Nephro-Urology Monthly

Published by: Kowsar

Primary Nocturnal Enuresis: A Review

Ersan Arda 1 , Basri Cakiroglu 1 , * and David T. Thomas 2
Authors Information
1 Hisar Intercontinental Hospital, Department of Urology, Istanbul, Turkey
2 Maltepe University Medical School, Department of Pediatric Surgery, Istanbul, Turkey
Article information
  • Nephro-Urology Monthly: July 01, 2016, 8 (4); e35809
  • Published Online: May 31, 2016
  • Article Type: Review Article
  • Received: December 26, 2015
  • Accepted: April 30, 2016
  • DOI: 10.5812/numonthly.35809

To Cite: Arda E, Cakiroglu B, Thomas D T. Primary Nocturnal Enuresis: A Review, Nephro-Urol Mon. 2016 ; 8(4):e35809. doi: 10.5812/numonthly.35809.

Copyright © 2016, Nephrology and Urology Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Context
2. Epidemiology
3. Three Main Factors in the Pathophysiology of Enuresis
4. Classification of Nocturnal Enuresis
5. Work Up
6. Approach to Treatment of a Child with Nocturnal Enuresis
7. Conclusions
  • 1. Neveus T, von Gontard A, Hoebeke P, Hjalmas K, Bauer S, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society. J Urol. 2006; 176(1): 314-24[DOI][PubMed]
  • 2. Tas T, Cakiroglu B, Hazar AI, Balci MB, Sinanoglu O, Nas Y, et al. Monosymptomatic nocturnal enuresis caused by seasonal temperature changes. Int J Clin Exp Med. 2014; 7(4): 1035-9[PubMed]
  • 3. Cakiroglu B, Tas T, Eyyupoglu SE, Hazar AI, Can Balci MB, Nas Y, et al. The adverse influence of spina bifida occulta on the medical treatment outcome of primary monosymptomatic nocturnal enuresis. Arch Ital Urol Androl. 2014; 86(4): 270-3[DOI][PubMed]
  • 4. von Gontard A, Heron J, Joinson C. Family history of nocturnal enuresis and urinary incontinence: results from a large epidemiological study. J Urol. 2011; 185(6): 2303-6[DOI][PubMed]
  • 5. Safarinejad MR. Prevalence of nocturnal enuresis, risk factors, associated familial factors and urinary pathology among school children in Iran. J Pediatr Urol. 2007; 3(6): 443-52[DOI][PubMed]
  • 6. von Gontard A, Schaumburg H, Hollmann E, Eiberg H, Rittig S. The genetics of enuresis: a review. J Urol. 2001; 166(6): 2438-43[PubMed]
  • 7. Norgaard JP, Djurhuus JC, Watanabe H, Stenberg A, Lettgen B. Experience and current status of research into the pathophysiology of nocturnal enuresis. Br J Urol. 1997; 79(6): 825-35[PubMed]
  • 8. Neveus T, Lackgren G, Tuvemo T, Jerker H, Hjalmas K, Stenberg A. Enuresis-background and treatment. S J Urol Nephro. 2000; 34(206): 1-44
  • 9. Rittig S, Knudsen UB, Norgaard JP, Pedersen EB, Djurhuus JC. Abnormal diurnal rhythm of plasma vasopressin and urinary output in patients with enuresis. Am J Physiol. 1989; 256(4 Pt 2)-71[PubMed]
  • 10. Yeung CK, Sreedhar B, Leung VT, Metreweli C. Ultrasound bladder measurements in patients with primary nocturnal enuresis: a urodynamic and treatment outcome correlation. J Urol. 2004; 171(6 Pt 2): 2589-94[PubMed]
  • 11. Watanabe H. Sleep patterns in children with nocturnal enuresis. Scand J Urol Nephrol Suppl. 1995; 173: 55-6[PubMed]
  • 12. Yeung CK, Diao M, Sreedhar B. Cortical arousal in children with severe enuresis. N Engl J Med. 2008; 358(22): 2414-5[DOI][PubMed]
  • 13. Neveus T, von Gontard A, Hoebeke P, Hjalmas K, Bauer S, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescents: Report from the standardisation committee of the international children’s continence society. J Urol. 2006; 176(1): 314-24
  • 14. Neveus T, Eggert P, Evans J, Macedo A, Rittig S, Tekgul S, et al. Evaluation of and treatment for monosymptomatic enuresis: a standardization document from the International Children's Continence Society. J Urol. 2010; 183(2): 441-7[DOI][PubMed]
  • 15. Khullar V, Cardozo LD, Salvatore S, Hill S. Ultrasound: a noninvasive screening test for detrusor instability. Br J Obstet Gynaecol. 1996; 103(9): 904-8[PubMed]
  • 16. Cvitkovic-Kuzmic A, Brkljacic B, Ivankovic D, Grga A. Ultrasound assessment of detrusor muscle thickness in children with non-neuropathic bladder/sphincter dysfunction. Eur Urol. 2002; 41(2): 214-8[PubMed]
  • 17. Cayan S, Doruk E, Bozlu M, Akbay E, Apaydin D, Ulusoy E, et al. Is routine urinary tract investigation necessary for children with monosymptomatic primary nocturnal enuresis? Urology. 2001; 58(4): 598-602[PubMed]
  • 18. Charalampous S, Printza N, Hashim H, Bantouraki M, Rompis V, Ioannidis E, et al. Bladder wall thickness and urodynamic correlation in children with primary nocturnal enuresis. J Pediatr Urol. 2013; 9(3): 334-8[DOI][PubMed]
  • 19. Yeung CK, Sihoe JD, Sit FK, Diao M, Yew SY. Urodynamic findings in adults with primary nocturnal enuresis. J Urol. 2004; 171(6 Pt 2): 2595-8[PubMed]
  • 20. Sehgal R, Paul P, Mohanty NK. Urodynamic evaluation in primary enuresis: an investigative and treatment outcome correlation. J Trop Pediatr. 2007; 53(4): 259-63[DOI][PubMed]
  • 21. Elmissiry M, Abdelkarim A, Badawy H, Elsalmy S, Ali GA. Refractory enuresis in children and adolescents: how can urodynamics affect management and what is the optimum test? J Pediatr Urol. 2013; 9(3): 348-52[DOI][PubMed]
  • 22. Yeung CK, Sreedhar B, Sihoe JD, Sit FK, Lau J. Differences in characteristics of nocturnal enuresis between children and adolescents: a critical appraisal from a large epidemiological study. BJU Int. 2006; 97(5): 1069-73[DOI][PubMed]
  • 23. Marshall GB, Trinder J, Bornstein JC. P 8.8 treatment of bedwetting (nocturnal enuresis) in australia and new zealand with the bell-and-pad apparatus. Auto Neuroscience. 2009; 149(1): 123-4
  • 24. Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the international children's continence society. J Urol. 2014; 191(6): 1863-5
  • 25. Deshpande AV, Caldwell PH. Medical management of nocturnal enuresis. Paediatr Drugs. 2012; 14(2): 71-7[DOI][PubMed]
  • 26. O'Regan S, Yazbeck S, Schick E. Constipation, bladder instability, urinary tract infection syndrome. Clin Nephrol. 1985; 23(3): 152-4[PubMed]
  • 27. Vogel W, Young M, Primack W. A survey of physician use of treatment methods for functional enuresis. J Dev Behav Pediatr. 1996; 17(2): 90-3[PubMed]
  • 28. Blum NJ. Nocturnal enuresis: behavioral treatments. Urol Clin North Am. 2004; 31(3): 499-507[DOI][PubMed]
  • 29. Glazener CM, Evans JH, Peto RE. Alarm interventions for nocturnal enuresis in children. Cochrane Database Syst Rev. 2005; (2)[DOI][PubMed]
  • 30. Rappaport L. Prognostic factors for alarm treatment. Scand J Urol Nephrol Suppl. 1997; 183: 55-7[PubMed]
  • 31. Houts AC, Berman JS, Abramson H. Effectiveness of psychological and pharmacological treatments for nocturnal enuresis. J Consult Clin Psychol. 1994; 62(4): 737-45[PubMed]
  • 32. Butler RJ, Holland P, Gasson S, Norfolk S, Houghton L, Penney M. Exploring potential mechanisms in alarm treatment for primary nocturnal enuresis. Scand J Urol Nephrol. 2007; 41(5): 407-13[DOI][PubMed]
  • 33. Rittig S, Schaumburg HL, Siggaard C, Schmidt F, Djurhuus JC. The circadian defect in plasma vasopressin and urine output is related to desmopressin response and enuresis status in children with nocturnal enuresis. J Urol. 2008; 179(6): 2389-95[DOI][PubMed]
  • 34. Tauris LH, Andersen RF, Kamperis K, Hagstroem S, Rittig S. Reduced anti-diuretic response to desmopressin during wet nights in patients with monosymptomatic nocturnal enuresis. J Pediatr Urol. 2012; 8(3): 285-90[DOI][PubMed]
  • 35. Hjalmas K, Arnold T, Bower W, Caione P, Chiozza LM, von Gontard A, et al. Nocturnal enuresis: an international evidence based management strategy. J Urol. 2004; 171(6 Pt 2): 2545-61[PubMed]
  • 36. Gokce MI, Hajiyev P, Suer E, Kibar Y, Silay MS, Gurocak S, et al. Does structured withdrawal of desmopressin improve relapse rates in patients with monosymptomatic enuresis? J Urol. 2014; 192(2): 530-4[DOI][PubMed]
  • 37. Kahan E, Morel D, Amir J, Zelcer C. A controlled trial of desmopressin and behavioral therapy for nocturnal enuresis. Medicine (Baltimore). 1998; 77(6): 384-8[PubMed]
  • 38. Bradbury MG, Meadow SR. Combined treatment with enuresis alarm and desmopressin for nocturnal enuresis. Acta Paediatr. 1995; 84(9): 1014-8[PubMed]
  • 39. Robson WL, Leung AK, Norgaard JP. The comparative safety of oral versus intranasal desmopressin for the treatment of children with nocturnal enuresis. J Urol. 2007; 178(1): 24-30[DOI][PubMed]
  • 40. Glazener CM, Evans JH, Peto RE. Tricyclic and related drugs for nocturnal enuresis in children. Cochrane Database Syst Rev. 2003; (3)[DOI][PubMed]
  • 41. de Gatta MF, Garcia MJ, Acosta A, Rey F, Gutierrez JR, Dominguez-Gil A. Monitoring of serum levels of imipramine and desipramine and individualization of dose in enuretic children. Ther Drug Monit. 1984; 6(4): 438-43[PubMed]
  • 42. Seyfhashemi M, Ghorbani R, Zolfaghari A. Desmopressin, Imipramine, and Oxybutynin in the Treatment of Primary Nocturnal Enuresis: A Randomized Clinical Trial. Iran Red Crescent Med J. 2015; 17(7): 16174[DOI][PubMed]
  • 43. Bolduc S, Upadhyay J, Payton J, Bagli DJ, McLorie GA, Khoury AE, et al. The use of tolterodine in children after oxybutynin failure. BJU Int. 2003; 91(4): 398-401[PubMed]
  • 44. Deshpande AV, Caldwell PH, Sureshkumar P. Drugs for nocturnal enuresis in children (other than desmopressin and tricyclics). Cochrane Database Syst Rev. 2012; 12[DOI][PubMed]
  • 45. Van Kampen M, Bogaert G, Akinwuntan EA, Claessen L, Van Poppel H, De Weerdt W. Long-term efficacy and predictive factors of full spectrum therapy for nocturnal enuresis. J Urol. 2004; 171(6 Pt 2): 2599-602[PubMed]
  • 46. Leebeek-Groenewegen A, Blom J, Sukhai R, Van Der Heijden B. Efficacy of desmopressin combined with alarm therapy for monosymptomatic nocturnal enuresis. J Urol. 2001; 166(6): 2456-8[PubMed]
  • 47. Lordelo P, Soares PV, Maciel I, Macedo AJ, Barroso UJ. Prospective study of transcutaneous parasacral electrical stimulation for overactive bladder in children: long-term results. J Urol. 2009; 182(6): 2900-4[DOI][PubMed]
  • 48. Lordelo P, Benevides I, Kerner EG, Teles A, Lordelo M, Barroso UJ. Treatment of non-monosymptomatic nocturnal enuresis by transcutaneous parasacral electrical nerve stimulation. J Pediatr Urol. 2010; 6(5): 486-9[DOI][PubMed]
  • 49. Tugtepe H, Thomas DT, Ergun R, Kalyoncu A, Kaynak A, Kastarli C, et al. The effectiveness of transcutaneous electrical neural stimulation therapy in patients with urinary incontinence resistant to initial medical treatment or biofeedback. J Pediatr Urol. 2015; 11(3): 137 e1-5[DOI][PubMed]
  • 50. Yamanishi T, Sakakibara R, Uchiyama T, Suda S, Hattori T, Ito H, et al. Comparative study of the effects of magnetic versus electrical stimulation on inhibition of detrusor overactivity. Urology. 2000; 56(5): 777-81[PubMed]
  • 51. But I. Conservative treatment of female urinary incontinence with functional magnetic stimulation. Urology. 2003; 61(3): 558-61[PubMed]
  • 52. But I, Varda NM. Functional magnetic stimulation: a new method for the treatment of girls with primary nocturnal enuresis? J Pediatr Urol. 2006; 2(5): 415-8[DOI][PubMed]
  • 53. Xiang B, Biji S, Liu JX, Chu WC, Yeung DK, Yeung CK. Functional brainstem changes in response to bladder function alteration elicited by surgical reduction in bladder capacity: a functional magnetic resonance imaging study. J Urol. 2010; 184(5): 2186-91[DOI][PubMed]
  • 54. Kang SH, Bae JH, Shim KS, Park HS, Cheon J, Lee JG, et al. Extracorporeal magnetic innervation therapy in children with refractory monosymptomatic nocturnal enuresis. Urology. 2007; 70(3): 576-80[DOI][PubMed]
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