P98 Incontinentio urinae 3 years old girl how long from symptom to cure case report

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Abstract

Background

Inability to prevent the discharge of urine is more common in adult, elderly population, but rare among children. When it occurs, we always think of congenital malformation. Ureter duplication is rarely clinically significant. In females occurs in cases of ectopic ureter entering the vagina, urethra or vestibule.

Aim

To show that sometimes it is not easy and takes long to find the cause of incontinentio urinae.

Case report

The mother of the girl aged 3 years 4 months came to a paediatrician complaining that although the girl controls sphincters her underwear is almost always wet. Her urine was checked several times, and she had no urine infection. During the next 3 years 8 months she was examined by the: urologist, nephrologist, neuro-surgeon, physiatrist, psychologist, than again urologist. She was first sent to the Centre for urinary disorders (‘University Children’s hospital – Tirsova’) where the uroflow was done, ultrasound, MR L-S part of spine (Dg: Spina bifida oculta –‘Mother and child Health Care Institute’), EMG and SEP n.tibialis, cystoscopy, MCUG and DMSA of kidneys (Military Medical Academy). After these examinations had done she was trained to control sphincter (no success); went through behavioural and biofeedback therapy; took Oxybutynin hydrochloride for 4 months (no effect); spoke with psychologist. As the problem remained the nephrologist sent her again to the experienced paediatric urologist who suggested MR urography. Dg was: Ureter duplex et ectopio ureteris extra-sphincterica pro polus sup. renis l sin. Left kidney had double PK system. She had a surgery and afterwards she was able to control urination.

Conclusions

In our case it took almost 4 years, devoted nephrologist and an experienced paediatric urologist to establish the cause of incontinentio urinae and to diagnose the congenital kidney malformation: Ureter duplex and ectopio ureteris renis l sin. The problem was solved surgically. As her paediatrician I will never forget the smile on her face when she said: ‘My underwear is dry.’ She was 7 years old, and about to start the school.

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