Adult Onset Nocturnal Enuresis: Identifying Causes, Cofactors and Impact on Quality of Life

Primary enuresis in adults: pathogenesis, clinical course and modern approaches to treatment: A review

The review article presents current data on the epidemiology, classification, pathogenesis, risk factors, diagnosis, and features of the clinical course of primary enuresis in adults. The main methods of treatment of patients with primary enuresis are described in detail. It has been shown that in the treatment of this category of patients, the leading role is given to the use of a synthetic analogue of the antidiuretic hormone desmopressin. A detailed analysis of the pharmacological properties and clinical use of desmopressin in patients with primary enuresis is presented. The advantages of prescribing a sublingual form of desmopressin, which ensures its high efficiency and good tolerability of therapy.

Quality of Life of Saudi Women With Chronic Lower Urinary Tract Symptoms

Background Chronic lower urinary symptoms (LUTS) are reported to affect more than half of women of all ages and have a significant impact on their quality of life (QoL). We aimed in this study to assess the QoL of adult Saudi women with chronic LUTS. Methods A cross-sectional study was done on 390 female patients diagnosed with LUTS at three tertiary care hospitals in Riyadh, Saudi Arabia, from October to December 2021. LUTS are classified into three categories: symptoms related to bladder storage (increased daytime frequency, nocturia, and urinary incontinence [UI]), symptoms of bladder voiding (hesitancy, extended micturition time, and insufficient emptying), and symptoms involved in the post-urination phase such as post-micturition dribbling. The data was collected using a self-administered questionnaire which comprised demographic characteristics, International Prostate Symptom Score (IPSS) for assessment of LUTS severity, and King's Health Questionnaire (KHQ) for assessment of QoL. Results After analyzing the study results, we found that symptoms were mild, moderate, and severe in 11%, 51%, and 39% of participants, respectively. Increased age and parity were found to have a significant association with increased symptom severity (p-value <0.05). The current study reported a moderate effect of LUTS on QoL. There was a significant correlation between increased symptom severity and negative impact on QoL, excluding the personal relationships domain. The highest scores in KHQ, which indicate worse QoL, were found in the domains of incontinence impact and emotions, while the lowest scores, which indicate better QoL, were found in the domains of social limitations and severity measures. Employed females were found to have worse QoL in the severity measures domain, which refers to the degree of urinary symptoms affecting day-to-day functioning. In addition, younger age, below 45 years, was found associated significantly with better QoL, especially in the domains of general health, personal relationships, and severity measures. Conclusion In the current study, the majority of patients reported moderate symptoms severity. Chronic LUTS have a significant impact on the QoL of Saudi women in many aspects, including physical, social, and emotional health, especially for those who have moderate to severe symptoms. Healthcare providers should assess high-risk women for the presence of LUTS. Furthermore, we recommend evaluating the QoL of patients with LUTS as a part of routine management.

The association between primary nonmonosymptomatic nocturnal enuresis and the presence of specific phobia: a case–control study

Background

Nocturnal enuresis (NE) is a common childhood condition characterized by recurrent bedwetting in children with normal bladder control over 5 years old. The pathogenesis of this condition is unknown, but it is believed to have a complex etiology. NE is primary or secondary, monosymptomatic or nonmonosymptomatic (NMNE). MNE children do not have lower urinary tract (LUT) impairment, and their voided volumes are generally normal. NMNE is linked to malfunction of the LUT, with or without daytime incontinence. Several investigations have discovered significant associations between psychiatric problems, especially anxiety disorders and NMNE. Specific phobia is the most common lifelong anxiety disorder, characterized by extreme anxiety when a stimulus is encountered or expected. This study investigated the association between specific phobia and primary NMNE.

Methods

A total of 204 children were studied, including 102 children with primary NMNE and 102 children in the control group. Girls with an FSS-II score greater than 75 and boys with a score greater than 78 were considered to have specific phobia disorder. The groups were compared using SPSS software version 23 and descriptive statistical methods.

Results

The results of the recent study showed that the mean age of the children in the case and control groups was 7.69 and 7.19 years, respectively (p-value = 0.063). The male to female ratio was 49–53 in the case group and 43–59 in the control group (p-value = 0.399). In the study, the frequency of specific phobia in the case group was 12.7% and in the control group was 9.8% (p-value = 0.507).

Conclusions

Despite the strong impacts of anxiety on children's NMNE, there is likely no significant association between specific phobia and primary NMNE.

The relative importance of different consequences of nocturnal enuresis among older women: A conjoint analysis experiment

INTRODUCTION

Adult nocturnal enuresis (NE) is an understudied and bothersome condition. Our objective was to conduct a conjoint analysis experiment to better understand the relative importance of NE consequences in older women.

METHODS

We developed a conjoint analysis survey that included four attributes related to NE (awakening at night, feeling rested in the morning, restricting fluid before bed, and wet perineal skin). We performed a prospective cross-sectional online study of women >62 years of age with NE using Sawtooth Software. Patients completed baseline questions, the International Consultation on Incontinence Questionnaire-nocturia Quality of Life (ICIQ-NqoL), and the conjoint analysis experiment. Hierarchical Bayes random effects regression analysis was used to determine the relative importance of the four attributes.

RESULTS

A total of 200 women with a mean age of 71 years completed the study. The most common management of NE was diapers/pads (132/200). Approximately half of the participants experienced NE several times a week or nightly (101/200). The most important attribute was the frequency of being awakened at night (34, standard deviation [SD]: 16) and the frequency of feeling rested in the morning (32, SD: 15). Limiting drinking before bed (18, SD: 12) and wet groin skin (16, SD: 10) had significantly lower importance scores (p < 0.05). Age, sleeping with a partner in bed, body mass index, NE severity score, and the ICIQ-NqOL score were not significantly associated with any of the importance scores.

CONCLUSIONS

Older women with NE place significantly more importance on the frequency of awakening at night, and feeling rested in the morning and lesser importance on associated lifestyle or physical manifestations of NE.

Treatment strategies for clozapine-induced nocturnal enuresis and urinary incontinence: a systematic review

BACKGROUND

Clozapine is the most effective medication for treatment-refractory schizophrenia but is associated with significant adverse drug reactions, including nocturnal enuresis and urinary incontinence. This side effect can be burdensome and lead to medication nonadherence and psychotic relapse. Evidence to guide treatment of clozapine-induced nocturnal enuresis and urinary incontinence is sparse. We therefore aimed to synthesize the evidence base to guide management for clinicians, patients, and their carers.

METHODS

We systematically searched PubMed, Embase, PsycInfo, CINAHL, and the Cochrane Trial Registry databases from inception to May 2021 for publications on management of clozapine-induced nocturnal enuresis and urinary incontinence using a PROSPERO preregistered search strategy.

RESULTS

We identified 22 case reports and case series describing 74 patients. Interventions included clozapine dose reduction, nonpharmacological treatment, and pharmacological treatments. Among pharmacological treatments, desmopressin, oxybutynin, trihexyphenidyl, tolterodine, imipramine, amitriptyline, ephedrine, pseudoephedrine, aripiprazole, and verapamil were associated with complete resolution of nocturnal enuresis and urinary incontinence. Balancing evidence for effectiveness against risk of adverse effects, we developed a management framework for clozapine-induced nocturnal enuresis and urinary incontinence.

CONCLUSIONS

Following assessment of urological, psychiatric, pharmacological, and common comorbid medical issues, first-line treatments should be nonpharmacological, including bathroom alarms, voiding before bedtime, and nocturnal fluid restriction. If these interventions do not provide adequate relief, aripiprazole should be trialed. Desmopressin may be considered for severe refractory cases, but monitoring for hyponatremia is essential.

The Clinical Features and Predictive Factors of Nocturnal Enuresis in Adult Women

Objective

Our current knowledge on nocturnal enuresis (NE) in adults is scarce due to its uncommon nature. The present study was designed to investigate symptom characteristics and risk factors of NE in adult women to improve the current clinical understanding and management of this rare disease.

Methods

Over a 3-year period, we enrolled 70 adult women who complained of bedwetting, with a frequency of at least once per week and a symptom duration of 3 months or longer. Patients were excluded if they had known pregnancy, current urinary tract infection, untreated malignancies, anatomical abnormalities, and irregular sleep cycle. The International Consultation on Incontinence Modular Questionnaire—female lower urinary tract symptoms and bladder diary were employed to appraise lower urinary tract symptoms and voiding behavior. Urodynamics was performed to assess the bladder function. A linear regression analysis was applied to determine potential risk factors for NE frequency.

Results

Among the recruited subjects, comorbidities and lower urinary tract symptoms were frequently reported. On bladder diary, patients commonly presented with nocturnal polyuria (NP), reduced nocturnal voided volumes (RNVVs), or both. Urodynamics revealed multiple dysfunctions, namely, detrusor overactivity (DO), urodynamic stress incontinence (USI), reduced compliance, bladder outlet obstruction, detrusor underactivity (DU), and simultaneous DO and DU. Patients with more frequent NE (≥4/week) demonstrated markedly increased body mass index, more comorbid conditions, worse incontinence symptoms, NP or NP plus RNVVs, reduced compliance, and poorer voiding possibly owing to DU. Whereas, RNVVs alone and worse overactive bladder-related parameters were associated with milder NE. Multivariate analysis indicated that frequency/urgency quality of life, incontinence symptom, NP + RNVVs, poor flow, increased bladder sensation, USI, and simultaneous detrusor overactivity plus DU were independent risk factors for NE severity.

Conclusion

NE in adult women may have both urological and non-urological pathophysiology. Imbalanced circadian urine production, jeopardized continence mechanisms, overactive bladder, and DU-induced poor voiding are major factors that contribute to the pathogenesis of NE in adult women. Focused treatments on restoring these functions should be individually considered.

Clinical efficacy of mebeverine for persistent nocturnal enuresis after orthotopic W-neobladder

OBJECTIVES

To investigate the efficacy of mebeverine for nocturnal incontinence in male patients with an ileal orthotopic bladder substitute (OBS).

PATIENTS AND METHODS

A randomised controlled trial was carried out for adult male patients who were nocturnal incontinent. Patients were allocated to receive mebeverine 200 mg or placebo once a day in the evening for 3 months. The primary outcome was to compare the continence status between groups, assessed by the urinary domain of the Bladder Cancer Index (BCI) and pad usage. The secondary outcomes were to assess the safety of mebeverine.

RESULTS

There were 55 patients in the placebo group and 58 in mebeverine group who completed the follow-up. The median (interquartile range) interval between OBS surgery and starting treatment was 9 (4-13) years in the placebo group and 9 (6-13) years in the mebeverine group. The mean (SD) 3-month urinary domain score of the BCI was 70.8 (5.6) and 86.4 (14.2) in the placebo and mebeverine groups, respectively (P < 0.001). At 3 months, 54 (98.2%) and 26 (44.8%) patients required the use of a night-time pad in the placebo and mebeverine groups, respectively. Mebeverine reduced the risk of pad use by 53.4% (95% confidence interval 40.1-66.6; P < 0.001). Constipation occurred in one (2.1%) and three (5.8%) patients in the placebo and mebeverine groups, respectively; abdominal distention occurred in two (3.8%) of the patients in the mebeverine group (P = 0.25).

CONCLUSION

Mebeverine decreases night-time pad use and improves the quality of life in male patients with an ileal OBS and is associated with minimal adverse events.

Prevalence, Risk Factors, and Psychological Effects of Primary Nocturnal Enuresis in Chinese Young Adults

Purpose

This study aimed to investigate the prevalence, risk factors, and effects of primary nocturnal enuresis (PNE) on physical and mental health in young adults in mainland China.

Methods

An anonymous questionnaire was used to collect information including the sociodemographic characteristics, history of PNE, family history, daytime voiding symptoms, Pittsburgh Sleep Quality Index (PSQI) scores, Self-Esteem Scale (SES), and Self-Rating Depression Scale (SDS). A total of 22,500 university students from 23 provinces and 368 cities in mainland China were included.

Results

In total, 21,082 questionnaires were collected, and 20,345 of them qualified for statistical analysis. The PNE prevalence was 1.17%, and the distribution of monosymptomatic nocturnal enuresis (MNE) and nonmonosymptomatic nocturnal enuresis (NMNE) was 66.1% and 33.9%, respectively. In total, 28% of respondents with PNE reported bedwetting daily, 31.6% between 1 and 7 times weekly, and 40.4% between 1 and 4 times monthly; 80% of PNE cases had no history of treatment. The prevalence of PNE in patients with a family history, frequency, urgency, urinary incontinence, and recurrent urinary tract infections was significantly higher than in those without these conditions (P<0.001). PNE was significantly correlated with the PSQI total score (sleep quality) (P=0.011). The SES score was lower and the SDS was higher (P<0.001) in the PNE group than in those without PNE.

Conclusions

In mainland China, the PNE prevalence among young adults was found to be high, and PNE had significant effects on physical and mental health. Risk factors included a family history, daytime voiding symptoms, and lack of treatment.

The clinical features and predictive factors of nocturnal enuresis in adult men

OBJECTIVES

To characterise the clinical features and to discover predictive factors of adult males with nocturnal enuresis (NE).

PATIENTS AND METHODS

A total of 43 eligible adult male patients (mean age was 57.8 years) were recruited prospectively over a 2-year period. After documentation of medical history, lower urinary tract symptoms (LUTS) were assessed using the International Consultation on Incontinence Modular Questionnaire-male LUTS (ICIQ-MLUTS), and a 3-day ICIQ-bladder diary (ICIQ-BD). Video-urodynamic studies (VUDS) were conducted conforming to the International Continence Society standards. Univariate and multivariate linear regressions were performed to determine potential predictive factors.

RESULTS

Patients with NE had a variety of LUTS and had a high incidence of obesity and comorbidities. On the ICIQ-BD, NE was associated with nocturnal polyuria (NP), reduced nocturnal bladder capacity (NBC), or a combination of both. Subgroup analysis indicated that patients with more frequent NE had: higher body mass index (BMI); more comorbidities; reduced daytime urinary frequency and urgency quality of life (QoL) sub-scores; and increased stress urinary incontinence (SUI) and nocturnal bedwetting sub-scores. Patients with reduced NBC only, had fewer NE episodes, while patients with NP, or with both NP and reduced NBC were more likely have frequent NE. Multivariate analysis confirmed that: BMI; neurogenic causes; sub-scores of SUI QoL and bedwetting domain; the presence of reduced NBC, and both NP and reduced NBC; and bladder outlet obstruction, were all independent predictive factors for the severity of NE.

CONCLUSIONS

NE n the adult male should be systemically assessed and treated, as obesity, neurogenic disorders, excessive urine production, bladder storage and emptying dysfunctions are risk factors. Bladder diaries and VUDS provide valuable information on potential pathophysiological causes, which could assist clinical evaluation and selection of focussed treatment.

A comprehensive review of adult enuresis

Nocturnal enuresis (NE) is a combined symptom of nocturia and urinary incontinence. In this review, we aim to summarize the current literature on NE in terms of its definition, diagnosis, and management. Recommended diagnostic evaluation of NE includes a focused history and physical examination, urinalysis, and when indicated, ultrasound examination, flow rate, urine volume chart, urodynamics, and cystoscopy. Therapeutic options include lifestyle modification and medications (i.e., desmopressin and anticholinergics).