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Behavioral comorbidity differs in subtypes of enuresis and urinary incontinence.

Zink S, Freitag CM, von Gontard A

Department of Child and Adolescent Psychiatry, Saarland University Hospital, Saarbrucken, Saarland, Germany. Susanne.zink@uniklinikum-saarland.de

PURPOSE: The aim of this prospective study is to describe the association of comorbid behavioral and somatic factors in children with different forms of nocturnal enuresis and daytime incontinence referred to a tertiary center. MATERIALS AND METHODS: A total of 166 consecutive children 5.1 to 16.4 years old were referred for detailed assessment between January 2004 and July 2006. Evaluation included a detailed history, pediatric examination, 24 to 48-hour voiding protocols, sonography and uroflow. Parents filled out the Child Behavior Checklist, a standardized parental questionnaire consisting of 113 problem items. ICD-10 diagnoses were given based on standardized mental state examination and mutual consensus conferences. RESULTS: In the full sample externalizing disorders were more than twice as common as internalizing disorders. Differences were found between children with nocturnal enuresis and daytime incontinence regarding parent reported externalizing behavior scores as well as rates of "at least 1 ICD-10 psychiatric diagnosis" and comorbid encopresis. Children with monosymptomatic nocturnal enuresis showed fewer internalizing disorders and lower rates of "at least 1 ICD-10 psychiatric diagnosis" and comorbid encopresis compared to those with nonmonosymptomatic nocturnal enuresis, urge incontinence and voiding postponement. The results of sonography and uroflow measures also differed between groups. CONCLUSIONS: Different subtypes of enuresis and urinary incontinence demonstrate differences in behavioral problems and psychiatric comorbidity. The highest rates of psychiatric comorbidity were found in the group of children with voiding postponement and the lowest were in children with monosymptomatic nocturnal enuresis. We recommend screening for comorbid psychiatric disorders in children with enuresis and urinary incontinence. Further investigations in a larger group of children are necessary.

Published 13 December 2007 in J Urol, 179(1): 295-8; discussion 298.
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