Excretory Urography for Evaluation of Enuresis

Enuresis is the involuntary discharge of urine occurring beyond the age when control of the urinary bladder should have been acquired.1 Eighty percent of children with enuresis have problems staying dry at night, 5% in the day, and 15% both day and night.2 The age at which children can be expected to stay dry at night is not well established and is often cause for extreme concern for parents and children alike. Most children are still not dry at night by age 2 years. In a study of 315 children, Klackenberg reported 87% dry by 3 years and 96% dry by 6 years. Essen and Peckham,4 reviewing the records of 12,000 children, found enuresis more prevalent in older ages. More than 10% of their patients were enuretic between ages 5 and 7 years and almost 5% were still having problems at 11 years of age. The etiology of enuresis is also difficult to define, and many different theories have been advanced. Bindelglas5 grouped these into five major categories: (1) organo-urogenic, including urologic malformations; (2) psychogenic; (3) developmental; (4) genetic; (5) environmental. The first of these categories must be of primary concern to the physician when confronted with an enuretic child, ie, could the symptoms possibly reflect a surgically correctable urologic abnormality? Radiologic procedures such as excretory urography and mictunition cystourethrography are the studies usually relied on to exclude an underlying anatomic lesion. Because of the potential risk and expense of any radiologic procedure as well as the possible low yield in this condition, the Committee on Radiology examined the utility of these studies in the routine evaluation of enuresis.