Recent advances in managing and understanding enuresis

Abstract

Enuresis, particularly in children during sleep, can be a debilitating condition, affecting the quality of life of the child and his or her family. The pathophysiology of nocturnal enuresis, though not clear, revolves around the inter-related mechanisms of overactive bladder, excessive nocturnal urine production, and sleep fragmentation. The first mechanism is more related to isolated nocturnal voiding, whereas the latter two are more related to nocturnal enuresis, in which circadian variations in arginine vasopressin hormone play a key role. A successful treatment would depend upon appropriately addressing the key factors precipitating nocturnal enuresis, necessitating an accurate diagnosis. Thus, advancements in diagnostic tools and treatment options play a key role in achieving overall success. This review summarizes recent advances in understanding the pathophysiology of nocturnal enuresis, diagnostic tools, and treatment options which can be explored in the future.

Keywords: enuresis; enuretic; nocturnal enuresis.

Figure 1.. Interplay between arginine vasopressin (AVP) and nocturnal enuresis (NE): understanding it better.

( a) NE is caused by three related mechanisms: bladder overactivity (more related to isolated nighttime voiding), nocturnal polyuria (NP), and sleep disorders (more related to NE: AVP plays a key role by regulating diuresis and sleep circadian rhythms). ( b) Copeptin, an attractive alternative biomarker for AVP measurement, which is released in equimolar quantities as AVP and has greater plasma stability compared with AVP. ( c) Failure of the normal circadian rhythm of AVP in case of NE, resulting in large volumes of urine being produced at night. This led to the use of synthetic AVP analogue “desmopressin” as a treatment option.