DINRNAL ENURESIS IS NOT A DIAGNOSIS - NEW RESULTS REGARDING OF CLASSIFICATION, PATHOGENESIS AND THERAPY OF FUNCTIONAL URINARY-INCONTINENCE IN CHILDREN

Newer research results have shown that the previous classification of enuresis into nocturnal, nocturnal and diurnal and diurnal forms is no t sufficient. Day wetting constitutes a heterogeneous group of syndrom es, which should be considered as functional urinary incontinences and which require differentiated diagnostics and therapies. General aspec ts of functional urinary incontinence are discussed, including: classi fication, epidemiology, symptomatology, especially the association wit h urinary tract infections, vesicoureteral reflux, obstipation and enc opresis. The rate of psychiatric problems seems to be increased compai red to children with nocturnal enuresis. Methodological problems of pr evious studies are discussed. General guidelines regarding diagnostics and therapy include the requirement of sonography, uroflowmetry with pelvic-floor-EMG, urinalysis and specific therapy-forms. The three mos t important syndromes are urge incontinence with urge symptoms, freque nt micturition, holding manoeuvres due to a physiological instability of the detrusor and Tower, mostly secondary psychiatric symptoms. Void ing postponement is a general refusal syndrome with a psychiatric etio logy, characterized by a postponement of micturition and retention of urine. The detrusor-sphincter-dyscoordination has as the main symptom a paradox contraction instead of relaxation of the bladder sphincter d uring micturition. It is recommended hat the previous classification s hould be left in favour of more specific diagnoses to ensure specific, causally effective therapies.