The exact etiology of nocturnal enuresis (NE) is unknown. But there are some suspected situations, such as developmental delay of antidiuretic hormone production at night, developmental delay of appropriate arousal thresholds, and nocturnal detrusor over-activity. 1 Rasmussen P.V. Kirk J. Borup K. et al. Enuresis nocturna can be provoked in normal healthy children by increasing the nocturnal urine output. Scand J Urol Nephrol. 1996; 30: 57-61 Crossref PubMed Scopus (20) Google Scholar , 2 Rittig S. Knudsen U.B. Norgaard J.P. et al. Abnormal diurnal rhythm of plasma vasopressin and urinary output in patients with enuresis. Am J Physiol. 1989; 256: F664-F671 PubMed Google Scholar , 3 Wolfish N.M. Pivik R.T. Busby K.A. Elevated sleep arousal thresholds in enuretic boys: clinical implications. Acta Paediatr. 1997; 86: 381-384 Crossref PubMed Scopus (152) Google Scholar , 4 Yeung C.K. Chiu H.N. Sit F.K. Bladder dysfunction in children with refractory monosymptomatic primary nocturnal enuresis. J Urol. 1999; 162 (discussion 1054-5): 1049-1054 PubMed Scopus (167) Google Scholar Underlying factors may change from one patient to another. This causes the treatment choice to differ, especially in the first evaluation of the patient. We value the editorial comments and would like to emphasize that the primary purpose of our report was to evaluate copeptin's role in the etiology of NE. Copeptin is more stable than arginine vasopressin (AVP) and reflects more stable plasma concentrations. We observed that copeptin levels decrease more significantly with increasing severity of the disease and a positive family history. Hence, in this group of patients, AVP deficiency at night may be the primary cause for NE, and these patients may benefit from desmopressin therapy much more than other patients. We agree with the editor that our study has some limitations. But this is a preliminary study, and by taking this study as a basis, further studies can be carried out with a greater number of patients and by measuring copeptin and AVP levels in the mornings and at nights and comparing desmopressin treatment outcomes according to copeptin levels thereby proving the marker's efficacy in clinical use. Editorial CommentUrologyVol. 82Issue 5PreviewWe know that primary monosymptomatic nocturnal enuresis (MNE) is a symptom of a multifactorial disease – insufficient arousal mechanism, smaller than expected bladder capacity, or nocturnal polyuria, or a combination of these, are some etiologies identified to date.1-3 Full-Text PDF