Is Renal Bladder Ultrasound Necessary in Monosymptomatic Primary Nocturnal Enuresis? A Case Control Study

Background: Primary nocturnal enuresis is the most common type of enuresis and has profound detrimental effects on quality-of-life and sleep patterns, and increased morbidity. The purpose of this study was to determine the frequency of urinary tract abnormalities found in ultrasound of children with monosymptomatic primary nocturnal enuresis (MPNE) and to compare with ultrasound findings of children without MPNE to determine whether performing ultrasound in these children is necessary. Methods: One hundred and two children aged three to 13 years with MPNE at Golestan Hospital affiliated to the Military University of Medical Sciences of Tehran, Iran from 2016 to 2017, were enrolled in this case-control study. The control group included 59 children with no history of voiding dysfunction, who had abdominal ultrasoud for other than urinary system-related causes. The ultrasound findings were compared between the MPNE and control group. Results: Urinary tract abnormality, detected by ultrasound, was found in 15 children (14.7%) in the MPNE group and one child (1.69%) of the control group, with a statistically significant difference (P < 0.05). Findings of the nocturnal enuresis group were mild unilateral or bilateral kidney fullness in three children (20%), kidney simple cysts in one child (6.66%), hydrocele in three children (20 %), increased thickness or irregularity in the bladder wall of eight children (53.33%), and increased bladder wall thickness in one child of the control group. Conclusions: Urinary abnormalities discovered by ultrasonography in MPNE were not clinically significant and did not require any other diagnostic tests. It may only be of concern to parents and cause unnecessary diagnostic procedures by the physician. This study showed that ultrasound should be done for patients with resistant or inappropriate clinical response during treatments.