[Clinical diagnosis of bladder dysfunction in enuretic children and adolescents].

OBJECTIVES To estimate the predictive value of diurnal voiding symptoms for the diagnosis of bladder dysfunction in enuretic children and teenagers receiving care at Fernandes Figueira Institute (Rio de Janeiro, Brazil). METHODS From June 1999 to May 2002, 91 patients (aged 5-17 years) with enuresis, both monosymptomatic and polysymptomatic, were assessed based on medical history, voiding chart, physical examination, and urodynamic studies. The medical history was investigated for detection of diurnal voiding symptoms. The predictive value of these symptoms for the diagnosis of bladder dysfunction was estimated. RESULTS Bladder dysfunction was observed in 94.5% of the children and teenagers with enuresis. Medical history identified 97.3% of patients with diurnal voiding symptoms. Increased discharge of urine was detected exclusively by voiding chart in only 2.7% of the patients. The positive predictive value of diurnal voiding symptoms for bladder dysfunction was 98.6%. There was a statistically significant association between diurnal voiding symptoms and bladder dysfunction (p < 0.005). The risk for bladder dysfunction was approximately 20 times higher in presence of these symptoms. CONCLUSIONS The presence of diurnal voiding symptoms was a strong predictor of bladder dysfunction. Medical history was a useful instrument for detecting diurnal voiding symptoms and establishing the diagnosis of bladder dysfunction.