Skip to main content

Advertisement

SpringerLink
Log in

The Evaluation and Treatment of Adult Nocturnal Enuresis

  • Voiding Dysfunction Evaluation (C Gomez, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Nocturnal enuresis is less common in adults than in childhood and is a significant cause of social and psychological debility and distress to patients, who may delay seeking treatment for fear of stigma. There is often an absence of significant underlying anatomical or functional pathology in patients with isolated nocturnal enuresis. A careful clinical assessment including a frequency-volume urine chart, post-voiding residual, and video-urodynamic assessment will identify the most appropriate treatment pathway by casting light on underlying pathophysiological abnormality. This will help direct the appropriate use of therapy whether it is desmopressin to reduce dieresis or an anticholinergic directed at detrusor overactivity. There is currently debate over the benefit of behavioral modification therapy, alarm systems and recently the role of posterior tibial nerve stimulation therapy in adult patients suffering from nocturnal enuresis. Adult onset nocturnal enuresis can be a sign of chronic retention and warrants urgent urological assessment and treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Abrams P et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37–49.

    Article  PubMed  Google Scholar 

  2. Yeung CK et al. Characteristics of primary nocturnal enuresis in adults: an epidemiological study. BJU Int. 2004;93(3):341–5.

    Article  CAS  PubMed  Google Scholar 

  3. Koff SA. Enuresis, in Campbell's Urology P.C. Walsh, Retik, A. B, Vaughan, Jr, et al, Editor., W. B. Saunders. p. 2065.

  4. Buckley BS, Lapitan MC. Prevalence of urinary and faecal incontinence and nocturnal enuresis and attitudes to treatment and help-seeking amongst a community-based representative sample of adults in the United Kingdom. Int J Clin Pract. 2009;63(4):568–73.

    Article  CAS  PubMed  Google Scholar 

  5. Hellstrom AL et al. Micturition habits and incontinence in 7-year-old Swedish school entrants. Eur J Pediatr. 1990;149(6):434–7.

    Article  CAS  PubMed  Google Scholar 

  6. Sakamoto K, Blaivas JG. Adult onset nocturnal enuresis. J Urol. 2001;165(6 Pt 1):1914–7.

    Article  CAS  PubMed  Google Scholar 

  7. Yeung CK et al. Urodynamic findings in adults with primary nocturnal enuresis. J Urol. 2004;171(6 Pt 2):2595–8.

    Article  CAS  PubMed  Google Scholar 

  8. Harrison-Woolrych M et al. Nocturnal enuresis in patients taking clozapine, risperidone, olanzapine and quetiapine: comparative cohort study. Br J Psychiatry. 2011;199(2):140–4.

    Article  PubMed  Google Scholar 

  9. Light JK. Continence mechanisms following orthotopic bladder substitution. Scand J Urol Nephrol Suppl. 1992;142:95–7.

    CAS  PubMed  Google Scholar 

  10. Zahariou A et al. The use of desmopressin in the management of nocturnal enuresis in patients with spinal cord injury. Eur Medicophys. 2007;43(3):333–8.

    CAS  Google Scholar 

  11. Ekinci O et al. Nocturnal enuresis in sickle cell disease and thalassemia major: associated factors in a clinical sample. Int J Hematol. 2013;98(4):430–6.

    Article  PubMed  Google Scholar 

  12. el-Bahnasawy MS et al. Persistent and occasional nocturnal enuresis in orthotopic urinary diversion: is there a urodynamic difference? BJU Int. 2005;96(9):1373–7.

    Article  PubMed  Google Scholar 

  13. Goonewardena SA, Sivapriyan S. High pressure chronic retention: a life-threatening clinical entity. Ceylon Med J. 2005;50(2):71–3.

    CAS  PubMed  Google Scholar 

  14. Ahmed AF et al. Efficacy of an enuresis alarm, desmopressin, and combination therapy in the treatment of saudi children with primary monosymptomatic nocturnal enuresis. Korean J Urol. 2013;54(11):783–90.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Caldwell PH, Nankivell G, Sureshkumar P. Simple behavioural interventions for nocturnal enuresis in children. Cochrane Database Syst Rev. 2013;7, CD003637.

    PubMed  Google Scholar 

  16. Shapiro E. Publications from the International Children's Continence Society. Rev Urol. 2010;12(4):e202–4.

    PubMed Central  PubMed  Google Scholar 

  17. Lin AD et al. Nocturnal enuresis in older adults. J Chin Med Assoc. 2004;67(3):136–40.

    PubMed  Google Scholar 

  18. Rittig S et al. Abnormal diurnal rhythm of plasma vasopressin and urinary output in patients with enuresis. Am J Physiol. 1989;256(4 Pt 2):F664–71.

    CAS  PubMed  Google Scholar 

  19. Stenberg A, Lackgren G. Desmopressin tablets in the treatment of severe nocturnal enuresis in adolescents. Pediatrics. 1994;94(6 Pt 1):841–6.

    CAS  PubMed  Google Scholar 

  20. Vandersteen DR, Husmann DA. Treatment of primary nocturnal enuresis persisting into adulthood. J Urol. 1999;161(1):90–2.

    CAS  PubMed  Google Scholar 

  21. Yucel S et al. Impact of urodynamics in treatment of primary nocturnal enuresis persisting into adulthood. Urology. 2004;64(5):1020–5. discussion 1025.

    Article  PubMed  Google Scholar 

  22. Burgu B et al. Prospective evaluation of factors affecting the response and relapse rates to desmopressin therapy in male monosymptomatic enuretic adults. Urology. 2009;74(4):915–9.

    Article  PubMed  Google Scholar 

  23. Hajdinjak T, Leskovar J. Comparison of nocturia response to desmopressin treatment between patients with normal and high nocturnal bladder capacity index. Sci World J. 2013. doi:10.1155/2013/878564. This study demonstrates that the effectiveness of desmopressin on nocturia is not dependant on the nocturnal bladder capacity index.

  24. Weiss JP et al. Desmopressin orally disintegrating tablet effectively reduces nocturia: results of a randomized, double-blind, placebo-controlled trial. Neurourol Urodyn. 2012;31(4):441–7.

    Article  CAS  PubMed  Google Scholar 

  25. Lose G et al. Clinical experiences with desmopressin for long-term treatment of nocturia. J Urol. 2004;172(3):1021–5.

    CAS  PubMed  Google Scholar 

  26. Goldberg H, et al. Low-Dose Oral Desmopressin for Treatment of Nocturia and Nocturnal Enuresis in Patients after Radical Cystectomy and Orthotopic Urinary Diversion. BJU Int. 2013. doi: 10.1111/bju.12598. A significant proportion of patients with neobladders respond to night-time dose of desmopressin.

  27. El-Bahnasawy MS et al. Clinical and urodynamic efficacy of oxybutynin and verapamil in the treatment of nocturnal enuresis after formation of orthotopic ileal neobladders. A prospective, randomized, crossover study. Scand J Urol Nephrol. 2008;42(4):344–51.

    Article  CAS  PubMed  Google Scholar 

  28. Jerlstrom T, Andersson G, Carringer M. Functional outcome of orthotopic bladder substitution: a comparison between the S-shaped and U-shaped neobladder. Scand J Urol Nephrol. 2010;44(4):197–203.

    Article  PubMed  Google Scholar 

  29. Hunsballe JM et al. Single dose imipramine reduces nocturnal urine output in patients with nocturnal enuresis and nocturnal polyuria. J Urol. 1997;158(3 Pt 1):830–6.

    Article  CAS  PubMed  Google Scholar 

  30. Negro CL, Muir GH. Chronic urinary retention in men: how we define it, and how does it affect treatment outcome. BJU Int. 2012;110(11):1590–4. An overview of the management of chronic urinary retention in men.

    Article  PubMed  Google Scholar 

  31. Homma Y et al. Clinical guideline for male lower urinary tract symptoms. Int J Urol. 2009;16(10):775–90.

    Article  PubMed  Google Scholar 

  32. Abeygunasekera AM et al. Significance of recent onset nocturnal enuresis in adult men: a prospective study. Ceylon Med J. 2004;49(3):79–81.

    CAS  PubMed  Google Scholar 

  33. Congregado Ruiz B et al. Peripheral afferent nerve stimulation for treatment of lower urinary tract irritative symptoms. Eur Urol. 2004;45(1):65–9.

    CAS  PubMed  Google Scholar 

  34. de Oliveira LF et al. Transcutaneous parasacral electrical neural stimulation in children with primary monosymptomatic enuresis: a prospective randomized clinical trial. J Urol. 2013;190(4):1359–63.

    PubMed  Google Scholar 

  35. Raheem AA et al. Role of posterior tibial nerve stimulation in the treatment of refractory monosymptomatic nocturnal enuresis: a pilot study. J Urol. 2013;189(1514). A novel treatment for nocturnal enuresis in adults.

  36. Fitzgerald MP et al. Nocturia, nocturnal incontinence prevalence, and response to anticholinergic and behavioral therapy. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(11):1545–50.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Compliance with Ethics Guideline

Conflict of Interest

Christopher Chapple reports grants and/or personal fees from Allergan, American Medical Systems, Astellas, Lilly, ONO, Pfizer, and Recordati, outside the submitted work. Chris Hillary declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Urology Research J Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK, S10 2JF

    Christopher James Hillary

  2. Office H26, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK, S10 2JF

    Christopher Chapple

Authors
  1. Christopher James Hillary
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher Chapple
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christopher James Hillary.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hillary, C.J., Chapple, C. The Evaluation and Treatment of Adult Nocturnal Enuresis. Curr Bladder Dysfunct Rep 9, 84–89 (2014). https://doi.org/10.1007/s11884-014-0237-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-014-0237-8

Keywords

Search

Navigation