AN ITALIAN EPIDEMIOLOGIC MULTICENTER STUDY OF NOCTURNAL ENURESIS

Objective To estimate the prevalence of enuresis in schoolchildren in Italy. Subjects and methods The Italian Club of Nocturnal Enuresis pro moted a prevalence study of nocturnal enuresis using a self-administer ed questionnaire in seven cities in Northern, Central and Southern Ita ly. The association between enuresis and potential risk factors, e.g. a family history of enuresis, stress, socioeconomic status and abnorma l diurnal voiding habits, was investigated. The perceived impact on th e child and on the family was also evaluated. A random-cluster samplin g scheme was used to obtain a sample of primary and secondary schoolch ildren from each city. One primary school and one secondary school for each socio-economic level was sampled in each city, giving a total of 42 schools surveyed; 9086 children were covered by the survey. In a c luster sampling method, the variance of prevalence is divided into two components, binomial and extra-binomial variability. Both the DSM III and DSM IV definitions of enuresis were used because at present, ther e is no consensus on the diagnostic criteria. Results Completed questi onnaires were received from 7012 children, an overall response rate of 77.2%. Those aged 6-14 years were analysed, restricting the sample to 6832 children, There were 250 enuretic children using the DSM III def inition of enuresis and 112 using the DSM IV definition, The overall p revalence was 3.8% and showed a decreasing trend with increasing age. Bedwetting was more frequent in boys than in girls. The prevalence of enuresis was higher when the child was from a family of low socioecono mic status despite the child's age group. The logistic. analysis showe d that familiality, stress, birthweight, age of attaining diurnal cont inence, soiling and, for girls, menstruation, were statistically signi ficant variables and thus contributed to predicting the probability of bedwetting, confirming the findings of previous studies, There was a large difference in prevalence using the two DSM definitions; a high p ercentage of DSM III enuretic children had more than two wet nights pe r week. Conclusion It is important that a consensus about the 'working definitions' of enuresis is reached to avoid bias in the recruitment step, to carry out comparable epidemiological studies and to obtain ad equate therapeutic responses.