Primary diurnal and nocturnal enuresis

Abstract

Diurnal and nocturnal enuresis may in many cases be a self-limiting condition, but may also persist to become a severe social disability resistant to conservative measures. A review of the literature on the condition has enabled an appraisal of the likely etiology, the most appropriate investigative techniques and treatment options. Occult neuropathy and delayed neurological and psychological maturation are strongly favored etiological factors. Sleep studies involving electroencephalography and natural-fill cystometry have made a significant contribution to the understanding of the condition. Pharmacological manipulation of the hormonal control of diuresis or of detrusor contractility has proved beneficial. Cystoplasty has been shown to be effective in resistant cases. Enuresis is predominantly associated with involuntary detrusor activity. Conservative treatment often alleviates the condition, but in resistant cases ‘clam’ enterocystoplasty may be considered although it is associated with a significant postoperative incidence of voiding dysfunction.