The Relationship Between Dysfunctional Voiding Symptom Score, Functional Bladder Capacity, and Bladder Wall Thickness on Ultrasonography in Children With Primary Nocturnal Enuresis

IntroductionThis study aimed to evaluate the relationship between self-reported daytime lower urinary tract symptoms (LUTS), Dysfunctional Voiding Symptom Score (DVSS), functional bladder capacity (FBC), and ultrasonographic bladder wall thickness (BWT) in children with primary nocturnal enuresis. MethodsWe evaluated 145 children (98 boys and 47 girls) aged 6 to 10 years diagnosed with primary nocturnal enuresis at our institution between 2020 and 2022.The relationship between self-reported LUTS, DVSS, and BWT was analyzed.Additionally, FBC was measured and the correlation between BWT and FBC was investigated. ResultsEnuresis frequency ranged from one to seven days per week.Of 145 children, 125 (86%) had enuresis four or more days per week.Eighty-one children had no self-reported LUTS.Among those without self-reported LUTS, DVSS daytime incontinence scores of ≥1 (items 1 and 2) were observed in five children (6%), whereas holding maneuvers (item 6) and urgency (item 7) were reported in 22 (27%) and 25 children (31%), respectively.In children with self-reported LUTS, items 1, 2, 6, and 7 were scored ≥1 in 35 (55%), 25 (39%), 38 (59%), and 50 children (78%), respectively.When monosymptomatic nocturnal enuresis (MNE) was defined as the absence of both self-reported LUTS and DVSS voiding items, 46 children were classified as having MNE and 99 as having non-monosymptomatic nocturnal enuresis (NMNE).No significant sex differences were observed between the MNE and NMNE groups.The median BWT was significantly greater in the NMNE group than in the MNE group (4.1 vs. 3.1 mm, p < 0.01).Using a BWT cut-off value of 3 mm to detect NMNE yielded a sensitivity of 86% and a specificity of 48%.FBC was significantly larger in the MNE group than in the NMNE group (median, 150 mL vs. 115 mL; p = 0.024).When the median FBC of the MNE group (150 mL) was used as a threshold, BWT was significantly greater in children with FBC ≤150 mL (n = 40) than in those with FBC >150 mL (n = 15) (median, 4.1 mm vs. 3.2 mm; p = 0.021). ConclusionsDaytime lower urinary tract symptoms were more accurately assessed by the DVSS than by self-reported symptoms.A structured assessment using the DVSS may help identify unrecognized LUTS and improve the differentiation between MNE and NMNE.Children with NMNE, as defined by the DVSS, and those with smaller FBC demonstrated greater ultrasonographic BWT.These findings suggest that in addition to FBC, BWT could serve as a valuable index of bladder storage function and may assist in treatment selection and predicting therapeutic outcomes.