A study of the factors causing secondary nocturnal enuresis in children.

To determine the differences or similarities in the clinical presentation between patients with primary and secondary nocturnal enuresis. A total of 170 patients with nocturnal enuresis were assessed at a busy tertiary care pediatric voiding dysfunction clinic at the University of Oklahoma Health Sciences Center. Patients with primary nocturnal enuresis (PNE) were compared with patients with secondary nocturnal enuresis (SNE) for a variety of clinical features, including gender, age when first voiding on their own, age on presentation, infrequent voiding, frequent voiding, urgency, daytime wetting, nocturia, urinary tract infection, constipation, vesicoureteral reflux, attention-deficit/hyperactivity disorder, uroflow results, and ultrasound evidence of a postvoid residual. The only significant difference between the patients with PNE and those with SNE was in the prevalence of constipation. Constipation was significantly associated with PNE (74.59% vs 57.54%; odds ratio: 2.17; 95% confidence interval: 1.07-4.41). When adjusted for a history of constipation, the age at which a child began to void on his or her own became statistically significant. Patients with SNE started to void on their own at 2.13 years (SD: 0.61), an average of 0.22 years earlier than those with PNE, who started to void on their own at 2.35 years. PNE and SNE likely share a common pathogenesis. Symptoms of daytime voiding dysfunction are common in patients with PNE and SNE. Daytime voiding habits might influence how the central nervous system responds at night to a full or contracting bladder.

Purpose: Sleep disordered breathing caused by tonsillar hypertrophy has been implicated as a cause of primary and secondary nocturnal enuresis in children. We prospectively studied the preoperative and postoperative rates of nocturnal and daytime incontinence in a group of children with tonsillar hypertrophy undergoing tonsillectomy compared to a matched control group undergoing surgery unrelated to the airway or urinary tract.Materials and Methods: A total of 326 toilet trained children 3 to 15 years old were included, with 257 in the tonsillectomy group and 69 in the control group. Severity of tonsillar hypertrophy was graded preoperatively on a scale of 1 to 4. A voiding questionnaire regarding number of bedwetting and daytime incontinence episodes per week, voids per day, bowel movements per week, secondary or primary enuresis and family history was completed by parents preoperatively, and at 3 and 6 months postoperatively.Results: Preoperatively the respective rates of nocturnal enuresis and daytime ...

Tonsillectomy Does Not Improve Bedwetting: Results of a Prospective Controlled Trial

Introduction:Sleep disorder caused by adenotonsillar hypertrophy has been implicated as a cause of primary and secondary nocturnal enuresis in children. This study was conducted to investigate the effect of adenotonsillectomy on enuresis in children with adenotonsillar hypertrophy.Materials and Methods:This prospective cohort study was conducted in Hamadan City in Western Iran, from April 2010 to December 2011. Ninety-seven children aged 3 to 12 years with adenotonsillar hypertrophy who were admitted to Besat Hospital for adenotonsillectomy were evaluated. The primary outcome was the number of incidents of bedwetting (nocturnal enuresis) post-operation compared with pre-operation. Patients were followed-up for 3 months. Data were collected using a questionnaire regarding number of bedwetting incidents, type of enuresis (primary or secondary), and family history of enuresis, as well as results of urine analysis. Results:Of 420 children admitted for adenotonsillectomy, 97 had a positive history of preoperative enuresis, including 42 girls and 55 boys, with mean age of 48 months. The parents of 84 (86.6%) children agreed to participate in the study. Three months after adenotonsillectomy, enuresis had resolved completely in 51 (60.7%) children and had shown relative improvement in 22 (26.2%) children. Enuresis had not improved in the remaining 11 (13.1%) children (P<0.001).Conclusion: The results of this study indicate that adenotonsillectomy can improve enuresis in the majority of children with adenotonsillar hypertrophy. However, further evidence based on large multi-center randomized clinical trials is required to confirm these results.

Introduction Nocturnal enuresis (NE) is a common pediatric condition. Previous studies have shown the association between OSA and NE. The underlying mechanism may be related to disruptions of sleep and increased sympathetic activation which may impair arousal from sleep. However, it is unclear whether primary or secondary NE is more likely to be associated with OSA. Therefore, this study aimed to investigate this issue. Methods We conducted a retrospective study of pediatric patients with NE who were referred to our sleep center and underwent diagnostic study at Cincinnati Children’s Hospital from January 2005 to September 2024. Patients were divided by NE type and age group (&amp;lt; 12 and ≥12 years old). Exclusion criteria included tracheostomy, ventilator dependence, and neurogenic bladder. OSA was defined by obstructive AHI &amp;gt;1.5/hr. Statistical comparisons between primary and secondary NE were performed by Chi-square for categorical variables and by Mann-Whitney test for continuous variables. Results 138 patients, aged 4-20 years old, met criteria for entry into analysis; 64.1% had primary NE, 35.9% had secondary NE. There was no difference in the age between primary[P] and secondary[S] NE (10.4±3.7 yo [P] vs 9.5±3.6 yo [S]; P=NS). For prevalence of OSA, there were no differences in the prevalence of OSA (61.9%[P] vs 60.0%[S]; P=NS) and percentage of mild, moderate and severe OSA between the two groups. For PSG parameters, there were no differences in the sleep efficiency, percentage of sleep stages (N1, N2, N3, REM), AHI or obstructive AHI (6.5±19.2/hr[P] vs 4.6±8.7/hr[S]; P=NS) between primary and secondary NE. Sub-group analysis of children (&amp;lt; 12) and adolescents (≥12) revealed no significant differences in the prevalence of OSA and PSG parameters in either age group. Conclusion Our study shows a high prevalence of OSA in our cohort of patients with NE who were referred to pediatric sleep clinics. Interestingly, there were no significant differences in the prevalence and severity of OSA between primary and secondary NE in both children and adolescents. These findings emphasize the need for comprehensive screening of OSA in both primary and secondary NE. Further studies are needed to assess the impact of OSA treatment on outcomes in children with NE. Support (if any)

Nocturnal enuresis (NE) is a common disease in children, commonly known as bedwetting. The International Children's Continence Society (ICCS) defines intermittent urinary incontinence during nighttime sleep in children aged 5 and above as enuresis. Enuresis can be divided into two types: primary nocturnal enuresis (PNE) and secondary nocturnal enuresis (SNE). PNE refers to nocturnal urinary control ability that has never been achieved for more than 6 months in children aged 5 and above with enuresis; SNE refers to the recurrence of enuresis symptoms after a period of more than 6 months of continuous nocturnal urinary control ability. SNE is relatively rare in clinical practice and is often caused by sudden stress events or other diseases such as snoring. Its pathogenesis and treatment are different from PNE. PNE is a multifactorial disease related to genetics, and its pathogenesis is not fully understood. There are not many research and review articles on its pathogenesis. In recent years, there has been significant progress in the epidemiology and pathogenesis of PNE. The following is a summary.

Effect of nocturnal enuresis on school-age children and their families in Thailand: A cross-sectional study.

NOCTURNAL ENURESIS: AN INTERNATIONAL EVIDENCE BASED MANAGEMENT STRATEGY

PREVALENCE OF DIURNAL VOIDING SYMPTOMS AND DIFFICULT AROUSAL FROM SLEEP IN CHILDREN WITH NOCTURNAL ENURESIS

Bedwetting (nocturnal enuresis) is common. It occurs in up to 20% of 5 year olds and 10% of 10 year olds, with a spontaneous remission rate of 14% per year. Weekly daytime wetting occurs in 5% of children, most of whom (80%) also wet the bed. Bedwetting can have a considerable impact on children and families, affecting a child's self-esteem and interpersonal relationships, and his or her performance at school. Primary nocturnal enuresis (never consistently dry at night) should be distinguished from secondary nocturnal enuresis (previously dry for at least 6 months). Important risk factors for primary nocturnal enuresis include family history, nocturnal polyuria, impaired sleep arousal and bladder dysfunction. Secondary nocturnal enuresis is more likely to be caused by factors such as urinary tract infections, diabetes mellitus and emotional stress. The treatment for monosymptomatic nocturnal enuresis (bedwetting with no daytime symptoms) is an alarm device, with desmopressin as second-line therapy. Treatment for non-monosymptomatic nocturnal enuresis (bedwetting with daytime symptoms--urgency and frequency, with or without incontinence) should initially focus on the daytime symptoms.Bedwetting without daytime symptoms, the most common toileting problem, can be effectively treated with an alarm device.

Primary and Secondary Enuresis: Pathophysiology, Diagnosis, and Treatment

Objective: to study the efficacy of pediatric Tenoten in the treatment of secondary nocturnal enuresis in children. Subjects and methods. A comparative randomized study of the results of treatment was conducted in 36 children aged 5 to 15 years with secondary enuresis, who received pediatric Tenoten (n = 18; Group 1) and fenibut (n = 18; Group 2). Tenoten (pediatric formulation) was given a sublingual tablet thrice daily for 2 months. Therapeutic effectiveness was evaluated by clinical parameters (the number of nocturnal enuresis episodes per month and anxiety scale scores). Results. There was a significant reduction or complete cessation of nocturnal enuresis episodes in the majority of children and a decrease in anxiety levels. Positive clinical changes were accompanied by a trend toward normalization of spectral coherent EEG characteristics. Conclusion. Treatment with pediatric Tenoten results in a reduction in the rate of nocturnal enuresis episodes and, in some cases, in their cessation, positively affects the psychological status of children, and improves the indicators of brain bioelectrical activity. The drug causes no adverse reactions and is well tolerated.

The study aims to evaluate bothersome lower urinary tract symptoms (LUTS), risk factors, and associated functional abnormalities in women reporting adult onset secondary nocturnal enuresis (SNE), to help understand factors associated with SNE. 12,795 women (age >18) attending a tertiary referral centre underwent a comprehensive standardized evaluation including urodynamic testing in accordance with the International Continence Society recommendations. Records of all patients reporting bedwetting while asleep were evaluated under various categories. Multiple logistic regression was used to identify statistically significant risk factors and urodynamic findings associated with SNE. The prevalence of SNE in women undergoing urodynamic testing for bothersome LUTS was 14.4% (1,838). High BMI (OR = 1.47, P < 0.001), cigarette smoking (OR = 2, P < 0.001), antidepressant usage (OR = 1.8, P < 0.001), neurological conditions (OR = 2.12, P < 0.001), and previous hysterectomy (OR = 1.19, P = 0.03) were significantly associated with SNE. Women with SNE significantly complained of overactive bladder (OAB) symptoms (OR = 1.65, P < 0.001) and slightly higher mean nocturia episodes (OR = 1.38, P < 0.0001). Low maximum urethral closure pressure (MUCP) (OR = 1.34, P < 0.0001) and detrusor overactivity incontinence (DOI) (OR = 1.75, P < 0.0001) were significantly associated with SNE. There was no significant association with the symptom of stress urinary incontinence (P = 0.264), urodynamic stress incontinence (P = 0.454) or detrusor overactivity (P = 0.231). Women with adult SNE usually present with OAB symptoms. SNE is associated with high BMI, cigarette smoking, antidepressant use, and neurological conditions. DOI and a low MUCP are possible pathophysiological mechanisms in SNE. Neurourol. Urodynam. 36:188-191, 2017. © 2015 Wiley Periodicals, Inc.

Background. Nocturnal enuresis (NE) is a common pediatric disorder that significantly affects emotional well-being and family quality of life. Despite its high prevalence, the pathogenesis of NE remains incompletely understood. Growing evidence indicates that NE is not solely a urological issue but rather a multifactorial neurodevelopmental disorder involving cortical immaturity, sleep-arousal dysfunction, and altered neurohormonal regulation. Aim. To identify neurophysiological and psychosocial contributors to nocturnal enuresis and to assess the effectiveness of therapeutic interventions. Methods. A prospective longitudinal pilot study was conducted at Alfraganus University Hospital (Tashkent, Uzbekistan) between June 2024 and February 2025, involving 47 children aged 5–15 years (mean age 9.6 ± 2.1 years) diagnosed with NE. Clinical, neurological, and psychological assessments were performed, including electroencephalography (EEG), magnetic resonance imaging (MRI), and the Test of Variables of Attention (TOVA). Serum vitamin D and vitamin B12 levels were measured. Statistical analyses were performed using SPSS version 25, applying the t-test, chi-square test, and Pearson correlation analysis. Treatment consisted of desmopressin for primary NE (administered for one month) and nootropic and anticholinergic therapy for secondary NE (administered for two months), followed by EEG monitoring. Desmopressin was administered at bedtime with evening fluid restriction, and treatment was temporarily discontinued during intercurrent illness to minimize the risk of hyponatremia. Results. A positive family history of NE was observed in 89% of cases. Psychological trauma was identified in 93.8% of children with secondary NE, while 68% had evidence of perinatal central nervous system injury. EEG findings demonstrated reduced alpha activity and increased delta activity, consistent with delayed cortical maturation. Vitamin D deficiency (&lt;20 ng/mL) was detected in 48.8% of participants, and vitamin B12 deficiency in 25.6%; both deficiencies showed a significant inverse correlation with NE frequency (r = –0.45, p &lt; 0.01). Treatment with desmopressin and nootropic therapy resulted in a significant reduction in the number of wet nights (p &lt; 0.05), along with improvements in EEG parameters and anxiety levels. Conclusion. Nocturnal enuresis in children is a multifactorial neurodevelopmental disorder associated with impaired arousal mechanisms and micronutrient deficiencies. Early diagnosis, multidisciplinary management, and correction of vitamin D and vitamin B12 deficiencies may enhance treatment outcomes. Personalized therapeutic strategies integrating pharmacological, neurophysiological, and behavioral approaches have the potential to improve neurological maturation and quality of life in affected children.

To estimate the prevalence of nocturnal enuresis in primary school children in Malaysia and to determine the factors associated with primary nocturnal enuresis. This was a cross-sectional survey. A total of 3371 self-administered questionnaires were distributed to parents of children aged 7, 9 and 12 years attending four primary schools in the city. The ICD-10 definition of enuresis was used. From an overall response rate of 73.8%, nocturnal enuresis was reported in 200 children (8%), primary nocturnal enuresis in 156 children (6.2%) and secondary nocturnal enuresis in 44 children (1.8%). Fifty-three percent of those with primary enuresis had a positive family history, and 54% had two or more wet nights per week. Eighty-seven percent had not sought any form of treatment despite 74% admitting to being embarrassed. Using logistic regression analysis, only three factors were significant predictors of primary nocturnal enuresis. These were: (i) younger age (P < 0.001); (ii) male sex (P < 0.033); and (iii) Indian ethnic group (P < 0.044) compared to Chinese. 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.