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The experience of the adolescent with homozygous sickle-cell disease is influenced by several factors that differentiate it from the older child entirely dependent on his parents. The objective of this study was to describe the state of health and to assess the quality of follow-up and to identify the determinants of poor monitoring of adolescent sickle-cell followed in Brazzaville for an average of 12 ± 9.6 years, starting from a cross-sectional study carried out at the Brazzaville University Hospital from March to September 2016. It is based on a questionnaire composed of elements of assessment of the state of health and the quality of the follow-up. The vaccination coverage of adolescents was low, 81.3% for DTCP, 66.5% for Typhim Vi, 50.2% for viral hepatitis B, 76.4% for pneumococcus, and 59.1% for the ROR. In the last two years prior to the survey, 99 (48.7%) adolescents had only 2 follow-up visits instead of 4 planned per year. Therapeutic compliance was good in 132 (65%). No hospitalizations were reported during this period in 23 adolescents (11.3%); in 180 cases (88.7%), however, adolescents were hospitalized one to three times apart from regular follow-up visits. Since the discovery of the disease, 177 (87.2%) adolescents had already been transfused, more than three times in 89 cases. A history of neurovascular seizures was found in 10 cases (5.2%) and priapism in 35 cases (18.2%). Paraclinical examinations were not systematic during follow-up visits. The socioeconomic level of the family and the level of education of the father had a negative impact on monitoring and adherence (Le vécu de l'adolescent atteint de drépanocytose homozygote est influencé par plusieurs facteurs qui le différencient de l'enfant moins âgé entièrement dépendant de ses parents. L'objectif de cette étude était de décrire l'état de santé, d'apprécier la qualité du suivi et d'identifier les déterminants de mauvais suivi de l'adolescent drépanocytaire suivi à Brazzaville depuis en moyenne 12 ± 9,6 ans, à partir d'une étude transversale réalisée au CHU de Brazzaville de mars à septembre 2016. Elle était fondée sur un questionnaire composé des éléments d'appréciation de l'état de santé et de la qualité du suivi. La couverture vaccinale des adolescents était faible : 81,3 % pour le DTCP, 66,5 % pour le Typhim Vi, 50,2 % pour l'hépatite virale B, 76,4 % pour le pneumocoque et 59,1 % pour le ROR. Au cours des deux dernières années ayant précédé l'enquête, 99 (48,7 %) adolescents avaient seulement deux consultations de suivi au lieu des quatre prévues par an. L'observance thérapeutique était bonne dans 132 cas (65 %). Aucune hospitalisation n'a été signalée pendant cette période chez 23 adolescents (11,3 %) ; par contre, dans 180 cas (88,7 %), les adolescents étaient hospitalisés une à trois fois en dehors des consultations régulières de suivi. Depuis la découverte de la maladie, 177 (87,2 %) adolescents avaient déjà été transfusés, plus de trois fois dans 89 cas. Les antécédents de crises neurovasculaires étaient retrouvés dans dix cas (5,2 %) et de priapisme dans 35 cas (18,2 %). Les examens paracliniques n'étaient pas systématiques au cours des visites de suivi. Les faibles niveaux socio-économiques de la famille et d'instruction du père impactaient négativement le suivi et l'observance thérapeutique (

In voiding disorders in childhood, after a precise diagnosis, treatment can be provided. Aspecific hygienic and dietetic measures are the basis of care in all micturating disorders and frequently must be established to allow a precise diagnosis. In case of enuresis, restriction of beverage and diuretic foods is recommended in the evening. Other treatments for enuresis should be proposed to motivated children. In the polyuric form of enuresis, the treatment is desmopressin (DDAVP) and in the form with low bladder capacity, alarms or a combination of these 2 treatments. In dysfunctional voiding, after caring for the secondary causes, and depending on the characteristics of the disorder, the first-step treatment is pelvic floor rehabilitation with or without anticholinergic therapy. Other medical treatments are used in a second step. Isolated urethral instability remains controversial.

The new definitions of voiding disorders in children should be used in clinical practice. Two major kinds of voiding disorders are identified: 1) isolated primary enuresis as a disorder occurring exclusively during sleep with no daytime leakage; 2) urinary dysfunctions that include uninhibited detrusor contraction, sphincter hypertonicity, and urethral instability. These dysfunctions may be primary or secondary. Constipation as an underlying cause is frequent and usually underestimated. The diagnostic process requires one (or more) long consultations. After ruling out a urine leak without a voiding disorder and secondary causes (constipation, inadequate hydration, poor voiding hygiene, crystalluria, etc.), the aim is to distinguish isolated sleep-time disorders (primary enuresis) from daytime ± sleep-time symptoms (primary urinary dysfunctions). Anamnesis, long and accurate, can be sensitized by a questionnaire completed at home. The physical examination focuses on the exclusion of anatomic abnormalities and local inflammation (vulvitis, balanitis, etc.). Diagnostic tests are rarely required at the beginning. Urodynamic exploration may be indicated, never at the first consultation, in case of primary urinary dysfunction. This diagnostic approach provides an appropriate therapeutic decision.

A retrospective study over seven years shows a high frequency of underlying psychological dimensions to enuresis, mainly regressive and passive, but also aggressive and erotic. It is therefore important to understand the meaning of this symptom and to take into account, in the treatment, underlying affective disorders.

Nocturnal enuresis is a frequent pediatric disease which necessitates an appropriate diagnostic and therapeutic approach. In this article, we discuss the epidemiology and physiopathology of this condition. Available evidence suggests that children with monosymptomatic nocturnal enuresis could be treated by bladder advice, the enuresis alarm and/or desmopressin. Therapy resistant cases should be handled by specialist centers.

Beware not to confuse talk about children with children's talk: this should be the golden rule for childhood professionals. Agitation and somatization disrupt the functioning of what is called the functional spheres. The child eats poorly, sleeps poorly, and has problems controlling his sphincters. He presents symptoms that the growing importance of education in today's modern world can no longer neglect. The diversity of the circumstances in which the child is recognized as "disruptive" shows just how much the borders between children and adults are permeable. The disruptive child is also a child disturbed by the adult world in which he is evolving. The author supports his hypotheses with several examples from his practice as a psychoanalyst.

The need for specific psychopharmacology trials in the pediatric population has been recognized and promoted by clinicians and regulatory instances. There are indeed specificities in symptom expression and pharmacological characteristics in this population, and recent studies showed that extrapolation from adult data is not always possible. Available results are insufficient to provide effective guidance for prescription and long-term evaluation of risk/benefit ratio in most indications. The aim of this article is to give an overview of efficacy and safety data in pediatric psychopharmacology.

The profile of enuretic patients consulting a hospital urology department was reviewed over a period of 15 months based on 102 cases. The study concerned 47 male subjects and 55female subjects with a mean age of 15 +/- 5.3 years. The mean weekly frequency of enuresis was 5.2 +/- 1.9 and enuresis occurred more than once a night for 41.6% of patients. Enuresis was primary in almost 67% of cases. Various aetiological factors for enuresis were identified from analysis of the clinical data and were generally associated: sleep factor (n=93), bladder factor (n=84), hormonalfactor (n=52). Patients were managed as a function of the factors identified. With a mean follow-up of 6 +/- 2.1 months, cure was obtained in 30.4% of cases and improvement was obtained in 24.5%. The various management problems are discussed as a function of socio-economic realities in Senegal and the authors emphasize the need for a multifactorial approach.

Enuresis nocturna is regularly treated by desmopressin, a vasopressin analog. Its side effects, notably neurological, are fortunately rare. We comment on 5 enuretic children on desmopressin who suffered from hyponatremic encephalopathy (natremia 115-127, median 117 mmol/l).Side effects appeared at therapeutic doses (10-40 mg/d intranasal). An excessive fluid intake at night was often noted, leading to a dilutional hyponatremia. This may be due to a lack of correct information to the parents. These children presented after a period of warning symptoms, such as headache, vomiting and altered consciousness. Parents could have sought earlier medical attention if they had been informed about these symptoms.In the absence of fluid restriction, severe hyponatremia can occur in enuretic children on desmopressin. It is therefore mandatory for the prescribing doctor to adequately inform patients and parents to limit fluids at night when desmopressin is used, and seek medical help quickly if any sign of intracranial hypertension appears.

To evaluate the efficacy of extracorporeal lithotripsy in the treatment of urinary stones in children.Thirty children (19 boys, 11 girls) with a mean age of 7 years (range: 14 months to 17 years) with a total of 32 urinary stones were treated by extracorporeal lithotripsy. The stone was situated in the kidney in 27 cases, the lumbar ureter in 4 cases and the pelvic ureter in 1 case. 19 patients had single stones, 9 patients had multiple pyelocaliceal stones and 3 had staghorn calculi.General anaesthesia was performed in 2/3 of cases (age10 years). The mean number of treatment sessions was 1.3. The success rate (absence of residual fragments) was 77%, while residual fragmentsor = 3 mm persisted in 4 cases. There were 3 failures. Complications occurred in 3 cases: ureteric obstruction (2), anuria (1) requiring complementary treatment: double J stent (1), nephrostomy (1), incision of ureterocele (1).Extracorporeal lithotripsy is effective in children and must be considered as first-line treatment for urinary stones in children. The only contraindication is untreated obstructive uropathy.

To evaluate the current incidence of nocturnal enuresis in France and the ways this condition is managed.A survey was conducted amongst 3,803 school children (5 to 10 years old). In addition, management of nocturnal enuresis proposed by various specialists were collected through an analysis of the literature.The incidence of nocturnal enuresis was found to be 9.2% (11.2% in the subgroup of patients 5 to 7 years of age). 42% of the children (the most severe cases) stated they were bothered by their problem and that it affected their social life, although the mothers had a tendency to minimize the impact of enuresis. 66% of the mothers of children suffering from moderate to severe enuresis did address the problem to a medical doctor, mainly a general practitioner. Amongst these latter, 20% did not propose any solution. The remaining mainly proposed advise for lifestyle and dietary habits as well as a "wait and see" attitude. As a specific treatment, drugs (oxybutynin 48%, desmopressin 22%, imipramine 12%) were prescribed more often than alarms as drugs proved to be more effective than alarms. 48% of the mothers of enuretic children considered that doctors do not pay enough attention to this problem. Options for specific treatments of nocturnal enuresis vary from one specialist to another.A consensus about the most appropriate management approach to nocturnal enuresis is needed. Management of voiding dysfunction should be part of the medical curriculum.

Monosymptomatic nocturnal enuresis is common in healthy school children. Treatment is often required because of social and psychological convenience. We therefore conducted a randomized prospective trial using either desmopressin (D) or alarm (A).Patients (n = 135) aged 6 to 16 years were enrolled between January 1992 and December 1994. Desmopressin (Minirin spray, Ferring SA) was given intranasally at a dose of 20 micrograms at bedtime and increased to 40 micrograms after 2 weeks if partial result was obtained. The alarm was a pad-bell device (Wet-stop, Sega) and the sound source was attached to the upper part of the pajamas. Inclusion criteria were: primary monosymptomatic nocturnal enuresis in healthy children, ageor = 6 years, absence of previous treatment using either desmopressin or alarm. The aim of the treatment was to achieve 100% dry nights. Patients were evaluated after 15 days on therapy by phone call and thereafter by attending the outpatient clinic at 2-3 and 4-6 months. At the time of the second evaluation, a switch from alarm to desmopressin (or vice-versa) was proposed to those who did not respond to the initial treatment.In group D (n = 62), only 27 children were included since 12 (19%) were switched to alarm and 23 (37%) were excluded because they were either non-compliant or lost to follow-up. In group A (n = 73), only 31 were included since six (8%) were switched to desmopressin and 36 (49%) were excluded for the same reasons as in group D. Prior to inclusion, the percentage of dry nights was 21% in group D and 14% in group A. After 15 days on therapy, patients from group D achieved 80% dry nights compared to 50% in group A (P = 0.001). After 3 months, patients from group D attained 85% dry nights vs 90% in group A. After 6 months, children from group A achieved 94% dry nights vs 78% in group D (P = 0.01).Desmopressin offers better short-term results than enuresis alarm but the latter is significantly more efficient in the long term. In France, the alarm device is not reimbursed by the national health service and therefore is poorly accepted, as suggested from the high rate of patients lost to follow-up.

Enuresis is a frequent manifestation with important psychological and social consequences in Africa. In order to help the public authorities to plan monitoring actions and better targeted health interventions, we carried out this prospective study in one district of Ouagadougou. The aim of this study was to describe and analyze enuretic children and teenagers' profile from 5- to 16-years old, and their parents' attitude toward the disorder.A cross-sectional study was conducted among 1,575 children and teenagers of this age group. Those children and teenagers were chosen from a random sample of 645 households. Sociodemographic and medical data were obtained from respondents by using a written questionnaire.The rate of young people affected was 12.95%. Among them, 78.9% had primary enuresis; 50.5% of them were not treated. Those with secondary enuresis were more easily treated than those with primary stage. 87.3% were traditionally treated and 3.4% of enuretic children were essentially submitted to fluid restrictions. In about 27% of the cases, children were punished by their parents.Sociodemographic characteristics of our sample were similar to those in the literature. However, the parents in our study rarely used modern treatment and had inappropriate attitudes toward the disorder. We recommend that the most important factors to be taken into account in the secondary prevention of enuresis are the parents' ignorance and/or their scepticism toward the modern therapeutic possibilities.

The clinical and urodynamic approach to enuretic children over a period of more than 20 years has allowed the authors to develop a multifactorial pathophysiological concept of this disorder. The main factors involved are psychological, familial, genetic, vesical, due to bladder immaturity, hormonal, due to a defect of nocturnal ADH secretion, hygiene and dietary habits, etc. The sleep factor is predominant in the majority of cases. Although nocturnal enuresis is apparently isolated in many cases, it is often associated with a state of bladder immaturity, sometimes latent during the day, but occurring at night with episodes of detrusor hyperactivity, occurring during various phases of sleep. In practice, the recognition, in children, of these factors, some of which require specific treatments, implies a management combining several of these therapeutic modalities.

Seminal vesicle cysts with ureteral ectopy and ipsilateral renal agenesis or dysplasia are rare congenital malformations. This study reports 7 consecutive cases in a single center and, for the first time in the literature, reports long-term results on 5 cases. Patients were between the age of 15 and 57 years. The malformation was diagnosed in all cases with excretory urography, computed tomography, magnetic resonance imaging and cystoscopy. 5 patients were followed after diagnosis for 26 to 119 months (mean 52 months). Only 2 of 7 patients primarily presented with nonspecific lower urinary tract symptoms. One patient (15 years old) showed significant enlargement of the cysts with compression of the urinary bladder and signs of urinary incontinence 10 years after primary diagnosis. The other 4 patients had no changes of their malformation. In conclusion, seminal vesicle cysts with ipsilateral renal agenesis are now more frequently diagnosed because of the increasing use of sectional imaging procedures. They are mostly asymptomatic and their morphology does not change with time. These data support the concept of only treating symptomatic patients.

Monosymptomatic enuresis in childhood can be divided in two subtypes by a nycthemeral diuresis profile, including urinary volume and osmolality. The first one is characterized by an abnormal circadian diuresis cycle, responsible for nocturnal polyuria and/or low urinary overnight osmolality, there is a good response to desmopressin; the other one is the so-called cognitive or idiopathic type, which provides a poor response to desmopressin.

Diurnal enuresis is very uncommon and may be related to early onset parent-to-child relationship disorders. As a symptom, enuresis can hinder nursery school socialization or can arise at this time. Two case-reports illustrate such an hypothesis.

Body fluid homeostasis is maintained by the kidney. Such an accurate control in achieved via the secretion of antidiuretic hormone (ADH), the secretion of which is regulated by hypothalamic osmoreceptors. Both urine flow rate and the excretion of most electrolytes have a diurnal rhythm; they increase during daytime and decrease during nighttime. Such a rhythm seems to be absent in some subjects who suffer from bedwetting because of relative polyuria. In these cases, the polyuria is associated with a decreased nocturnal secretion of ADH and the subsequent excretion of dilated urine. A deficit in the nocturnal secretion of ADH thus appears to explain the response to desmopressin of children with a polyuric form of enuresis.

We still do not know whether Imipramine works exactly as an antidiuretic. The aim of this study was to investigate any existing urinary or serum factor differences between 9 children with primary nocturnal enuresis and six age and sex matched controls and to see if therapy with Imipramine could modify these parameters. All subjects underwent an evaluation of daily and nightly urinary volume, daily fluid intake, morning plasma and urine osmolality, plasma aldosterone, electrolytes, blood urea nitrogen and plasma glucose. The results, using a one-way ANOVA, would suggest the following: 1) enuretic children have a higher 24 urinary volume with a reduced osmolality compared to controls; 2) Aldosterone does not seem to be involved in the pathogenesis of enuresis; 3) Imipramine HCL therapy does reduce the volume of urine lost in diapers, and its efficiency can be documented objectively; 4) Imipramine HCL's mechanism appears to be related to an increased renal water resorption.

Bedwetting is present in 5 to 7% of children aged 7 to 8 years. The history of the disorder and the examination of the child are of main importance. This is usually the first step to identify nocturnal enuresis, bladder or urethral instability and other voiding dysfunctions. Therapeutic failure is often related to an inadequate analysis of the disorder. For nocturnal enuresis, the best results are obtained with alarms and/or desmopressine; bladder instability usually requires oxybutinine chlorydrate and urethral instability can be treated with biofeedback therapy. The management of other voiding dysfunctions depends on urodynamic assessment.

The financial cost of bedwetting management is often underestimated. A study including 48 children aged 6 to 16 years was carried out in the outpatient clinic in order to evaluate the cost of these disorders during a 4 month-period. The diagnosis was the following: nocturnal enuresis (n = 15), bladder instability (n = 22) and other voiding dysfunction (n = 11). Our results showed that these expenses were quite important. A relationship between the kind of voiding dysfunction and the subsequent expenses was observed: the more complex was the disorder, the more expensive it was (average expenses = 1317 FF/year for nocturnal enuresis, 2506 FF/year for bladder instability and 3174 FF/year for other dysfunctions). Subsidiary expenses (transport, diapers and extrawashing) constituted an important part of the whole expenses: 46% in nocturnal enuresis, 42% in bladder instability and 38% in other dysfunctions.

Disorders of the vesico-sphincteral system are due to multiple causes (urological, gynaecological, neurological, psycho-behavioural, iatrogenic) which may be associated. By providing information on the type and evolution of these disorders and on the circumstances in which they developed, questioning is fundamental for the diagnosis. Completed by physical examination, it must precede all exploratory methods, including urodynamic, electrophysiological and radiological examinations. It allows these examinations to be graded and, compared with the results, it gives a better understanding of the physiopathology and aetiology of micturition disorders and therefore ensures their better treatment.

Primary or secondary nocturnal enuresis in adults (over the age of 15 years) is rare, but is associated with considerable psychosocial repercussions. The aim of this retrospective study was to determine whether urodynamic studies have any predictive value for the efficacy of the treatments proposed in these patients. This study was based on 20 patients (8 females and 12 males) between the ages of 15 and 33 years (mean: 23.75 years), studied between 1982 and 1990 with a mean follow-up of 13.35 months. Enuresis was primary in 12 patients and secondary in 8 patients. 11 patients had already received one or more treatments without success. Patients with clinically obvious neurological disease were excluded from the study. The urodynamic assessment included water cystomanometry, water urethromanometry with a perfused catheter and uroflowmetry. In addition to the investigation of other associated disturbances of micturition, the following complementary investigations were performed: urine culture in every case, IVU and/or cystography (n = 18), cystoscopy (n = 3), renal and vesical ultrasonography (n = 1). The urodynamic assessment was abnormal in 16 out of 20 cases: marked detrusor hyperactivity (n = 15), impaired compliance (n = 6), significant urethral instability (n = 7), isolated premature urge (n = 1). 15 patients presented with diurnal disorders dominated by frequency (n = 13), urgency (n = 9) and urge incontinence (n = 4); detrusor hyperactivity was detected in every case. The abnormalities observed on the urodynamic assessment guided treatment, allowing correction of enuresis in 3/4 of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

A 4-year-old boy was treated with oxybutinine and desmopressine because of bladder instability associated with secondary enuresis. He was admitted with obnubilation, vomiting and experienced two seizure episodes concomitantly with hyponatremia and hypoosmolality. The child healed promptly under water restriction and intravenous administration of sodium chloride. This case report suggests that desmopressine may be responsible for severe side-effects. This drug should not be widely used and its indications should be restricted to patients with proven antidiuretic hormone secretion abnormalities.

Bed-wetting is a frequent feature in school-age children. A pilot transversal study was carried out in school-children from the city of Villeurbanne in order to study the prevalence of bed-wetting in school-age children. Answers to a questionnaire were exhaustively obtained from 1,677 children in primary school before school-camp. An other questionnaire was given to parents of children from nursery-school: answers were obtained for 386 children, i.e. 95% of the sample. The rate of children suffering from bed-wetting was 49% between 3 and 4 years of age, 4% between 7 and 6 years of age and 1% between 11 and 12 years of age. These results are comparable to those reported in the literature. Within the range 4-7 years of age, the estimation of bed-wetting exhibited a lower frequency in the school-camp questionnaire probably reflecting its speculated social inconvenience, as compared with the answers to the nursery-school questionnaire rather reflecting a close estimation of property attainment. The reported prevalence rates provided no discriminant criteria regarding the mechanism of bed-wetting.