Enuresis: Diagnostic Tests

Obligatory medical device diagnostics.

  • Abdominal ultrasonography (ultrasound of abdominal organs): kidneys and urinary tract [residual urine?, bladder wall thickness/etrusor wall thickness, kidneys, rectal width] (waivable in NEM* ).

* NEM (Monosymptomatic Enuresis).

Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and mandatory medical device diagnostics – for differential diagnosis.

  • Uroflowmetry (urine flow measurement to assess the bladder emptying pattern; multiple determination up to 5 min after micturition required) with residual urine determination and/or pelvic floor EMG (synonym: pelvic floor electromyography; to detect micturition disorders caused by nerves or muscle diseases) – for children with evidence of an organic cause (rare!) or in children with urinary incontinence during the day and conspicuous ultrasound findings and repeatedly detectable residual urine.
  • If necessary, micturition cystourethrography (MZU; synonym: micturition cyst urethrography, MCU); examination method in which the urinary bladder and urethra before and during micturition (urination) are depicted with the help of contrast medium in the context of an X-ray examination), cystomanometry (examination method in which the pressure and capacity of the urinary bladder is measured) or video urodynamics – for children with evidence of an organic cause (rare! ) or in children with urinary incontinence during the day and abnormal ultrasound findings and repeatedly detectable residual urine.
  • Magnetic resonance imaging (MRI); e.g. MR urography, MRI of the spine – for further diagnosis.
  • Anal/rectomanometry (pressure measurement of the rectum and sphincter system) – in the presence of comorbidity (concomitant disease) fecal retention or constipation / constipation.

Findings in the basic diagnosis of urinary incontinence

Frequency of micturition (frequency of urination)
  • Decreased: ≤ 3 micturitions/day.
  • Increased: ≥ 8 mictions/day
Residual urine (ml)
  • Children 4-6 years old: > 20 ml
  • Children 7-12 years old: > 10 ml
Bubble wall thickness (mm)
  • When the urinary bladder is filled: < 3 mm.
  • With empty urinary bladder: < 5 mm
Rectum diameter
  • Constipation: rectal diameter > 30 mm + pelotting (hemispherical indentation) of the filled bladder due to fecal masses in the rectum (rectum) (ICCS).
Bladder capacity (ml)
  • Expected micturition volume (child’s age [years] + 1) ∙ 30 (ml)1 Range: 65-150% of expected volume.
  • Small < 65% of the expected micturition volume.
  • Large > 150 % of the expected micturition volume
Nocturnal polyuria (increased urination at night).
  • Nocturnal urination >130% of the bladder capacity expected for age (micturition voumen)
Polyuria
  • Urine volume > 4 ml/kgKG and h or > 1,200 ml/m2KOF and day.

1 Applicable up to 12 years of age.

ICCS International Children’s Continence Society