The Effect of Adenotonsillectomy on Pediatric Nocturnal Enuresis: a Prospective Cohort Study

Document Type : Original

Authors

1 Department of Otolaryngology & Head and Neck surgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.

2 Department of Urology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.

3 Research Center for Health Sciences , Department of Epidemiology & Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.

Abstract

Introduction:
Sleep disorder caused by adenotonsillar hypertrophy has been implicated as a cause of primary and secondary nocturnal enuresis in children.  This study was conducted to investigate the effect of adenotonsillectomy on enuresis in children with adenotonsillar hypertrophy.
 Materials and Methods:
This prospective cohort study was conducted in Hamadan City in Western Iran, from April 2010 to December 2011. Ninety-seven children aged 3 to 12 years with adenotonsillar hypertrophy who were admitted to Besat Hospital for adenotonsillectomy were evaluated. The primary outcome was the number of incidents of bedwetting (nocturnal enuresis) post-operation compared with pre-operation. Patients were followed-up for 3 months. Data were collected using a questionnaire regarding number of bedwetting incidents, type of enuresis (primary or secondary), and family history of enuresis, as well as results of urine analysis.
 Results:
Of 420 children admitted for adenotonsillectomy, 97 had a positive history of preoperative enuresis, including 42 girls and 55 boys, with mean age of 48 months. The parents of 84 (86.6%) children agreed to participate in the study. Three months after adenotonsillectomy, enuresis had resolved completely in 51 (60.7%) children and had shown relative improvement in 22 (26.2%) children. Enuresis had not improved in the remaining 11 (13.1%) children (P<0.001).
 Conclusion: 
The results of this study indicate that adenotonsillectomy can improve enuresis in the majority of children with adenotonsillar hypertrophy. However, further evidence based on large multi-center randomized clinical trials is required to confirm these results.

Keywords

References

References
1. Lawless MR, McElderry DH. Nocturnal enuresis: current concepts. Pediatr Rev. 2001; 22(12): 339–407.
2. Forsythe WI, Redmond A. Enuresis and spontaneous cure rate. Study of 1129 enuresis. Arch Dis Child. 1974; 49(4): 259–63.
3. Jalkut MW, Lerman SE, Churchill BM. Enuresis. Pediatr Clin North Am. 2001; 48(6): 1461–88.
4. Akis N, Irgil E, Aytekin N. Enuresis and the effective factors-a case-control study. Scand J Urol Nephrol. 2002; 36(3): 199–203.
5. Brooks LJ, Topol HI. Enuresis in children with sleep apnea. J Pediatr. 2003; 142(5): 515–8.
6. Kaditis AG, Finder J, Alexopoulos EI, Starantzis K, Tanou K, Gampeta S et al. Sleep-disordered breathing in 3,680 Greek children. Pediatr Pulmonol. 2004; 37(6): 499–509.
7. Stone J, Malone PS, Atwill D, McGrigor V, Hill CM. Symptoms of sleep-disordered breathing in children with nocturnal enuresis. J Pediatr Urol. 2008; 4(3): 197–202.
 
8. Weider DJ, Sateia MJ, West RP. Nocturnal enuresis in children with upper airway obstruction. Otolaryngol Head Neck Surg. 1991; 105(3): 427–32.
9. Cinar U, Vural C, Cakir B, Topuz E, Karaman MI, Turgut S. Nocturnal enuresis and upper airway obstruction. Int J Pediatr Otorhinolaryngol. 2001; 59(2): 115–8.
10. Basha S, Bialowas C, Ende K, Szeremeta W. Effectiveness of adenotonsillectomy in the resolution of nocturnal enuresis secondary to obstructive sleep apnea. Laryngoscope. 2005; 115(6): 1101–3.
11. Firoozi F, Batniji R, Aslan AR, Firoozi F, Batniji R, Aslan AR et al. Resolution of diurnal incontinence and nocturnal enuresis after adenotonsillectomy in children. J Urol. 2006; 175(5): 1885–8.
12. Weissbach A, Leiberman A, Tarasiuk A, Goldbart A, Tal A. Adenotonsilectomy improves enuresis in children with obstructive sleep apnea syndrome. Int J Pediatr Otorhinolaryngol. 2006; 70(8): 1351–6.
13. Leiberman A, Stiller-Timor L, Tarasiuk A, Tal A. The effect of adenotonsillectomy on children suffering from obstructive sleep apnea syndrome (OSAS): the Negev perspective. Int J Pediatr Otorhinolaryngol. 2006; 70(10): 1675–82.
14. Kaditis AG, Alexopoulos EI, Hatzi F, Kostadima E, Kiaffas M, Zakynthinos E et al. Overnight change in brain natriuretic peptide levels in children with sleep-disordered breathing. Chest. 2006; 130(5): 1377–84.
15. Potter LR, Yoder AR, Flora DR, Antos LK, Dickey DM. Natriuretic peptides: their structures, receptors, physiologic functions and therapeutic applications. Handb Exp Pharmacol. 2009; 191: 341–66.
16.  Gokاe A, Aslan S, Yalcinkaya FR, Davarci M,  Kaya YS, Savas N, et al. Improvement of monosymptomatic enuresis after  adenotonsillectomy in children with obstructive sleep apnea syndrome. Turk J Med Sci. 2012; 42(5): 757–61.
Iranian Journal of Otorhinolaryngology
Volume 25, Issue 1 - Serial Number 1
January and February 2013
Pages 37-40

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