2009- A. Gokce and colleagues (Hatay, Turkey) investigated the prevalence of nocturnal enuresis (NE) or night time bedwetting in children who were diagnosed with obstructive sleep apnea syndrome (OSAS) and the rate of resolution or improvement in NE following adenotonsillectomy.
They presented their results, which won the 3rd Richard Wolf Prize for Best Abstract, at the recent EAU 3rd North Eastern European Meeting (NEEM) held in Szczecin, Poland.
The researchers conducted a retrospective chart review of 541 patients who underwent adenotonsillectomy for OSAS secondary to adenotonsillar hyperplasia between January 2005 and January 2009. A total of 398 patients between the ages of 5 and 18 years at the time of surgery were included in 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 mouth breathing.
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: How frequently did your child wet the bed before surgery? And did your child improve after surgery in his/her enuretic episodes? If yes was this a complete stop? Or a partial stop?
The researchers categorised the patients postoperatively into three 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.
The researchers said they 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," the authors concluded.
Source: A. Gokce, S. Aslan, "Improvement of nocturnal enuresis after adenotonsillectomy in children with obstructive sleep apnea syndrome," 3rd Prize for Best Abstract, Richard Wolf Awards, EAU 3rd North Eastern European Meeting (NEEM), 11-12 September 2009, Szczecin, Poland.
