Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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Pathogenesis of Enuresis: Brain, Sleep Dysfunction and Psychological Effects

야뇨증의 병태생리: 뇌, 수면장애 그리고 정신적 효과

  • 박관진 (서울대학교 의과대학 비뇨기과학교실)
  • Received : 2012.04.13
  • Accepted : 2012.04.22
  • Published : 2012.04.30
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Abstract

The relationship between central nervous system (CNS) and enuresis has not been sufficiently elucidated despite the presence of several circumstantial evidences. Contrary to common belief, polysomnographic sleep analysis revealed that the disturbance of arousal rather than deep sleep was responsible for enuresis. Subsequent studies confirmed depressed sympathetic tone and retarded brainstem reflex indicating abnormal arousal threshold in enuretics. In accordance with the bladder-brain dialogue, chronic stimulation of bladder may modify the brainstem function elevating arousal threshold. Epidemiological studies have suggested the association between enuresis and various psychosomatic disorders like attention deficit hyperactivity disorder (ADHD), which has shown the abnormal brainstem reflex similar to enuresis. Taken together, CNS is assumed to play a crucial role in the pathogenesis of enuresis. Psychological assessment is vital to understand the psychodynamic effect of enuresis. Studies have shown that the prevalence of psychological problems was higher in enuretic children and externalization of the symptoms was usually found. Several explanations have been brought up regarding the development of enuresis and psychological problems. Enuresis may cause psychological problems and vice versa. Otherwise, both may be associated with other variables, such as socioeconomic status (SES).

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References

  1. Wolfish NM. Sleep/Arousal and enuresis subtypes. J Urol 2001;166:2444-7. https://doi.org/10.1016/S0022-5347(05)65612-1
  2. Wolfish NM, Pivik RT, Busby KA. Elevated sleep arousal thresholds in enuretic boys: clinical implications. ActaPaediatr 1997;86:381-4.
  3. Neveus T, Stenberg A, Lackgren G, Tuvemo T, Hetta J. Sleep of children with enuresis: a polysomnographic study. Pediatrics 1999;103:1193-7. https://doi.org/10.1542/peds.103.6.1193
  4. Hunsballe JM. Increased delta component in computerized sleep electroencephalographic analysis suggests abnormally deep sleep in primary monosymptomatic nocturnal enuresis. Scand J Urol Nephrol 2000;34:294-302. https://doi.org/10.1080/003655900750048305
  5. Gillin JC, Rapoport JL, Mikkelsen EJ, Langer D, Vanskiver C, Mendelson W. EEG sleep patterns in enuresis: a further analysis and comparison with normal controls. Biol Psychiatry 1982; 17:947-53.
  6. Yeung CK, Diao M, Sreedhar B. Cortical arousal in children with severe enuresis. N Engl J Med 2008;358:2414-5. https://doi.org/10.1056/NEJMc0706528
  7. Fujiwara J, Kimura S, Tsukayama H, Nakahara S, Haibara S, Fujita M et al. Evaluation of the autonomic nervous system function in children with primary monosymptomatic nocturnal enuresis--power spectrum analysis of heart rate variability using 24-hour Holter electrocardiograms. Scand J Urol Nephrol 2001;35:350-6. https://doi.org/10.1080/003655901753224396
  8. Ornitz EM, Russell AT, Hanna GL, Gabikian P, Gehricke JG, Song D et al. Prepulse inhibition of startle and the neurobiology of primary nocturnal enuresis. Biol Psychiatry 1999;45:1455-66. https://doi.org/10.1016/S0006-3223(98)00205-4
  9. Baeyens D, Roeyers H, Naert S, Hoebeke P, VandeWalle J. The impact of maturation of brainstem inhibition on enuresis: a startle eye blink modification study with 2-year followup. J Urol 2007;178:2621-5. https://doi.org/10.1016/j.juro.2007.07.061
  10. Xiang B, Biji S, Liu JX, Chu WC, Yeung DK, Yeung CK. Functional brainstem changes in response to bladder function alteration elicited by surgical reduction in bladder capacity: a functional magnetic resonance imaging study. J Urol 2010;184:2186-91. https://doi.org/10.1016/j.juro.2010.06.095
  11. Baeyens D, Roeyers H, D'Haese L, Pieters F, Hoebeke P, Vande-Walle J. The prevalence of ADHD in children with enuresis: comparison between a tertiary and non-tertiary care sample. Acta Paediatr 2006;95:347-52. https://doi.org/10.1080/08035250500434736
  12. Baeyens D, Roeyers H, Demeyere I, Verte S, Hoebeke P, VandeWalle J. Attention-deficit/hyperactivity disorder (ADHD) as a risk factor for persistent nocturnal enuresis in children: a two-year follow-up study. Acta Paediatr 2005;94:1619-25. https://doi.org/10.1080/08035250510041240
  13. Baeyens D, Roeyers H, Van Erdeghem S, Hoebeke P, VandeWalle J. The prevalence of attention deficit-hyperactivity disorder in children with nonmonosymptomatic nocturnal enuresis: a 4-year followup study. J Urol 2007;178:2616-20. https://doi.org/10.1016/j.juro.2007.07.059
  14. Durkin MS, Khan N, Davidson LL, Zaman SS, Stein ZA. The effects of a natural disaster on child behavior: evidence for posttraumatic stress. Am J Public Health 1993;83:1549-53. https://doi.org/10.2105/AJPH.83.11.1549
  15. Moffatt ME. Nocturnal enuresis: psychologic implications of treatment and non treatment. J Pediatr 1989;114:697-704. https://doi.org/10.1016/S0022-3476(89)80884-4
  16. von Gontard A, Baeyens D, Van Hoecke E, Warzak WJ, Bachmann C. Psychological and psychiatric issues in urinary and fecal incontinence. J Urol 2011;185:1432-6. https://doi.org/10.1016/j.juro.2010.11.051
  17. Von Gontard A, Hollmann E. Comorbidity of functional urinary incontinence and encopresis: somatic and behavioral associations. J Urol 2004;171:2644-7. https://doi.org/10.1097/01.ju.0000113228.80583.83
  18. De Bruyne E, Van Hoecke E, Van Gompel K, Verbeken S, Baeyens D, Hoebeke P. Problem behavior, parental stress and enuresis. J Urol 2009;182:2015-20. https://doi.org/10.1016/j.juro.2009.05.102

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