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al menos una vez al mes en ni&#241;os mayores de 4<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; La IF puede ser secundaria a estre&#241;imiento o aislada&#46; La primera es la m&#225;s habitual &#40;80&#37;&#41; y ocasionada por rebosamiento fecal&#44; y se conoce como IF retentiva&#46; La IF no asociada a estre&#241;imiento es la menos frecuente &#40;20&#37;&#41; y se le conoce como IF no retentiva&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La Sociedad Internacional para la Continencia en Ni&#241;os &#40;ICCS&#41; recomienda utilizar los criterios Roma IV para el diagn&#243;stico de los trastornos defecatorios funcionales en ni&#241;os<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">3&#44;14</span></a>&#46; Debido a la importancia del estudio y manejo del h&#225;bito intestinal en pacientes con STUI&#44; en 2013 la ICCS public&#243; las gu&#237;as para el manejo de la DI en pacientes con sintomatolog&#237;a urinaria<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La proximidad anat&#243;mica de ambos sistemas y su inervaci&#243;n compartida facilitan que la afectaci&#243;n de uno influya en el otro<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">15</span></a>&#46; La coexistencia de estre&#241;imiento y trastornos del tracto urinario&#44; como incontinencia urinaria&#44; urgencia&#44; frecuencia e ITU recurrentes&#44; est&#225; bien establecida desde hace a&#241;os&#46; En t&#233;rminos generales&#44; el estre&#241;imiento puede afectar tanto al vaciado como al llenado vesical&#44; pues la compresi&#243;n mec&#225;nica del recto lleno de heces&#44; sobre la pared posterior de la vejiga y tr&#237;gono origina disminuci&#243;n de la capacidad vesical&#44; urgencia&#44; incontinencia y frecuencia&#59; y adem&#225;s&#44; cambios en la fisiolog&#237;a y en los est&#237;mulos neurales de la vejiga y de los m&#250;sculos del suelo p&#233;lvico&#44; lo que conduce a una disminuci&#243;n progresiva en la necesidad de orinar&#44; hiperactividad del detrusor&#44; vaciamiento insuficiente y aumento significativo del residuo posmiccional<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">2</span></a>&#46; La compresi&#243;n del recto sobre el tr&#237;gono y el cuello vesical puede ocasionar obstrucci&#243;n del tracto de salida&#44; lo que aumenta a&#250;n m&#225;s el residuo posmiccional y la posibilidad de reflujo vesicoureteral&#46; Por otro lado&#44; el recto lleno de heces origina una contracci&#243;n del esf&#237;nter anal externo&#44; lo que provoca&#44; a su vez&#44; una falta de relajaci&#243;n del esf&#237;nter uretral externo y del suelo p&#233;lvico&#46; Esto sugiere que los esf&#237;nteres anal y uretral son una unidad funcional con entrada compartida a los reflejos sacros del intestino&#44; vejiga y uretra proximal<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">13&#44;16</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La enuresis es una micci&#243;n involuntaria que ocurre durante el sue&#241;o a partir de los 5<span class="elsevierStyleHsp" style=""></span>a&#241;os de edad&#44; con una frecuencia de al menos 4 veces al mes&#46; Los pacientes enur&#233;ticos con STUI difieren cl&#237;nica&#44; patog&#233;nica y terap&#233;uticamente de aquellos que no presentan sintomatolog&#237;a durante el d&#237;a&#44; por ello es importante la diferenciaci&#243;n de ambas entidades&#46; La enuresis que no se acompa&#241;a de STUI&#44; sin disfunci&#243;n vesical&#44; se define como enuresis monosintom&#225;tica &#40;EM&#41;&#59; ni&#241;os con enuresis y STUI presentan enuresis no monosintom&#225;tica &#40;ENM&#41;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">9&#44;11</span></a>&#44; precisando un manejo y tratamiento espec&#237;fico diferente a los pacientes monosintom&#225;ticos&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El objetivo del estudio es determinar la influencia del estre&#241;imiento en la EM y la ENM y conocer la prevalencia de las 3 entidades as&#237; como de DTUI y DVI en la poblaci&#243;n&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material y m&#233;todo</span><p id="par0050" class="elsevierStylePara elsevierViewall">Realizamos un estudio observacional transversal de prevalencia&#46; Estudiamos una muestra representativa de ni&#241;os y ni&#241;as de 5 a 9<span class="elsevierStyleHsp" style=""></span>a&#241;os escolarizados en la comunidad gallega&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Seg&#250;n los datos poblacionales del Instituto Galego de Estad&#237;stica&#44; se hizo un c&#225;lculo del tama&#241;o muestral necesario para la realizaci&#243;n del estudio&#46; Se obtuvo una muestra representativa de cada provincia&#44; mediante un muestreo aleatorio de municipios estratificados por tama&#241;o&#46; En cada uno de ellos se seleccionaron aleatoriamente colegios p&#250;blicos&#44; privados y concertados&#44; tanto del &#225;mbito rural como del urbano&#44; de educaci&#243;n infantil y primaria&#44; mediante el programa Epidat v&#46;3&#46;1&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Se enviaron los cuestionarios a los colegios para que fueran repartidos en los diferentes cursos&#46; Estos fueron an&#243;nimos y voluntarios y obtuvimos un total de 3&#46;675 cuestionarios&#44; de los cuales se seleccionaron n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>772 por estricto orden de recogida&#44; que nos permitieron estudiar los datos con una precisi&#243;n del 3&#37; y una seguridad del 97&#37;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Se elabor&#243; un cuestionario &#40;<a class="elsevierStyleCrossRef" href="#sec0040">Anexo</a>&#41; sobre los h&#225;bitos miccionales&#44; intestinales y s&#237;ntomas espec&#237;ficos de DVI&#44; donde se incluyeron los &#237;tems del cuestionario PLUTSS de STUI&#46; Dicho cuestionario fue traducido y validado al castellano previamente por el grupo de autores<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a>&#46; Los cuestionarios fueron repartidos en los colegios tras la autorizaci&#243;n de la junta directiva de los mismos y con una hoja de informaci&#243;n del estudio para los padres&#44; que eran quienes rellenaban el cuestionario&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Se defini&#243; estre&#241;imiento como &#62;<span class="elsevierStyleHsp" style=""></span>2 puntos Roma III modificados&#44; ya que eran los criterios en vigor en el momento de la realizaci&#243;n del estudio<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se consider&#243; DI aquellos ni&#241;os que presentaban estre&#241;imiento&#44; IF o ambas&#46; Adem&#225;s&#44; si el ni&#241;o asociaba cl&#237;nica miccional o un cuestionario PLUTSS<span class="elsevierStyleHsp" style=""></span>&#43; &#40;puntuaci&#243;n &#8805;<span class="elsevierStyleHsp" style=""></span>8&#44;5&#41;&#44; se consider&#243; como DVI&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo de las variables incluidas en el estudio&#46; Se estudi&#243; la asociaci&#243;n entre variables cualitativas con el test Chi-cuadrado o test exacto de Fisher&#46; Se realiz&#243; la comparaci&#243;n de medias en dos grupos&#44; tras comprobar la normalidad con los test de Kolmogorov-Smirnov&#44; T de Student o U de Mann-Whitney&#44; seg&#250;n proced&#237;a&#46; Se estudi&#243; la asociaci&#243;n entre variables cuantitativas con el coeficiente de correlaci&#243;n de Pearson o Spearman&#44; teniendo en cuenta la distribuci&#243;n de las variables&#46; Se realizaron modelos de regresi&#243;n log&#237;stica para determinar qu&#233; variables se asocian de forma independiente con un resultado de PLUTSS<span class="elsevierStyleHsp" style=""></span>&#43;&#44; EM&#44; ENM&#44; estre&#241;imiento e IF&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0085" class="elsevierStylePara elsevierViewall">Se estudiaron 772 encuestas de ni&#241;os de entre 5 y 9<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; siendo el 52&#44;8&#37; del sexo femenino y el 47&#44;2&#37; del masculino&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La prevalencia de enuresis fue del 9&#44;1&#37;&#44; siendo EM en el 62&#44;9&#37; y ENM en el 37&#44;1&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Se observ&#243; una disminuci&#243;n de la prevalencia de enuresis con la edad&#44; como se ve en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">La prevalencia de estre&#241;imiento fue del 20&#44;0&#37;&#44; con un total de 154 ni&#241;os estre&#241;idos&#46; Exist&#237;a IF en 22 ni&#241;os&#44; lo que supone una prevalencia del 2&#44;8&#37; del total de la serie&#59; el 60&#37; s&#243;lo manchaba la ropa interior y en el 40&#37; las p&#233;rdidas fecales eran importantes&#46; En la mayor&#237;a de estos ni&#241;os&#44; la IF fue retentiva &#40;2&#44;1&#37; del total&#41;&#59; siendo no retentiva tan solo en 6 pacientes&#46; En conjunto&#44; 160 ni&#241;os &#40;20&#44;8&#37;&#41; presentan alg&#250;n tipo de DI&#44; observando que la mayor&#237;a de los pacientes con IF eran estre&#241;idos como se ha comentado previamente&#46; En 40 ni&#241;os &#40;5&#44;2&#37;&#41; se observ&#243; DVI&#46; Tanto la IF como las DVI son m&#225;s frecuentes en varones&#44; con valores estad&#237;sticamente significativos &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis bivariado para estudiar los signos cl&#237;nicos en los que influye significativamente la presencia de estre&#241;imiento &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Se observ&#243; que el estre&#241;imiento se relaciona de forma significativa con las siguientes variables&#58; puntuaci&#243;n del PLUTSS&#44; DTUI&#44; incontinencia urinaria diurna &#40;IUD&#41;&#44; STUI&#44; urgencia miccional&#44; p&#233;rdidas hacia el ba&#241;o&#44; ENM e IF&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Los resultados m&#225;s significativos de la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se representan en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46; Como se puede observar&#44; todos los s&#237;ntomas o trastornos del tracto urinario inferior aumentan su prevalencia si existe estre&#241;imiento asociado&#44; salvo la EM que es el &#250;nico problema de los mencionados no relacionado con DTUI&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discusi&#243;n</span><p id="par0115" class="elsevierStylePara elsevierViewall">Las disfunciones vesicales e intestinales describen un amplio espectro de alteraciones que incluye patrones miccionales o defecatorios anormales<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">18</span></a>&#46; La ICCS define la presencia de DTUI a partir de los 5<span class="elsevierStyleHsp" style=""></span>a&#241;os de edad&#44; pues es esta edad a partir de la que se considera que deben haber terminado el proceso de aprendizaje miccional<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">10</span></a>&#46; Del mismo modo un paciente se considera enur&#233;tico tambi&#233;n a partir de los 5<span class="elsevierStyleHsp" style=""></span>a&#241;os<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">10</span></a>&#46; Por el contrario&#44; la ICCS define la DI a partir de los 4<span class="elsevierStyleHsp" style=""></span>a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">10&#44;11</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Para conocer la prevalencia de las disfunciones intestinales y vesicales&#44; los estudios epidemiol&#243;gicos analizan la mayor&#237;a de las veces la frecuencia de incontinencia urinaria diurna&#44; y enuresis sobre todo&#59; en otros casos la existencia de STUI seg&#250;n distintitos criterios&#44; y pocas veces utilizan cuestionarios validados de graduaci&#243;n de la sintomatolog&#237;a urinaria para definir los criterios de DTUI&#46; Las DI son analizadas la mayor&#237;a de las veces seg&#250;n los criterios Roma III &#40;en muchos casos modificados&#41;&#44; o seg&#250;n otros criterios diferentes definidos en cada publicaci&#243;n&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">El cuestionario PLUTSS se trata de una herramienta de diagn&#243;stico y seguimiento para los pacientes con DTUI&#46; Desde el 2017&#44; dicho cuestionario est&#225; traducido y validado culturalmente al castellano&#44; por lo que se recomienda su uso para la valoraci&#243;n de pacientes con STUI&#44; permitiendo una homogeneizaci&#243;n entre series y publicaciones<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La prevalencia de enuresis observada en nuestro estudio es del 9&#44;1&#37;&#44; 5&#44;7&#37; de EM y 3&#44;4&#37; de ENM&#46; La edad tiene un papel primordial en la prevalencia de la enuresis&#46; En la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> se observa la prevalencia por sexo y edad en nuestra poblaci&#243;n&#44; as&#237; como su bajada exponencial con la edad&#44; lo que se asemeja mucho a lo ya publicado en otras poblaciones<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">19&#8211;21</span></a>&#44; rondando el 14&#37; a los 5<span class="elsevierStyleHsp" style=""></span>a&#241;os y bajando progresivamente hasta un 2&#37; a los 9<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">La enuresis es m&#225;s frecuente en el sexo masculino<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">20&#44;22&#8211;25</span></a>&#44; y esto concuerda con nuestros resultados&#44; pues se observa un riesgo mayor de enuresis en varones &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;72&#41; sobre todo de EM &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;91&#41;&#46; Nuestro trabajo muestra una relaci&#243;n algo mayor que la publicada en otras culturas como el grupo de Ozkan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">20</span></a> &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;60&#41; o el de Esezobor et al&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">25</span></a> &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;56&#41;&#44; pero menor que la de otros grupos nacionales con poblaciones similares&#44; como la de Mart&#237;nez Agull&#243; et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">23</span></a> &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;34&#41;&#44; o la de Guti&#233;rrez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">22</span></a> &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;52&#41;&#59; no obstante&#44; este &#250;ltimo indica que con la edad la diferencia entre sexos se va equilibrando&#46; En nuestra serie a los 8-9<span class="elsevierStyleHsp" style=""></span>a&#241;os la resoluci&#243;n es mucho mayor en ni&#241;as y la diferencia en la prevalencia vuelve a ser importante &#40;8&#44;2&#37; en ni&#241;os vs&#46; 0&#44;7&#37; en ni&#241;as&#41;&#59; esta diferencia se puede explicar probablemente por la maduraci&#243;n m&#225;s precoz de las ni&#241;as respecto a los ni&#241;os&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">La prevalencia de estre&#241;imiento fue del 20&#44;0&#37;&#44; el mismo porcentaje observado en el reciente estudio epidemiol&#243;gico de estre&#241;imiento de Fujitani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">26</span></a>&#46; En un estudio similar al nuestro realizado por Chung et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">27</span></a> en Corea sobre un total de 19&#46;240 ni&#241;os de entre 5 y 13<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; los autores utilizaron unos criterios menos estrictos&#44; definiendo estre&#241;imiento como la presencia de &#60;<span class="elsevierStyleHsp" style=""></span>3 deposiciones&#47;semana&#44; o deposiciones tipo I-II de Bristol&#44; pero observaron una prevalencia similar de estre&#241;imiento &#40;18&#44;5&#37;&#41;&#46; Nuestros resultados tambi&#233;n se asemejan a los de Loening-Baucke<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a> &#40;22&#44;6&#37;&#41; que utilizaron los criterios de Iowa &#40;similares a los de Roma III&#41;&#46; En 2018 se public&#243; una revisi&#243;n sistem&#225;tica de 11 a&#241;os que reporta una prevalencia de estre&#241;imiento de entre el 0&#44;5 y 32&#44;2&#37;&#44; con una media del 9&#44;5&#37; &#40;IC 95&#37;&#58; 7&#44;5-12&#44;1&#41;&#44; en 35 trabajos que utilizan los criterios Roma III o IV<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">28</span></a>&#46; Es destacable que un alto porcentaje de los trabajos analizados en este estudio se realizaron en Asia &#40;46&#37;&#41;&#59; solo 2 en Europa y otros 2 en Norteam&#233;rica&#59; sin embargo&#44; es en este &#250;ltimo donde se observ&#243; una mayor prevalencia de estre&#241;imiento&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">En nuestra serie se observ&#243; una incidencia global de IF del 2&#44;8&#37;&#59; la prevalencia fue pr&#225;cticamente similar a la de otros estudios<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a>&#46; La IF en pa&#237;ses occidentales oscila entre el 0&#44;8 y 4&#44;1&#37;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">29&#44;30</span></a>&#44; y en pa&#237;ses asi&#225;ticos entre el 2 y 7&#44;8&#37;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">27&#44;31</span></a>&#46; Un estudio holand&#233;s reporta mayor riesgo en ni&#241;os de 5-6<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;4&#44;1&#37;&#41; que en los de 11-12 &#40;1&#44;6&#37;&#41;&#44; lo que indica una posible influencia madurativa<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">30</span></a>&#59; adem&#225;s&#44; observan un riesgo elevado de trastornos psicol&#243;gicos&#44; pero a pesar de ello tan solo el 27-37&#37; consulta por su DI&#46; La ICCS recomienda realizar valoraci&#243;n psicol&#243;gica y&#47;o psiqui&#225;trica inicial a todos los ni&#241;os con IF no retencionista por la alta tasa de problemas mentales asociados que presentan&#46; En nuestra serie el estre&#241;imiento es el principal factor de riesgo de la IF &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#44;249&#41;&#44; pero en nuestro estudio han mostrado tambi&#233;n ser factores predisponentes&#58; sexo masculino &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;407&#41;&#44; iniciar la escolarizaci&#243;n sin completar el entrenamiento miccional &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;609&#41; y presentar DTUI &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;271&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">La asociaci&#243;n de disfunci&#243;n vesical e intestinal se observ&#243; en nuestro estudio en el 5&#44;2&#37; de los casos&#44; siendo significativamente m&#225;s frecuente en el sexo masculino &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;952&#41;&#46; Se observ&#243; que el 75&#37; de las DVI eran pacientes posponedores&#44; es decir&#44; que retrasaban la micci&#243;n y&#47;o defecaci&#243;n&#46; Nuestros criterios para identificar a pacientes con DVI fueron estrictos&#44; y para ello necesitaban tener una puntuaci&#243;n PLUTSS<span class="elsevierStyleHsp" style=""></span>&#43; y estre&#241;imiento o IF&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Cl&#225;sicamente se ha considerado al estre&#241;imiento como factor de riesgo de enuresis&#44; pero uno de los principales trabajos publicados que defiende esta hip&#243;tesis estudia &#250;nicamente 30 ni&#241;os enur&#233;ticos<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">32</span></a>&#44; siendo una serie muy corta para imponer datos fisiopatol&#243;gicos y espec&#237;ficos reales&#46; Cada vez hay m&#225;s publicaciones que no observan esta asociaci&#243;n&#44; reportando una prevalencia de estre&#241;imiento similar en enur&#233;ticos y no enur&#233;ticos<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">24&#44;33</span></a>&#46; En nuestro estudio tampoco se encuentran diferencias estad&#237;sticamente significativas&#59; y menos a&#250;n si se valoran &#250;nicamente los ni&#241;os con EM&#44; pues se observa que los estre&#241;idos mostraron menor EM que los no estre&#241;idos &#40;4&#44;8&#37; vs&#46; 5&#44;9&#37;&#41;&#46; La prevalencia de estre&#241;imiento en los pacientes con ENM s&#237; fue significativamente mayor que en el resto de la poblaci&#243;n pedi&#225;trica de nuestra serie &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;9&#41; &#40;36&#44;5&#37; SE vs&#46; 19&#44;2&#37; sin SE&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">En nuestra serie&#44; a diferencia de la EM&#44; la DTUI y la ENM han mostrado una clara relaci&#243;n con el estre&#241;imiento&#59; por tanto&#44; concluimos que la asociaci&#243;n que cl&#225;sicamente se ha establecido entre EM y estre&#241;imiento no es real&#44; y probablemente esta relaci&#243;n puede haber sido desencadenada por una falta de diferenciaci&#243;n precisa entre la EM y la ENM&#44; donde s&#237; es muy frecuente dicha asociaci&#243;n&#46; El estre&#241;imiento&#44; por tanto&#44; no es un factor de riesgo de EM&#44; pero s&#237; de DTUI y como consecuencia tambi&#233;n de ENM&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">En nuestra serie se observa que existe una asociaci&#243;n entre la presencia de estre&#241;imiento y el valor num&#233;rico del PLUTSS &#40;R<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;088&#41;&#44; al igual que lo descrito en el trabajo de Loening-Baucke<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a>&#46; Adem&#225;s&#44; observamos que el estre&#241;imiento aumenta el riesgo de presencia de STUI &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;523&#41;&#44; urgencia miccional &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;295&#41; y sobre todo IF &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#44;132&#41;&#46; Probablemente todos estos s&#237;ntomas son secundarios a los vaciados vesical y rectal incompletos y a la contractura secundaria del suelo p&#233;lvico para evitarlas&#46; Esta relaci&#243;n entre estre&#241;imiento y DTUI se ha tratado de explicar por la proximidad anat&#243;mica del recto y la vejiga&#44; la inervaci&#243;n compartida a nivel de sacro y de centros neurales centrales&#44; adem&#225;s de por la contracci&#243;n de la musculatura estriada adyacente a ambas estructuras y empleada en las continencias urinaria y fecal o en la posposici&#243;n de la micci&#243;n o defecaci&#243;n&#59; de ah&#237; probablemente la importante relaci&#243;n entre estas maniobras y el riesgo de disfunci&#243;n vesical o intestinal<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">15</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusiones</span><p id="par0170" class="elsevierStylePara elsevierViewall">Es fundamental el diagn&#243;stico diferencial entre EM y ENM en la valoraci&#243;n inicial de los pacientes con enuresis&#46; El estre&#241;imiento no influye en la prevalencia de EM&#44; pero sin embargo constituye un importante factor de riesgo de la DTUI y de la ENM&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicto de intereses</span><p id="par0175" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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            0 => "Estre&#241;imiento"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cl&#225;sicamente se ha considerado el estre&#241;imiento como un factor de riesgo de la enuresis&#44; aunque cada vez hay m&#225;s publicaciones que reportan una prevalencia de estre&#241;imiento similar en enur&#233;ticos y no enur&#233;ticos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Determinar la influencia del estre&#241;imiento en la enuresis monosintom&#225;tica y la no monosintom&#225;tica y conocer la prevalencia de las 3 entidades as&#237; como de disfunciones del trato urinario inferior y disfunci&#243;n vesicointestinal en la poblaci&#243;n&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material y m&#233;todo</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional transversal de prevalencia sobre una muestra representativa de la poblaci&#243;n gallega de ni&#241;os y ni&#241;as escolarizados de 5 a 9<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; Se realiz&#243; una encuesta en los colegios sobre h&#225;bitos miccionales e intestinales que inclu&#237;a las preguntas del cuestionario <span class="elsevierStyleItalic">Paediatric Lower Urinary Tract Scoring System</span> &#40;PLUTSS&#41; de diagn&#243;stico y graduaci&#243;n de las disfunciones del tracto urinario inferior&#46; Se consider&#243; la enuresis seg&#250;n los criterios de la Sociedad Internacional para la Continencia en Ni&#241;os &#40;ICSS&#41;&#44; y si adem&#225;s asociaba sintomatolog&#237;a diurna&#44; se clasific&#243; como enuresis no monosintom&#225;tica&#46; El estre&#241;imiento se valor&#243; de acuerdo con los criterios Roma III y la escala de heces de Bristol adaptados&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 772 encuestas en el estudio&#46; La prevalencia de estre&#241;imiento fue del 20&#37;&#44; la de enuresis del 9&#44;1&#37; &#40;enuresis monosintom&#225;tica 62&#44;9&#37; y no monosintom&#225;tica 37&#44;1&#37;&#41; y la de disfunci&#243;n vesicointestinal del 5&#44;2&#37;&#46; Observamos que el estre&#241;imiento no influye en la presencia de enuresis monosintom&#225;tica&#44; pero s&#237; en la enuresis no monosintom&#225;tica y las disfunciones del trato urinario inferior&#44; donde constituye un importante factor de riesgo&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Es fundamental el diagn&#243;stico diferencial entre enuresis monosintom&#225;tica y no monosintom&#225;tica en la valoraci&#243;n inicial de un paciente enur&#233;tico&#44; ya que el manejo terap&#233;utico y las caracter&#237;sticas de ambas entidades son diferentes&#44; constituyendo el estre&#241;imiento un factor de riesgo solamente en el caso de las enuresis no monosintom&#225;ticas&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Constipation has classically been considered as a risk factor of enuresis&#44; although there are increasingly more publications that report a similar prevalence of constipation in both enuretics and non-enuretics&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To determine the influence of constipation in monosymptomatic and non-monosymptomatic enuresis&#44; and to find out the prevalence of the three disorders&#44; as well the lower urinary tract dysfunction and bladder-bowel dysfunction in the population&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material and method</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional observational prevalence study on a representative population sample of 5 to 9 year-old school boys and girls of Galicia&#44; Spain&#46; A questionnaire was completed in the schools on urinary and bowel habits&#44; which included questions from the Paediatric Lower Urinary Tract Scoring System &#40;PLUTSS&#41; diagnostic questionnaire and grading of the lower urinary tract dysfunctions&#46; The enuresis was diagnosed using the International Children&#39;s Continence Society &#40;ICSS&#41;&#44; and if it was also associated with diurnal symptoms&#44; it was also classified as non-monosymptomatic enuresis&#46; The constipation was evaluated using the Rome III criteria and the adapted Bristol stool scale&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A total of 772 questionnaires were included in the study&#46; The prevalence of constipation was 20&#37; and that of enuresis was 9&#46;1&#37; &#40;62&#46;9&#37; monosymptomatic enuresis and 37&#46;1&#37; non-monosymptomatic&#41;&#44; with the prevalence of bladder-bowel dysfunction being 5&#46;2&#37;&#46; It was observed that constipation had no influence on the presence of monosymptomatic enuresis&#44; but it did have an influence on non-monosymptomatic enuresis and lower urinary tract dysfunctions&#44; where it was a significant risk factor&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The differential diagnosis between monosymptomatic and non-monosymptomatic enuresis is essential in the initial evaluation of the patient with enuresis&#44; since the therapeutic management and the characteristics of both disorders are different&#44; with constipation only being a risk factor in cases of non-monosymptomatic enuresis&#46;</p></span>"
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">129 &#40;83&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">566 &#40;91&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IUD</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;22&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80 &#40;13&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;990&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;1&#44;367&#59; 2&#44;899&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">119 &#40;77&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">538 &#40;87&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sintomatolog&#237;a urinaria diurna</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">104 &#40;67&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">295 &#40;47&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;302&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;1&#44;678&#59; 3&#44;160&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;32&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">323 &#40;52&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Urgencia miccional</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;38&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">133 &#40;21&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;295&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;1&#44;667&#59; 2&#44;899&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94 &#40;61&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">485 &#40;78&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Polaquiuria</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;21&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">104 &#40;16&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;315&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#44;904&#59; 1&#44;912&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">122 &#40;79&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">514 &#40;83&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dolor al orinar</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;798&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#44;093&#59; 6&#44;867&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;655&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">153 &#40;99&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">614 &#40;99&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Fuerza para orinar</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;3&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;303&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#44;628&#59; 2&#44;701&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;476&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">147 &#40;95&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">596 &#40;96&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P&#233;rdidas por urgencia</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;11&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;508&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;1&#44;479&#59; 4&#44;252&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">137 &#40;88&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">589 &#40;95&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Volver a orinar al poco tiempo</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;662&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#44;754&#59; 3&#44;664&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;203&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">148 &#40;95&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">602 &#40;97&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ITU</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;14&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 &#40;11&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;251&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#44;811&#59; 1&#44;929&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;311&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">132 &#40;85&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">544 &#40;88&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Enuresis</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;12&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;538&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#44;870&#59; 2&#44;716&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;136&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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Original
Influencia del estreñimiento en la enuresis monosintomática y en el síndrome enurético
Influence of constipation on monosymptomatic enuresis and in enuretic syndrome
María Rodríguez-Ruiza,
Autor para correspondencia
mrodruiz86@gmail.com

Autor para correspondencia.
, Roberto Mendez-Gallartb, Manuel García Méridac, Iván Somoza-Argibaya
a Servicio de Cirugía Pediátrica, Hospital Materno Infantil, Complexo Hospitalario Universitario de A Coruña, A Coruña, España
b Servicio de Cirugía Pediátrica, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
c Servicio de Cirugía Pediátrica, Hospital Regional Universitario de Málaga, Málaga, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La presencia de estre&#241;imiento&#44; incontinencia fecal &#40;IF&#41;&#44; o ambas se define como disfunci&#243;n intestinal &#40;DI&#41;&#46; El estre&#241;imiento supone el 3-5&#37; de las consultas de pediatr&#237;a y un 25&#37; de las de gastroenterolog&#237;a pedi&#225;trica<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a>&#46; Los ni&#241;os con morbilidad gastrointestinal&#44; en forma de estre&#241;imiento e IF&#44; asocian con frecuencia sintomatolog&#237;a del tracto urinario inferior &#40;STUI&#41; &#40;22-34&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; El 30&#37; presenta incontinencia urinaria y el 10&#37; infecciones del tracto urinario &#40;ITU&#41;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">3&#8211;6</span></a>&#46; Incluso sin referir sintomatolog&#237;a&#44; los ni&#241;os con estre&#241;imiento tienen par&#225;metros miccionales anormales<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Por otra parte&#44; se ha estimado que m&#225;s de la mitad de los ni&#241;os con disfunci&#243;n del tracto urinario inferior &#40;DTUI&#41; tienen DI asociada&#59; de estos el 30&#37; acuden por primera vez a la consulta con impactaci&#243;n fecal y el 80&#37; de ellos presentan adem&#225;s IF&#44; secundaria a la retenci&#243;n fecal<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">5&#44;8</span></a>&#46; La incidencia de esta asociaci&#243;n es&#44; por lo tanto&#44; alta&#46; Es muy frecuente que los pacientes que acuden por primera vez al gastroenter&#243;logo por estre&#241;imiento tengan los mismos s&#237;ntomas que los que acuden por primera vez al ur&#243;logo por una DTUI<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A esta asociaci&#243;n&#44; en ni&#241;os que no presentan alteraciones neurol&#243;gicas reconocibles&#44; se le denomina actualmente disfunci&#243;n vesicointestinal &#40;DVI&#41;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">9&#8211;12</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El cuestionario PLUTSS <span class="elsevierStyleItalic">&#40;Paediatric Lower Urinary Tract Scoring System&#41;</span> se cre&#243; con el fin de diagnosticar y graduar las DTUI de forma poco invasiva adem&#225;s de crear un arma para monitorizar la respuesta al tratamiento<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">10</span></a>&#46; Una puntuaci&#243;n &#8805;<span class="elsevierStyleHsp" style=""></span>8&#44;5 en el cuestionario tiene una sensibilidad del 100&#37; y una especificidad del 95&#37; en la determinaci&#243;n de DTUI<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La IF se trata de la p&#233;rdida involuntaria de heces en lugares inapropiados&#44; al menos una vez al mes en ni&#241;os mayores de 4<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; La IF puede ser secundaria a estre&#241;imiento o aislada&#46; La primera es la m&#225;s habitual &#40;80&#37;&#41; y ocasionada por rebosamiento fecal&#44; y se conoce como IF retentiva&#46; La IF no asociada a estre&#241;imiento es la menos frecuente &#40;20&#37;&#41; y se le conoce como IF no retentiva&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La Sociedad Internacional para la Continencia en Ni&#241;os &#40;ICCS&#41; recomienda utilizar los criterios Roma IV para el diagn&#243;stico de los trastornos defecatorios funcionales en ni&#241;os<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">3&#44;14</span></a>&#46; Debido a la importancia del estudio y manejo del h&#225;bito intestinal en pacientes con STUI&#44; en 2013 la ICCS public&#243; las gu&#237;as para el manejo de la DI en pacientes con sintomatolog&#237;a urinaria<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La proximidad anat&#243;mica de ambos sistemas y su inervaci&#243;n compartida facilitan que la afectaci&#243;n de uno influya en el otro<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">15</span></a>&#46; La coexistencia de estre&#241;imiento y trastornos del tracto urinario&#44; como incontinencia urinaria&#44; urgencia&#44; frecuencia e ITU recurrentes&#44; est&#225; bien establecida desde hace a&#241;os&#46; En t&#233;rminos generales&#44; el estre&#241;imiento puede afectar tanto al vaciado como al llenado vesical&#44; pues la compresi&#243;n mec&#225;nica del recto lleno de heces&#44; sobre la pared posterior de la vejiga y tr&#237;gono origina disminuci&#243;n de la capacidad vesical&#44; urgencia&#44; incontinencia y frecuencia&#59; y adem&#225;s&#44; cambios en la fisiolog&#237;a y en los est&#237;mulos neurales de la vejiga y de los m&#250;sculos del suelo p&#233;lvico&#44; lo que conduce a una disminuci&#243;n progresiva en la necesidad de orinar&#44; hiperactividad del detrusor&#44; vaciamiento insuficiente y aumento significativo del residuo posmiccional<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">2</span></a>&#46; La compresi&#243;n del recto sobre el tr&#237;gono y el cuello vesical puede ocasionar obstrucci&#243;n del tracto de salida&#44; lo que aumenta a&#250;n m&#225;s el residuo posmiccional y la posibilidad de reflujo vesicoureteral&#46; Por otro lado&#44; el recto lleno de heces origina una contracci&#243;n del esf&#237;nter anal externo&#44; lo que provoca&#44; a su vez&#44; una falta de relajaci&#243;n del esf&#237;nter uretral externo y del suelo p&#233;lvico&#46; Esto sugiere que los esf&#237;nteres anal y uretral son una unidad funcional con entrada compartida a los reflejos sacros del intestino&#44; vejiga y uretra proximal<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">13&#44;16</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La enuresis es una micci&#243;n involuntaria que ocurre durante el sue&#241;o a partir de los 5<span class="elsevierStyleHsp" style=""></span>a&#241;os de edad&#44; con una frecuencia de al menos 4 veces al mes&#46; Los pacientes enur&#233;ticos con STUI difieren cl&#237;nica&#44; patog&#233;nica y terap&#233;uticamente de aquellos que no presentan sintomatolog&#237;a durante el d&#237;a&#44; por ello es importante la diferenciaci&#243;n de ambas entidades&#46; La enuresis que no se acompa&#241;a de STUI&#44; sin disfunci&#243;n vesical&#44; se define como enuresis monosintom&#225;tica &#40;EM&#41;&#59; ni&#241;os con enuresis y STUI presentan enuresis no monosintom&#225;tica &#40;ENM&#41;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">9&#44;11</span></a>&#44; precisando un manejo y tratamiento espec&#237;fico diferente a los pacientes monosintom&#225;ticos&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El objetivo del estudio es determinar la influencia del estre&#241;imiento en la EM y la ENM y conocer la prevalencia de las 3 entidades as&#237; como de DTUI y DVI en la poblaci&#243;n&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material y m&#233;todo</span><p id="par0050" class="elsevierStylePara elsevierViewall">Realizamos un estudio observacional transversal de prevalencia&#46; 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de los cuales se seleccionaron n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>772 por estricto orden de recogida&#44; que nos permitieron estudiar los datos con una precisi&#243;n del 3&#37; y una seguridad del 97&#37;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Se elabor&#243; un cuestionario &#40;<a class="elsevierStyleCrossRef" href="#sec0040">Anexo</a>&#41; sobre los h&#225;bitos miccionales&#44; intestinales y s&#237;ntomas espec&#237;ficos de DVI&#44; donde se incluyeron los &#237;tems del cuestionario PLUTSS de STUI&#46; Dicho cuestionario fue traducido y validado al castellano previamente por el grupo de autores<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a>&#46; Los cuestionarios fueron repartidos en los colegios tras la autorizaci&#243;n de la junta directiva de los mismos y con una hoja de informaci&#243;n del estudio para los padres&#44; que eran quienes rellenaban el cuestionario&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Se defini&#243; estre&#241;imiento como &#62;<span class="elsevierStyleHsp" style=""></span>2 puntos Roma III modificados&#44; ya que eran los criterios en vigor en el momento de la realizaci&#243;n del estudio<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se consider&#243; DI aquellos ni&#241;os que presentaban estre&#241;imiento&#44; IF o ambas&#46; Adem&#225;s&#44; si el ni&#241;o asociaba cl&#237;nica miccional o un cuestionario PLUTSS<span class="elsevierStyleHsp" style=""></span>&#43; &#40;puntuaci&#243;n &#8805;<span class="elsevierStyleHsp" style=""></span>8&#44;5&#41;&#44; se consider&#243; como DVI&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo de las variables incluidas en el estudio&#46; Se estudi&#243; la asociaci&#243;n entre variables cualitativas con el test Chi-cuadrado o test exacto de Fisher&#46; Se realiz&#243; la comparaci&#243;n de medias en dos grupos&#44; tras comprobar la normalidad con los test de Kolmogorov-Smirnov&#44; T de Student o U de Mann-Whitney&#44; seg&#250;n proced&#237;a&#46; Se estudi&#243; la asociaci&#243;n entre variables cuantitativas con el coeficiente de correlaci&#243;n de Pearson o Spearman&#44; teniendo en cuenta la distribuci&#243;n de las variables&#46; Se realizaron modelos de regresi&#243;n log&#237;stica para determinar qu&#233; variables se asocian de forma independiente con un resultado de PLUTSS<span class="elsevierStyleHsp" style=""></span>&#43;&#44; EM&#44; ENM&#44; estre&#241;imiento e IF&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0085" class="elsevierStylePara elsevierViewall">Se estudiaron 772 encuestas de ni&#241;os de entre 5 y 9<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; siendo el 52&#44;8&#37; del sexo femenino y el 47&#44;2&#37; del masculino&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La prevalencia de enuresis fue del 9&#44;1&#37;&#44; siendo EM en el 62&#44;9&#37; y ENM en el 37&#44;1&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Se observ&#243; una disminuci&#243;n de la prevalencia de enuresis con la edad&#44; como se ve en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">La prevalencia de estre&#241;imiento fue del 20&#44;0&#37;&#44; con un total de 154 ni&#241;os estre&#241;idos&#46; Exist&#237;a IF en 22 ni&#241;os&#44; lo que supone una prevalencia del 2&#44;8&#37; del total de la serie&#59; el 60&#37; s&#243;lo manchaba la ropa interior y en el 40&#37; las p&#233;rdidas fecales eran importantes&#46; En la mayor&#237;a de estos ni&#241;os&#44; la IF fue retentiva &#40;2&#44;1&#37; del total&#41;&#59; siendo no retentiva tan solo en 6 pacientes&#46; En conjunto&#44; 160 ni&#241;os &#40;20&#44;8&#37;&#41; presentan alg&#250;n tipo de DI&#44; observando que la mayor&#237;a de los pacientes con IF eran estre&#241;idos como se ha comentado previamente&#46; En 40 ni&#241;os &#40;5&#44;2&#37;&#41; se observ&#243; DVI&#46; Tanto la IF como las DVI son m&#225;s frecuentes en varones&#44; con valores estad&#237;sticamente significativos &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis bivariado para estudiar los signos cl&#237;nicos en los que influye significativamente la presencia de estre&#241;imiento &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Se observ&#243; que el estre&#241;imiento se relaciona de forma significativa con las siguientes variables&#58; puntuaci&#243;n del PLUTSS&#44; DTUI&#44; incontinencia urinaria diurna &#40;IUD&#41;&#44; STUI&#44; urgencia miccional&#44; p&#233;rdidas hacia el ba&#241;o&#44; ENM e IF&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Los resultados m&#225;s significativos de la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se representan en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46; Como se puede observar&#44; todos los s&#237;ntomas o trastornos del tracto urinario inferior aumentan su prevalencia si existe estre&#241;imiento asociado&#44; salvo la EM que es el &#250;nico problema de los mencionados no relacionado con DTUI&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discusi&#243;n</span><p id="par0115" class="elsevierStylePara elsevierViewall">Las disfunciones vesicales e intestinales describen un amplio espectro de alteraciones que incluye patrones miccionales o defecatorios anormales<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">18</span></a>&#46; La ICCS define la presencia de DTUI a partir de los 5<span class="elsevierStyleHsp" style=""></span>a&#241;os de edad&#44; pues es esta edad a partir de la que se considera que deben haber terminado el proceso de aprendizaje miccional<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">10</span></a>&#46; Del mismo modo un paciente se considera enur&#233;tico tambi&#233;n a partir de los 5<span class="elsevierStyleHsp" style=""></span>a&#241;os<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">10</span></a>&#46; Por el contrario&#44; la ICCS define la DI a partir de los 4<span class="elsevierStyleHsp" style=""></span>a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">10&#44;11</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Para conocer la prevalencia de las disfunciones intestinales y vesicales&#44; los estudios epidemiol&#243;gicos analizan la mayor&#237;a de las veces la frecuencia de incontinencia urinaria diurna&#44; y enuresis sobre todo&#59; en otros casos la existencia de STUI seg&#250;n distintitos criterios&#44; y pocas veces utilizan cuestionarios validados de graduaci&#243;n de la sintomatolog&#237;a urinaria para definir los criterios de DTUI&#46; Las DI son analizadas la mayor&#237;a de las veces seg&#250;n los criterios Roma III &#40;en muchos casos modificados&#41;&#44; o seg&#250;n otros criterios diferentes definidos en cada publicaci&#243;n&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">El cuestionario PLUTSS se trata de una herramienta de diagn&#243;stico y seguimiento para los pacientes con DTUI&#46; Desde el 2017&#44; dicho cuestionario est&#225; traducido y validado culturalmente al castellano&#44; por lo que se recomienda su uso para la valoraci&#243;n de pacientes con STUI&#44; permitiendo una homogeneizaci&#243;n entre series y publicaciones<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La prevalencia de enuresis observada en nuestro estudio es del 9&#44;1&#37;&#44; 5&#44;7&#37; de EM y 3&#44;4&#37; de ENM&#46; La edad tiene un papel primordial en la prevalencia de la enuresis&#46; En la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> se observa la prevalencia por sexo y edad en nuestra poblaci&#243;n&#44; as&#237; como su bajada exponencial con la edad&#44; lo que se asemeja mucho a lo ya publicado en otras poblaciones<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">19&#8211;21</span></a>&#44; rondando el 14&#37; a los 5<span class="elsevierStyleHsp" style=""></span>a&#241;os y bajando progresivamente hasta un 2&#37; a los 9<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">La enuresis es m&#225;s frecuente en el sexo masculino<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">20&#44;22&#8211;25</span></a>&#44; y esto concuerda con nuestros resultados&#44; pues se observa un riesgo mayor de enuresis en varones &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;72&#41; sobre todo de EM &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;91&#41;&#46; Nuestro trabajo muestra una relaci&#243;n algo mayor que la publicada en otras culturas como el grupo de Ozkan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">20</span></a> &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;60&#41; o el de Esezobor et al&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">25</span></a> &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;56&#41;&#44; pero menor que la de otros grupos nacionales con poblaciones similares&#44; como la de Mart&#237;nez Agull&#243; et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">23</span></a> &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;34&#41;&#44; o la de Guti&#233;rrez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">22</span></a> &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;52&#41;&#59; no obstante&#44; este &#250;ltimo indica que con la edad la diferencia entre sexos se va equilibrando&#46; En nuestra serie a los 8-9<span class="elsevierStyleHsp" style=""></span>a&#241;os la resoluci&#243;n es mucho mayor en ni&#241;as y la diferencia en la prevalencia vuelve a ser importante &#40;8&#44;2&#37; en ni&#241;os vs&#46; 0&#44;7&#37; en ni&#241;as&#41;&#59; esta diferencia se puede explicar probablemente por la maduraci&#243;n m&#225;s precoz de las ni&#241;as respecto a los ni&#241;os&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">La prevalencia de estre&#241;imiento fue del 20&#44;0&#37;&#44; el mismo porcentaje observado en el reciente estudio epidemiol&#243;gico de estre&#241;imiento de Fujitani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">26</span></a>&#46; En un estudio similar al nuestro realizado por Chung et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">27</span></a> en Corea sobre un total de 19&#46;240 ni&#241;os de entre 5 y 13<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; los autores utilizaron unos criterios menos estrictos&#44; definiendo estre&#241;imiento como la presencia de &#60;<span class="elsevierStyleHsp" style=""></span>3 deposiciones&#47;semana&#44; o deposiciones tipo I-II de Bristol&#44; pero observaron una prevalencia similar de estre&#241;imiento &#40;18&#44;5&#37;&#41;&#46; Nuestros resultados tambi&#233;n se asemejan a los de Loening-Baucke<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a> &#40;22&#44;6&#37;&#41; que utilizaron los criterios de Iowa &#40;similares a los de Roma III&#41;&#46; En 2018 se public&#243; una revisi&#243;n sistem&#225;tica de 11 a&#241;os que reporta una prevalencia de estre&#241;imiento de entre el 0&#44;5 y 32&#44;2&#37;&#44; con una media del 9&#44;5&#37; &#40;IC 95&#37;&#58; 7&#44;5-12&#44;1&#41;&#44; en 35 trabajos que utilizan los criterios Roma III o IV<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">28</span></a>&#46; Es destacable que un alto porcentaje de los trabajos analizados en este estudio se realizaron en Asia &#40;46&#37;&#41;&#59; solo 2 en Europa y otros 2 en Norteam&#233;rica&#59; sin embargo&#44; es en este &#250;ltimo donde se observ&#243; una mayor prevalencia de estre&#241;imiento&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">En nuestra serie se observ&#243; una incidencia global de IF del 2&#44;8&#37;&#59; la prevalencia fue pr&#225;cticamente similar a la de otros estudios<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a>&#46; La IF en pa&#237;ses occidentales oscila entre el 0&#44;8 y 4&#44;1&#37;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">29&#44;30</span></a>&#44; y en pa&#237;ses asi&#225;ticos entre el 2 y 7&#44;8&#37;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">27&#44;31</span></a>&#46; Un estudio holand&#233;s reporta mayor riesgo en ni&#241;os de 5-6<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;4&#44;1&#37;&#41; que en los de 11-12 &#40;1&#44;6&#37;&#41;&#44; lo que indica una posible influencia madurativa<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">30</span></a>&#59; adem&#225;s&#44; observan un riesgo elevado de trastornos psicol&#243;gicos&#44; pero a pesar de ello tan solo el 27-37&#37; consulta por su DI&#46; La ICCS recomienda realizar valoraci&#243;n psicol&#243;gica y&#47;o psiqui&#225;trica inicial a todos los ni&#241;os con IF no retencionista por la alta tasa de problemas mentales asociados que presentan&#46; En nuestra serie el estre&#241;imiento es el principal factor de riesgo de la IF &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#44;249&#41;&#44; pero en nuestro estudio han mostrado tambi&#233;n ser factores predisponentes&#58; sexo masculino &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;407&#41;&#44; iniciar la escolarizaci&#243;n sin completar el entrenamiento miccional &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;609&#41; y presentar DTUI &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;271&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">La asociaci&#243;n de disfunci&#243;n vesical e intestinal se observ&#243; en nuestro estudio en el 5&#44;2&#37; de los casos&#44; siendo significativamente m&#225;s frecuente en el sexo masculino &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;952&#41;&#46; Se observ&#243; que el 75&#37; de las DVI eran pacientes posponedores&#44; es decir&#44; que retrasaban la micci&#243;n y&#47;o defecaci&#243;n&#46; Nuestros criterios para identificar a pacientes con DVI fueron estrictos&#44; y para ello necesitaban tener una puntuaci&#243;n PLUTSS<span class="elsevierStyleHsp" style=""></span>&#43; y estre&#241;imiento o IF&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Cl&#225;sicamente se ha considerado al estre&#241;imiento como factor de riesgo de enuresis&#44; pero uno de los principales trabajos publicados que defiende esta hip&#243;tesis estudia &#250;nicamente 30 ni&#241;os enur&#233;ticos<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">32</span></a>&#44; siendo una serie muy corta para imponer datos fisiopatol&#243;gicos y espec&#237;ficos reales&#46; Cada vez hay m&#225;s publicaciones que no observan esta asociaci&#243;n&#44; reportando una prevalencia de estre&#241;imiento similar en enur&#233;ticos y no enur&#233;ticos<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">24&#44;33</span></a>&#46; En nuestro estudio tampoco se encuentran diferencias estad&#237;sticamente significativas&#59; y menos a&#250;n si se valoran &#250;nicamente los ni&#241;os con EM&#44; pues se observa que los estre&#241;idos mostraron menor EM que los no estre&#241;idos &#40;4&#44;8&#37; vs&#46; 5&#44;9&#37;&#41;&#46; La prevalencia de estre&#241;imiento en los pacientes con ENM s&#237; fue significativamente mayor que en el resto de la poblaci&#243;n pedi&#225;trica de nuestra serie &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;9&#41; &#40;36&#44;5&#37; SE vs&#46; 19&#44;2&#37; sin SE&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">En nuestra serie&#44; a diferencia de la EM&#44; la DTUI y la ENM han mostrado una clara relaci&#243;n con el estre&#241;imiento&#59; por tanto&#44; concluimos que la asociaci&#243;n que cl&#225;sicamente se ha establecido entre EM y estre&#241;imiento no es real&#44; y probablemente esta relaci&#243;n puede haber sido desencadenada por una falta de diferenciaci&#243;n precisa entre la EM y la ENM&#44; donde s&#237; es muy frecuente dicha asociaci&#243;n&#46; El estre&#241;imiento&#44; por tanto&#44; no es un factor de riesgo de EM&#44; pero s&#237; de DTUI y como consecuencia tambi&#233;n de ENM&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">En nuestra serie se observa que existe una asociaci&#243;n entre la presencia de estre&#241;imiento y el valor num&#233;rico del PLUTSS &#40;R<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;088&#41;&#44; al igual que lo descrito en el trabajo de Loening-Baucke<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a>&#46; Adem&#225;s&#44; observamos que el estre&#241;imiento aumenta el riesgo de presencia de STUI &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;523&#41;&#44; urgencia miccional &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;295&#41; y sobre todo IF &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#44;132&#41;&#46; Probablemente todos estos s&#237;ntomas son secundarios a los vaciados vesical y rectal incompletos y a la contractura secundaria del suelo p&#233;lvico para evitarlas&#46; Esta relaci&#243;n entre estre&#241;imiento y DTUI se ha tratado de explicar por la proximidad anat&#243;mica del recto y la vejiga&#44; la inervaci&#243;n compartida a nivel de sacro y de centros neurales centrales&#44; adem&#225;s de por la contracci&#243;n de la musculatura estriada adyacente a ambas estructuras y empleada en las continencias urinaria y fecal o en la posposici&#243;n de la micci&#243;n o defecaci&#243;n&#59; de ah&#237; probablemente la importante relaci&#243;n entre estas maniobras y el riesgo de disfunci&#243;n vesical o intestinal<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">15</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusiones</span><p id="par0170" class="elsevierStylePara elsevierViewall">Es fundamental el diagn&#243;stico diferencial entre EM y ENM en la valoraci&#243;n inicial de los pacientes con enuresis&#46; El estre&#241;imiento no influye en la prevalencia de EM&#44; pero sin embargo constituye un importante factor de riesgo de la DTUI y de la ENM&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicto de intereses</span><p id="par0175" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cl&#225;sicamente se ha considerado el estre&#241;imiento como un factor de riesgo de la enuresis&#44; aunque cada vez hay m&#225;s publicaciones que reportan una prevalencia de estre&#241;imiento similar en enur&#233;ticos y no enur&#233;ticos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Determinar la influencia del estre&#241;imiento en la enuresis monosintom&#225;tica y la no monosintom&#225;tica y conocer la prevalencia de las 3 entidades as&#237; como de disfunciones del trato urinario inferior y disfunci&#243;n vesicointestinal en la poblaci&#243;n&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material y m&#233;todo</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional transversal de prevalencia sobre una muestra representativa de la poblaci&#243;n gallega de ni&#241;os y ni&#241;as escolarizados de 5 a 9<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; Se realiz&#243; una encuesta en los colegios sobre h&#225;bitos miccionales e intestinales que inclu&#237;a las preguntas del cuestionario <span class="elsevierStyleItalic">Paediatric Lower Urinary Tract Scoring System</span> &#40;PLUTSS&#41; de diagn&#243;stico y graduaci&#243;n de las disfunciones del tracto urinario inferior&#46; Se consider&#243; la enuresis seg&#250;n los criterios de la Sociedad Internacional para la Continencia en Ni&#241;os &#40;ICSS&#41;&#44; y si adem&#225;s asociaba sintomatolog&#237;a diurna&#44; se clasific&#243; como enuresis no monosintom&#225;tica&#46; El estre&#241;imiento se valor&#243; de acuerdo con los criterios Roma III y la escala de heces de Bristol adaptados&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 772 encuestas en el estudio&#46; La prevalencia de estre&#241;imiento fue del 20&#37;&#44; la de enuresis del 9&#44;1&#37; &#40;enuresis monosintom&#225;tica 62&#44;9&#37; y no monosintom&#225;tica 37&#44;1&#37;&#41; y la de disfunci&#243;n vesicointestinal del 5&#44;2&#37;&#46; Observamos que el estre&#241;imiento no influye en la presencia de enuresis monosintom&#225;tica&#44; pero s&#237; en la enuresis no monosintom&#225;tica y las disfunciones del trato urinario inferior&#44; donde constituye un importante factor de riesgo&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Es fundamental el diagn&#243;stico diferencial entre enuresis monosintom&#225;tica y no monosintom&#225;tica en la valoraci&#243;n inicial de un paciente enur&#233;tico&#44; ya que el manejo terap&#233;utico y las caracter&#237;sticas de ambas entidades son diferentes&#44; constituyendo el estre&#241;imiento un factor de riesgo solamente en el caso de las enuresis no monosintom&#225;ticas&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introducci&#243;n"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objetivo"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Material y m&#233;todo"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Resultados"
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          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusiones"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Constipation has classically been considered as a risk factor of enuresis&#44; although there are increasingly more publications that report a similar prevalence of constipation in both enuretics and non-enuretics&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To determine the influence of constipation in monosymptomatic and non-monosymptomatic enuresis&#44; and to find out the prevalence of the three disorders&#44; as well the lower urinary tract dysfunction and bladder-bowel dysfunction in the population&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material and method</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional observational prevalence study on a representative population sample of 5 to 9 year-old school boys and girls of Galicia&#44; Spain&#46; A questionnaire was completed in the schools on urinary and bowel habits&#44; which included questions from the Paediatric Lower Urinary Tract Scoring System &#40;PLUTSS&#41; diagnostic questionnaire and grading of the lower urinary tract dysfunctions&#46; The enuresis was diagnosed using the International Children&#39;s Continence Society &#40;ICSS&#41;&#44; and if it was also associated with diurnal symptoms&#44; it was also classified as non-monosymptomatic enuresis&#46; The constipation was evaluated using the Rome III criteria and the adapted Bristol stool scale&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A total of 772 questionnaires were included in the study&#46; The prevalence of constipation was 20&#37; and that of enuresis was 9&#46;1&#37; &#40;62&#46;9&#37; monosymptomatic enuresis and 37&#46;1&#37; non-monosymptomatic&#41;&#44; with the prevalence of bladder-bowel dysfunction being 5&#46;2&#37;&#46; It was observed that constipation had no influence on the presence of monosymptomatic enuresis&#44; but it did have an influence on non-monosymptomatic enuresis and lower urinary tract dysfunctions&#44; where it was a significant risk factor&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The differential diagnosis between monosymptomatic and non-monosymptomatic enuresis is essential in the initial evaluation of the patient with enuresis&#44; since the therapeutic management and the characteristics of both disorders are different&#44; with constipation only being a risk factor in cases of non-monosymptomatic enuresis&#46;</p></span>"
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            "identificador" => "abst0030"
            "titulo" => "Introduction"
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            "identificador" => "abst0035"
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            "titulo" => "Material and method"
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            "titulo" => "Results"
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            "titulo" => "Conclusions"
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            "apendice" => "<p id="par0185" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Anexo A"
            "titulo" => "Material adicional"
            "identificador" => "sec0040"
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        "tipo" => "MULTIMEDIAFIGURA"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Prevalencia de enuresis por edad y sexo&#46;</p>"
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        "identificador" => "fig0010"
        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Prevalencia de signos cl&#237;nicos seg&#250;n presenten o no estre&#241;imiento&#46;</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">DTUI&#58; disfunci&#243;n tracto urinario inferior&#59; EM&#58; enuresis monosintom&#225;tica&#59; ENM&#58; enuresis no monosintom&#225;tica&#59; ITU&#58; infecciones tracto urinario&#59; IUD&#58; incontinencia urinaria diurna&#46;</p>"
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                  """
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;302&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;1&#44;678&#59; 3&#44;160&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;32&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">323 &#40;52&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Urgencia miccional</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;38&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">133 &#40;21&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;295&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;1&#44;667&#59; 2&#44;899&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94 &#40;61&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">485 &#40;78&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Polaquiuria</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;21&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">104 &#40;16&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;315&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#44;904&#59; 1&#44;912&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">122 &#40;79&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">514 &#40;83&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dolor al orinar</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;798&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#44;093&#59; 6&#44;867&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;655&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">153 &#40;99&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">614 &#40;99&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Fuerza para orinar</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;3&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;303&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#44;628&#59; 2&#44;701&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;476&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">147 &#40;95&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">596 &#40;96&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P&#233;rdidas por urgencia</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;11&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;508&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;1&#44;479&#59; 4&#44;252&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">137 &#40;88&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">589 &#40;95&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Volver a orinar al poco tiempo</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;662&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#44;754&#59; 3&#44;664&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;203&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">148 &#40;95&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">602 &#40;97&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ITU</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;14&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 &#40;11&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;251&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#44;811&#59; 1&#44;929&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;311&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">132 &#40;85&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">544 &#40;88&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Enuresis</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;12&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;538&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#44;870&#59; 2&#44;716&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;136&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">135 &#40;87&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">566 &#40;91&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">EM</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;4&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;5&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;795&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#44;347&#59; 1&#44;820&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;586&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">147 &#40;95&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">581 &#40;94&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ENM</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;289&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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ISSN: 16954033
Idioma original: Español
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