The prevalence of nocturnal enuresis in urban-dwelling Malaysian children is similar to that reported from Korea and Taiwan but appears to be lower than that reported from developed countries. Predictive factors associated with primary nocturnal enuresis included lower age group, male sex and Indian ethnicity.

The SE of Malaysian children with monosymptomatic NE aged 10 years and above is significantly lower than their peers. This effect is seen particularly among girls, adolescents and those with frequent wetting. In the light of these findings, the 'wait and see' approach by the Malaysian medical profession is no longer appropriate. Treatment should begin before the age of 10 years.

Study design: Prospective cross-sectional multidimensional study using clinical assessment and standard measures. Objectives: To determine the medical and social factors associated with parenting stress among mothers of children with spina bifida. Setting: Spina bifida clinics of two tertiary hospitals in urban Kuala Lumpur, Malaysia. Methods: A total of 81 mothers of children aged 1-18 years completed the Parenting Stress IndexShort Form (PSI/SF). Each child's adaptive skills were assessed using the Vineland Adaptive Behaviour Scales (VABS), Interview Edition. Medical and social data were obtained from direct interviews and case note reviews. Hierarchical multiple regression analysis was used to investigate factors that were determinants for high scores in the parental distress (PD), difficult child (DC) and parent-child dysfunctional interaction (P-CDI) subdomains of the PSI/SF. Results were expressed as beta coefficient (b) and 95% confidence intervals (95% CIs). Results: Single-parent families (b 8.6, 95% CI 3.4-13.9) and the need for clean intermittent catheterization of bladder (b 3.5, 95% CI 0.7-6.2) were associated with high PD scores. Clean intermittent catheterization (b 3.0, 95% CI 0.5-5.5) was associated with higher DC scores. Lower composite VABS scores (b À0.08, 95% CI À0.02 to À0.15) and mother as the sole caregiver (b 2.6, 95% CI 0.15-4.96) was associated with higher P-CDI scores. Conclusion: The need for clean intermittent catheterization was the only medical factor associated with parenting stress in mothers of children with spina bifida. This was mediated by single parenthood, caregiver status and the child's adaptive skills.

Congenital dermal sinus (CDS) and occult spinal dysraphism are suspected when a cutaneous marker overlies the spine of a newborn. CDS can have the appearance of a simple dimple and occur within the gluteal cleft without any skin markers. CDS are the commonest cause of intramedullary spinal cord abscess.

Study design: This study was designed as a comparative cross-sectional cross-over trial on children performing clean intermittent catheterization (CIC) with reused catheters for 1 or 3 weeks. Objectives: To determine the incidence of symptomatic urinary tract infection (UTI) and bacteriuria (defined as colony count of ⩾ 10 5 colony forming units per ml of a single strain of organism) in these two different frequencies of catheter change. Setting: Multidisciplinary children's neurogenic bladder clinics at two tertiary care hospitals in Kuala Lumpur Malaysia. Methods: Forty children aged between 2 and 16 years performing CIC for at last 3 years were recruited. Medical and social data were obtained from case files. Baseline urine cultures were taken. All children changed CIC catheters once in 3 week for the first 9 weeks followed by once a week for the next 9 weeks. Three-weekly urine cultures were obtained throughout the study. Standardization of specimen collection, retrieval and culture was ensured between the two centers. Results: At baseline, 65% of children had bacteriuria. This prevalence rose to 74% during the 3-weekly catheter change and dropped to 34% during the weekly catheter change (Z-score 6.218; Po0.001). Persistence of bacteriuria (all three specimens in each 9-week period) changed significantly from 60 to 12.5%, respectively (Po0.005). There was no episode of UTI during the 18-week study period. Conclusion: Reuse of CIC catheters for up to 3 weeks in children with neurogenic bladders appears to increase the prevalence of bacteriuria but does not increase the incidence of symptomatic UTI.