The Effect of Adenotonsillectomy on Pediatric Nocturnal Enuresis: a Prospective Cohort Study

Introduction: Sleep disorder caused by adenotonsillar hypertrophy has been implicated as a cause of primary and secondary nocturnal enuresis in children.  This study was conducted to investigate the effect of adenotonsillectomy on enuresis in children with adenotonsillar hypertrophy.  Materials and Methods: This prospective cohort study was conducted in Hamadan City in Western Iran, from April ۲۰۱۰ to December ۲۰۱۱. Ninety-seven children aged ۳ to ۱۲ years with adenotonsillar hypertrophy who were admitted to Besat Hospital for adenotonsillectomy were evaluated. The primary outcome was the number of incidents of bedwetting (nocturnal enuresis) post-operation compared with pre-operation. Patients were followed-up for ۳ months. Data were collected using a questionnaire regarding number of bedwetting incidents, type of enuresis (primary or secondary), and family history of enuresis, as well as results of urine analysis.  Results: Of ۴۲۰ children admitted for adenotonsillectomy, ۹۷ had a positive history of preoperative enuresis, including ۴۲ girls and ۵۵ boys, with mean age of ۴۸ months. The parents of ۸۴ (۸۶.۶%) children agreed to participate in the study. Three months after adenotonsillectomy, enuresis had resolved completely in ۵۱ (۶۰.۷%) children and had shown relative improvement in ۲۲ (۲۶.۲%) children. Enuresis had not improved in the remaining ۱۱ (۱۳.۱%) children (P<۰.۰۰۱).  Conclusion:  The results of this study indicate that adenotonsillectomy can improve enuresis in the majority of children with adenotonsillar hypertrophy. However, further evidence based on large multi-center randomized clinical trials is required to confirm these results.