Acta Pædiatrica ISSN 0803-5253

REGULAR ARTICLE

The impact of a history of childhood nocturnal enuresis on adult nocturia and urgency Shunji Akashi ([email protected])1, Kazue Tomita2 1.Shintoshin Child Clinic, Saitama, Japan 2.Department of Pediatrics, Katushika Medical Center, Jikei University School of Medicine, Tokyo, Japan

Keywords Nocturia, Nocturnal enuresis, Urgency Correspondence Shunji Akashi, Shintoshin Child Clinic, 4-262-10 Matsui Building 4F, Kishiki-cho, Omiya-ku, Saitama-shi, Saitama-ken 330-0843, Japan. Tel: +81-48-648-0260 | Fax: +81-48-648-0260 | Email: [email protected] Received 7 March 2014; accepted 14 May 2014. DOI:10.1111/apa.12694

ABSTRACT Aim: This study examined the association between a childhood history of nocturnal enuresis and nocturia and urgency as an adult.

Methods: A questionnaire was completed by 3649 parents and grandparents of children with nocturnal enuresis. The age range of the respondents was 30–89, and 54% were female. The questionnaire included the respondent’s age, underlying disease, the age at which nocturnal enuresis was resolved and any current nocturia and urgency. Results: The responses enabled us to analyse the risk factors for nocturia and urgency for the total sample, the history of nocturnal eneurisis for 2555 adults aged from 30 to 79 years and the age when nocturnal enuresis resolved for 1300 adults aged from 30 to 49 years. Respondents were significantly more likely to have nocturia and urgency as adults if they had a history of nocturnal enuresis and were aged ≥12 years when their nocturnal enuresis resolved. Conclusion: A childhood history of nocturnal enuresis, particularly nocturnal enuresis that resolved at ≥12 years old, was associated with an increased frequency of adult nocturia and urgency. The impact of previous nocturnal enuresis on adult nocturia and urgency presents a risk that is comparable to ageing and prostatic disease.

INTRODUCTION During adulthood, the frequency and severity of lower urinary tract symptoms (LUTS), including nocturia and urgency, increase with age (1–4). Recent studies have indicated that adult LUTS are associated with bladderrelated problems during childhood (5–9), and it is well known that children with nocturnal enuresis (NE) frequently come from families with a history of NE. In view of this, we conducted a survey of more than 3649 parents and grandparents of children with NE to investigate their history of NE and any current issues with nocturia and urgency. The findings enabled us to establish the impact of a history of NE on adult nocturia and urgency.

PATIENTS AND METHODS The parents and grandparents of children treated for NE, without underlying disease, at our outpatient clinics between July and August 2012 were informed of the purpose, methods and publication of this study. They were told that participation was voluntary and that participation or nonparticipation would not affect the child’s current treatment. They were also assured that any information they

provided would be in the strictest confidence. A total of 4195 parents and grandparents of 863 children with NE were contactable and provided informed consent (Fig. 1). They completed a questionnaire that provided details on their current age, presence or absence of underlying disease, the age when NE resolved and any current issues with nocturia and urgency. If they provided imprecise data on their age when NE was resolved, we confirmed this when we collected the forms. When we excluded the incomplete questionnaires, we had 3649 valid responses from 1695 men and 1954 women aged between 30 and 89 years of age. Adults aged between 80 and 89 years were excluded because only a small number of respondents did not have

Key notes 



 Abbreviations LUTS, Lower urinary tract symptoms; NE, Nocturnal enuresis.

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This study examined the association between childhood nocturnal enuresis (NE) and nocturia and urgency as an adult. A survey of 3649 adults with NE showed that they were significantly more likely to have nocturia and urgency if they had a history of NE and were aged ≥12 years when it resolved. The impact of previous NE on adult nocturia and urgency presents a comparable risk to ageing and prostatic disease.

©2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014 103, pp. e410–e415

Akashi and Tomita

Childhood nocturnal enuresis and adult urinary problems

Figure 1 Flow diagram of the questionnaire-based survey study.

underlying diseases. This left us with 2555 responses from parents and grandparents without underlying disease on the frequency of nocturia and urgency frequency based on historical NE. The responses came from 1124 men and 1431 women aged between 30 and 79 years. We separated these adults into two groups: those with a history of NE and those without a history of NE. We were able to analyse the frequency of nocturia and urgency, based on a precise age at resolution of NE, in 1300 adults aged between 30 and 49 years without underlying disease. The sample comprised 598 men and 702 women. These adults were also divided into four age groups: under 6 years of age, 6 to 8 years of age, nine to 11 years of age and 12 years or above. The risk factor analysis for adult nocturia and urgency included all 3649 respondents. Multivariate logistic regression analyses were performed using age, history of NE and underlying diseases. The odds ratios (OR) and 95% confidence intervals (CI) are shown in Table 4. The history of NE group included respondents who had NE after 6 years of age, with NE defined as: bedwetting one

or more nights a month, nocturia of one of more void per night and presence of urgency or urgency to urinate one or more days per week. To protect the respondent’s personal information, the questionnaires were collected in separate envelopes. The forms were coded with a serial number unique to this study, for entry and analysis. The ethics committee of the Jikei University School of Medicine approved the study protocol (approval number 24-0566822). Frequencies were compared using chi-square tests, and risk factors were analysed using logistic regression models with SAS version 9.1.3 (SAS Institute Inc., Cary, NC, USA). p < 0.05 was considered significant.

RESULTS Table 1 shows the number of respondents with valid responses by age, sex and the presence of underlying disease. The common underlying diseases that affected LUTS were diabetes mellitus, hypertension, prostatic diseases and neurological diseases. Table 2 shows the

©2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014 103, pp. e410–e415

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Childhood nocturnal enuresis and adult urinary problems

Akashi and Tomita

Table 1 Number of respondents with valid responses to the questionnaire-based survey about their history of nocturnal enuresis and current nocturia and urgency, compared by those with underlying disease and those without 30–39

40–49

50–59

60–69

70–79

80–89

Total

Age (years)

Men

Women

Men

Women

Men

Women

Men

Women

Men

Women

Men

Women

Respondents with underlying disease Respondents without underlying disease Total

11 230 241

22 334 356

53 379 432

26 374 400

20 93 113

15 105 120

152 213 365

219 382 601

265 209 474

204 236 440

43 27 70

18 19 37

Men

Women

544 1151 1695

504 1450 1954

Underlying diseases: diabetes mellitus, hypertension, prostatic diseases, neurological diseases and other diseases.

Table 2 Frequency of nocturia and urgency in adults without underlying disease aged 30–79 years, comparing those with a history of NE and those with no history of NE History of nocturnal enuresis

Age group (years)

Absent + Present

Men 30–39 + 40–49 + 50–59 + 60–69 + 70–79 + Women 30–39 + 40–49 + 50–59 + 60–69 + 70–79 +

Nocturia

Urgency

≥1 void/night

N

Mean age (years) M (SD)

94 136 180 199 47 46 134 79 143 66

36.7 36.7 44.6 44.7 54.7 54.2 66.0 66.0 74.5 75.0

(2.1) (2.1) (2.5) (2.7) (3.5) (3.3) (2.5) (2.7) (2.7) (2.8)

0 12 5 22 5 16 37 38 47 48

(0.0) (8.8) (2.8) (11.1) (10.6) (34.8) (27.6) (48.1) (32.9) (72.7)

188 146 233 141 71 34 300 82 182 54

36.2 36.3 44.3 43.6 55.3 54.9 65.0 65.0 74.1 74.1

(2.5) (2.4) (2.4) (2.1) (3.4) (3.8) (2.6) (2.6) (2.3) (2.7)

0 10 2 16 4 10 46 39 48 36

(0.0) (6.8) (0.9) (11.3) (5.6) (29.4) (15.3) (47.6) (26.4) (66.7)

N (%)

≥2 voids/night p

∗∗

∗∗

∗∗

∗∗

∗∗

∗∗

∗∗

∗∗

∗∗

∗∗

N (%)

0 6 0 9 1 7 8 18 9 31

(0.0) (4.4) (0.0) (4.5) (2.1) (15.2) (6.0) (22.8) (6.3) (47.0)

0 6 1 8 1 6 15 19 12 17

(0.0) (4.1) (0.4) (5.7) (1.4) (17.6) (5.0) (23.2) (6.6) (31.5)

≥1 day/7 days p



∗∗



∗∗

∗∗

∗∗

∗∗

∗∗

∗∗

∗∗

N (%)

1 10 2 9 0 5 3 10 10 13

(1.1) (7.4) (1.1) (4.5) (0.0) (10.9) (2.2) (12.7) (7.0) (19.7)

5 19 7 18 3 6 25 19 18 15

(2.7) (13.0) (3.0) (12.8) (4.2) (17.5) (8.3) (23.2) (9.9) (27.8)

p







∗∗

∗∗

∗∗

∗∗



∗∗

∗∗

N, Number of respondents; M, Mean; SD, Standard deviation. ∗∗p < 0.01; ∗p < 0.05 (chi-square tests); comparisons between the respondents with and without a history of nocturnal enuresis by age group.

frequency of nocturia and urgency among the 2555 adult respondents without underlying disease, by history of NE, age and sex. Age distribution did not differ significantly between the groups with history of NE and no history of NE. The frequency of nocturia, urgency and severe nocturia, defined as two or more voids a night, was significantly higher in both sexes in the history of NE group. Table 3 shows the frequency of nocturia and urgency among the 30-year-old to 49-year-old adults without underlying disease, broken down into the four age groups covering when NE was resolved. The age distribution did not differ significantly between the four groups. Although the frequency of nocturia and urgency did not show marked variations in the adults with a history of NE, and a resolution of NE at between six and 11 years of age, the

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frequency of both significantly increased in those whose NE resolved when they were 12 years old or more. Table 4 shows the multivariate analyses results regarding the risk factors for adult nocturia and urgency in all respondents with a history of NE and valid responses for age and underlying diseases. In men, history of NE was a risk factor for nocturia (OR, 3.832 [95% CI, 3.014–4.871]) and urgency (OR, 2.669 [95% CI, 1.842–3.868]) that was at a comparable level to ageing and prostatic disease. In women, a history of NE was a risk factor for nocturia (OR, 4.097 [95% CI, 3.260–5.150]) and urgency (OR, 3.840 [95% CI, 2.870– 5.140]) at a comparable level to ageing. Thus, a history of NE played a more significant role than underlying diseases such as diabetes mellitus, hypertension and neurological diseases.

©2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014 103, pp. e410–e415

Akashi and Tomita

Childhood nocturnal enuresis and adult urinary problems

Table 3 Frequency of nocturia and urgency in adults without underlying disease aged 30–49 years, according to the age when nocturnal enuresis was resolved Nocturia (≥1 void/night)

Resolution age of nocturnal enuresis (years) Men

The impact of a history of childhood nocturnal enuresis on adult nocturia and urgency.

This study examined the association between a childhood history of nocturnal enuresis and nocturia and urgency as an adult...
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