Abstract
BackgroundNocturnal enuresis (NE) is a very common chronic pediatric problem with bad psychological consequences.MethodsForty primary monosymptomatic nocturnal enuresis (MNE) children and 20 healthy controls were recruited in the study and subjected to history taking, neurological and urological examinations, and psychological assessment using the Arabic-translated and validated version of child behavior checklist, sleep architecture studying through one-night polysomnography (PSG), and vasopressin levels determination both diurnal and nocturnal.ResultsEnuretic children had positive family history of NE in 42.5%, inverted vasopressin circadian rhythm in 52.5% and PSG changes in the form of increased N3 deep sleep % of total sleep time (TST), sleep stage transition index (SSTI), periodic limb movement index (PLMI), and snore index. Enuretic children PSG showed decreased deep sleep latency, N1% of TST, N2% of TST, and REM % of TST. The child behavior checklist showed higher anxious depressed symptoms, social problem, attention problems, and internalizing problems in enuretic children than control subjects.ConclusionsMNE is a heterogeneous disorder with multiple factors interplay in its pathogenesis. So, the management must be tailored patient by patient according to the dominating etiology.
Highlights
Nocturnal enuresis (NE) is a very common chronic pediatric problem with bad psychological consequences
Eighteen NE children had history of desmopressin treatment trial; 5 had nearly complete response for more than 3 months but response was drug dependent and rapid relapse of bedwetting occurred on drug stoppage, 4 had partial response with decreased bedwetting frequency by about 50%, and 9 had sluggish or no response
There was no significant difference in the incidence of spina bifida occulta (SBO) among patients and control subjects (22.5 versus 20% respectively)
Summary
Nocturnal enuresis (NE) is a very common chronic pediatric problem with bad psychological consequences. NE is the second most common chronic pediatric problem affecting 10–15% of children by the age of 5 years (Butler & Heron 2008). Nocturnal enuresis may be functional or organic due to neurological or urological diseases. The organic causes of NE constitute less than 5% of cases (Joinson et al 2007). Functional enuresis may be primary with no Primary NE may be either monosymptomatic nocturnal enuresis (MNE) with normal daytime voiding patterns or non-monosymptomatic NE caused by overactive bladder and presented by daytime wetting, urinary frequency, urgency, hesitancy and interrupted stream with variable-sized wet patches, repeated lower urinary or genital pain, and awakening after wetting (Khedr et al 2015; Telli et al 2015)
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