Avaliação do diário miccional de crianças com enurese monossintomática e bexiga hiperativa

Abstract

INTRODUCTION: The voiding diary (VD) is an important tool in the evaluation of children with lower urinary tract dysfunction (LUTS) and enuresis providing important information on bladder function. It is a simple, noninvasive, low cost method that best reproduces voiding habits. Important references such as voiding frequency, maximal voided volume (MVV), average voided volume (AVV) and nocturnal volume (NV), are easily extracted from VD and are valuable in diagnosing and monitoring these diseases. Recording all urinary episodes and fluid intake demands lots of work from the family and VD is usually not done properly. OBJECTIVES: To compare the data obtained in VD among children with LUTS and enuresis, to evaluate whether a day of VD recording would be sufficient to guide treatment and to evaluate the correlation between MVV and the higher urine volume with the EBC. METHODS: Children aged 5 to 14 years with overactive bladder (OAB) and primary monosymptomatic enuresis (PME) were instructed to perform a three-day VD as part of their assessment. The data obtained from VD were evaluated for the first day (1dVD), the first two days (2dVD) and every 3 days (3dVD) and compared according to the MVV, AVV, frequency and NV including diaper weight + plus the first morning urine. RESULTS: 98 children that fulfilled inclusion criteria composed the study sample. Mean age was 8.23 ± 2.26 years (53% male) were included. Of these, 59 had PME and 30 OAB. The AVV, frequency and NV were similar, regardless of how many days urinary episodes were recorded (p = 0.13; p = 0.96; p = 0.36, respectively). Only MVV was higher on average 23 ml in 2dVD (202.2 ± 73.3 ml) compared to 1dVD (179.2 ± 76.5 ml) (p <0.01) . As for the correlation of MVV and expected bladder capacity (EBC), it is observed that MVV corresponds to 68% of EBC in children with PME, while in children with OAB it is 70%. In the assessment of MVV with the highest urine volume on the day, including the first urination, in 57.6% of enuretics, the highest urine volume is MVV, whereas in children with overactive bladder, in MVV 66.6% is greater urine volume. BlandAltman plot was performed to propose a new formula to calculate EBC in school age children with LUTS, EBC = 25*age+11. CONCLUSIONS: Although MVV was lower by a small volume in 1dVD, we believe that 1 day VD is sufficient to assess these children. The EBC formula proposed by ICCS overestimates bladder capacity in this population. Therefore, we propose the use of a new formula (EBC=25*age+11) to estimate bladder capacity these children.