Tag Archive | "pediatric urology"

More Boys Wet Their Beds Than Girls

Researchers from the Prince of Wales Hospital at the Chinese University of Hong Kong had parents of about 3,000 girls and 3,100 boys ages six to eleven years old fill out questionnaires on how often their kids wet their beds.

The researchers found-

*  5 in 100 kids wet their beds at night

* 7 out of 100 boys wet their beds at least once a month compared to 3 out of 100 girls

* 9 out of 100 six year olds wet their beds versus 2 out of 100 eleven year olds

Commenting on the study is Dr. Joseph Barone, pediatric urologist at the Bristol-Myers Squibb Children’s Hospital in New Brunswick, New Jersey. He said “Bedwetting is hereditary in 4 out of 10 cases.  Sometimes the link between the bladder and the brain isn’t fully developed yet and more boys than girls tend to be bedwetters because girls mature faster.  By age 15, 99% of kids outgrow bedwetting.”

He added, “In most children, the best way to cure bedwetting is to use an alarm. This is a sensor in a child’s underwear, which goes off when it gets wet. It’s connected to an alarm on a wristband or next to their head. The alarm systems are considered the first choice, and they work 80 to 90 percent of the time if used properly.  If this doesn’t work, there are also medications, such as desmopressin acetate (known as DDAVP) or imipramine. However, these do have side effects, and they are a treatment, not a cure.”

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Urinary Disease Screening in Children

For many genetic diseases, physicians recommend screening among family members to monitor the disease, ensuring early detection and possible treatment.  But in the case of vesicoureteral reflux, or VUR, it may not be as beneficial to screen siblings of young children who have this urinary reflux disease.

Approximately 1% of children have VUR, and their siblings are at higher risk—more than one-quarter of children whose sibling has VUR also have the disease.  As a result, doctors currently suggest screening all siblings of VUR patients, regardless of whether or not they have symptoms.

But according to a new pediatric study, researchers found that screening siblings of VUR patients before they develop symptoms would prevent only a small number of urinary tract infections (UTI), while costing a significant amount of money and radiation exposure associated with the unpleasant procedure.

“You really have to screen a large number of asymptomatic siblings in order to prevent one infection,” study author Dr. Jonathan Routh of Children’s Hospital Boston explained.

In fact, Routh and his colleagues suggest that in order to prevent just one UTI, hundreds of children must be screened, potentially costing hundreds of thousands of dollars.

In addition, the antibiotics often prescribed for the condition may not be as effective as once believed.  Normally, prophylactic antibiotics are prescribed for UTIs in children with VUR.  If, in fact, prophylactic antibiotics worked, only 30 one-year-old siblings would need to be screened in order to prevent one febrile UTI (or an infection accompanied by fever, which is a sign that the infection may involve the kidneys).  This amounts to $56,000 per averted infection.  But if more conservative estimates of the effectiveness of prophylaxis are used, then 430 siblings would have to be screened to prevent one UTI, costing $820,000 per infection.

“Best case scenario:  You’d still have to screen 30 perfectly normal children in order to prevent one febrile urinary tract infection,” Routh noted.

Not even the American Urological Association is recommending universal screening for siblings of children with VUR.  The AUA has updated guidelines for when screening makes sense for this disease.

Despite the results of this analysis, parents are still going to be concerned about their individual child.  Although Routh acknowledges this concern, he explains that the results do apply to individual children as well.  “It is unlikely that any one child is going to have a direct benefit from that screening.”

Many doctors support Routh’s study, including Dr. Kourosh Afshar, who has studied VUR at the University of British Columbia.  He states that in order to truly test the benefits of screening in real children, many would have to be followed for years, generating an enormous cost.

Universal screening is so costly and prevents so few cases that Dr. Afshar says, “I don’t recommend it as a doctor.”

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