The effect of tonsillectomy and adenoidectomy on enuresis nocturna in pediatric patients
Tonsillektomi ve adenoidektominin pediatrik hastalarda enürezis nokturna üzerine etkisi
Eda Şimşek 1 *
1 Kayseri Şehir Eğitim ve Araştırma Hastanesi, Kulak Burun Boğaz Kliniği, Kayseri Türkiye
* Corresponding Author
Ortadogu Tıp Derg, Volume 10, Issue 4, pp. 427-430
https://doi.org/10.21601/ortadogutipdergisi.469575
OPEN ACCESS
Download Full Text (PDF)
Abstract
Aim: Enuresis nocturna (EN) is a condition that is characterized by frequent intermittent night-time incontinence in children. The aim of this study was to investigate the effect of tonsillectomy and adenoidectomy on EN in patients with tonsil hypertrophy and adenoid hypertrophy.
Material and Method: Thirty pediatric patients who were admitted to urology clinic between May 2015 and May 2016, who had completed toilet training and who were diagnosed with enuresis nocturna between the ages of 5 and 16 and had open mouth, snoring, breathing in sleep, were included in the study. A detailed ear,nose,throat examination and flexible endoscopic examination were performed in all patients. Patients were grouped according to tonsil and adenoid size. Demographic and examination findings of the patients were recorded. Patients were operated according to the condition of tonsils and adenoids, and 6 months later, control was performed.
Results: The mean age of the participants was 9.36 ± 2.85. While 21 (70%) patients underwent adenoidectomy, 5 (16.6%) patients underwent tonsillectomy and 4 (13.3%) underwent tonsillectomy and adenoidectomy. Postoperative follow-up 6 months later, 15 (71.4%) patients underwent adenoidectomy and 1 (20%) underwent tonsillectomy, and 2 (50%) patients who underwent tonsillectomy and adenoidectomy were completely followed by the disappearance of complaints nocturnal enuresis. Thus, in the preoperative and postoperative 6th month evaluation, there was a statistically significant difference in the improvement of complaints of enuresis nocturna after surgery (p‹0.01).
Conclusion: In conclusion, surgery for upper airway obstruction due to tonsil and adenoid hypertrophy in enuresis nocturna patients may contribute to the reduction of complaints of enuresis nocturna.
Öz
Amaç: Enürezis nokturna (EN) çocuklarda sık görülen aralıklı gece idrar kaçırmaları ile karakterize olan bir durumdur. Üst solunum yolu obstrüksiyonun pediatrik popülasyonda en önemli nedenlerinin başında tonsil ve adenoid hipertrofileri gelmektedir. Bu çalışmada tonsil hipertofisi ve adenoid hipertrofisi tanısı alan hastalarda tonsillektomi, adenoidektominin ve adenotonsillektominin EN üzerine etkisini incelenmesi amaçlandı.
Gereç ve Yöntem: Çalışmaya Mayıs 2015 ile Mayıs 2016 tarihleri arasında üroloji polikiniğine başvurmuş, tuvalet eğitimini tamamlamış ve yaşları 5 ile 16 arasındaki enürezis nokturna tanısı konulmuş olan, ağzı açık uyuma, horlama, uykuda nefes durma şikayeti olan 30 çocuk hasta dahil edildi. Tüm hastalar detaylı kulak,burun, boğaz muayenesi ve fleksibl endoskopik muayenesi yapıldı. Hastalar tonsil ve adenoid büyüklüklerine göre gruplandırıldı. Hastaların demografik ve muayene bulguları kayıt edildi. Hastalar tonsil ve adenoidlerin durumuna göre opere edildi ve postoperatif 6 ay sonra kontrolleri yapıldı .
Bulgular: Çalışmaya katılan bireylerin ortalama yaşları 9,36±2.85 idi. Yirmi bir (%70) hastaya adenoidektomi uygulanırken 5 (%16,6) hastaya tonsillektomi , 4 (%13,3) hastaya adenotonsillektomi yapıldı.. Cerrahi uygulanan hastaların postopertif 6 ay sonra yapılan kontrollerinde adenoidektomi yapılan 15 (%71,4) hastada ve tonsillektomi yapılan 1 (%20), adenotonsillektomi yapılan 2 (%50) hastada enürezis nokturna şikayetlerinin tamamen ortadan kalktığı izlendi. Böylece preoperatif ve postoperatif 6. ayda yapılan değerlendirmede, cerrahi sonrası enürezis nokturna şikayetlerinde düzelme açısından istatistiksel anlamlı fark olduğu görüldü (p‹0.01).
Sonuç: Sonuç olarak enürezis nokturna hastalarında tonsil ve adenoid hipertrofisi nedeniyle üst solunum yolu obstrüksiyonun cerrahisi enürezis nokturna şikayetlerinin azalmasına katkı sağlayabilir.
- Brodsky L. Modern assessment of tonsils and adenoids. Pediatr Clin North Am 1989; 36: 1551–69.
- Li AM, Wong E, Kew J, Hui S, Fok TF. Use of tonsil size in the evaluation of obstructive sleep apnea. Arch Dis Child 2002; 87: 156-15
- Lehmann KJ, Nelson R, MacLellan D, Anderson P, Romao RL. The role of adenotonsillectomy in the treatment of primary nocturnal enuresis in children: A systematic review. J Pediatr Urol 2018; 14, 53.e1-53.e8.
- Kaya KS, Türk B, Erol ZN, Akova P, Coşkun BU. Pre- and post-operative evaluation of the frequency of nocturnal enuresis and Modified Pediatric Epworth Scale in pediatric obstructive sleep apnea patients. Int J Pediatr Otorhinolaryngol 2018; 105: 36-9.
- Neveus, T, von Gontard A, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. J Urol 2006; 176: 314-24.
- Weissbach A, Leiberman A, Tarasiuk A, et al. Adenotonsilectomy improves enuresis in children with obstructive sleep apnea syndrome. Int J Pediatr Otorhinolaryngol 2006; 70: 1351-135
- Wang RC, Elkins TP, Keech D, Wauquier A, Hubbard D. Accuracy of clinical evaluation in pediatric obstructive sleep apnea. Otolaryngology: Head and Neck Surgery 1998; 118: 69-73.
- Kovacevic L, Lu H, Wolfe-Christensen C, et al. Adenotonsillectomy normalizes hormones and urinary electrolytes in children with nocturnal enuresis and sleep-disordered breathing. Urology 2015; 86: 158-61
- Alexopoulos EI, Kostadima E, Pagonari I, Zintzaras E, Gourgoulianis K, Kaditis AG. Association between primary nocturnal enuresis and habitual snoring in children. Urology 2006; 68: 406–409.
- Jeyakumar A, Rahman SI, Armbrecht ES, Mitchell R. The association between sleep-disordered breathing and enuresis in children. Laryngoscope 2012; 122: 1873-7.
- Forsythe WI, Redmond A. Enuresis and spontaneous cure rate. Study of 1129 enuretics. Arch Dis Child 1974; 49: 259-63.
- Kalorin CM, Mouzakes J, Gavin JP, et al. Tonsillectomy does not improve bedwetting: results of a prospective controlled trial. J Urol 2010; 184: 2527-31.
Citation