Micturating cysto-urethrography in the investigation of enuresis.

Enuresis is an important human problem. The persistence of the disability is regarded with despair by parents, while the patients' distress and embarrassment are difficult to assess. In spite of investigations and treatment by paediatricians, urologists and psychiatrists there is still no reliable cure. During a period of post-graduate study in Stockholm one of us became interested in a new cysto-urethrographic technique in process of development by Kjelberg and Rudhe. We considered that the technique might, with modification, be a valuable means of investigating cases of persistent enuresis. The simple cysto-urethrographic technique described below is largely due to the inspiration and help provided by our Swedish colleagues. Examination of the urinary tract by ordinary methods does not, as a rule, reveal any abnormality, but this method of investigation has shown that there is in fact a surprisingly high incidence of organic abnormalities in enuretic children. Enuresis may be defined as the involuntary discharge of urine and it assumes clinical importance in a child over 3 years of age. It is usually nocturnal but may be either diurnal and nocturnal, or diumal alone. The incidence of enuresis in childhood varies with many factors such as age, environment, heredity, legitimacy, etc. Sheldon (1944) in a series of 5,000 children from residential homes between 5 and 10 years of age reported 5% to be suffering from enuresis. Thorne (1944) studied 1,000 army recruits and found that 16% gave a history of enuresis after 5 years of age. Despert (1944) showed that of 1,000 unselected children between 4 and 12 years of age enuresis was present in 26 %. These figures show that enuresis occurs in 5 to 25 % of children between the ages of 4 and 12 years. From an examination of army recruits the incidence of enuresis in adult males was reported by Cohen (1947) to be as high as 2 5 % in U.S. army recruits. It is reasonable to assume therefore that as the majority of enuretic children recover, their condition is functional in origin. The remainder, which form about 10%, persist and are likely to have some organic disorder. Most paediatric textbooks infer that organic disease can be excluded if a careful history is taken and an adequate examination of the patient and the urine made; on the other hand, some textbooks advise examination by a urologist if the enuresis fails to improve with treatment. It is our experience that in spite of an adequate history and clinical examination the diagnosis of abnormalities of the urinary system is seldom possible unless special investigations, such as micturating cysto-urethrography, are undertaken. Furthermore, such investigations will lead to the earlier diagnosis of urological conditions which, if untreated, may give rise to a far more serious condition than the initial symptom of enuresis.