Eliane Maria Garcez O. Fonseca

Diagnóstico clínico de disfunção miccional em crianças e adolescentes enuréticos

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.

A enurese em criancas e seus significados para suas famílias: abordagem qualitativa sobre uma intervencão profissional em saúde

Objectives: to discuss perception and meanings by families to child related enuresis through a social and anthropological perspective in the context of issues identified in the explanatory models of disease. Methods: experience report, based on semi-structured interviews performed with twenty four (24) families/caretakers of children with enuresis. Results: families of patients with enuresis expressed the need of defining the disease in a subjective manner, attempting to understand it through the feelings that it unleashes, of the changes in behavior and effects caused in other people by this disease. It was determined that enuresis is grouped in two overlapping fields: the one holding the child responsible for his or her enuresis and external factors such as the family environment and economic and social situation. Conclusions: it is recommended that healthcare professionals be aware of the risk of the biomedical regulation of their speech for it interferes with the understanding and the development of adequate treatment. Healthcare professionals should be informed on the possibility of child abuse related to enuresis and the discussion of possible strategies when working with this type of patient.

Diaper removal and difficulties in acquiring continence

whichapproaches an important issue that has little visibility in Bra-zilian journals. When reading that review, the statement inthe first paragraph of the introduction, about sphincter con-trol,drewourattention:“Allchildrenwillacquirethatcontrol,but the difficulty in acquiring it is a major concern for parents(…).” Although most children will naturally achieve conti-nence, there is a group that, due to functional or structuralreasons,willnotachievethatability,beingexposedtotheriskof a series of consequences ranging from psychological andsocialproblemstorenalfailure.