A comprehensive review of adult enuresis

Abstract

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).

Fig. 1

Mechanisms of nocturnal continence.

Fig. 2

Assessment in adult enuresis. NE: nocturnal enuresis; OSA: obstructive sleep apnea; UDS: urodynamic study.

Fig. 3

Specific therapy for adult enuresis. *Possible explanation for decreasing nocturnal enuresis (NE) after mid-urethral sling placement is prevention of urinary leakage to proximal urethra and stress induced overactivity. ^Higher severity of enuresis in hemolytic disorders is associated with increased admission; therefore, efforts to manage chronic disease may help manage and better treat NE. ^#Although in nocturnal diuresis due to overproduction, desmopressin is treatment of choice, one should be cautioned in patients with kidney and liver disease, water intoxication, and hyponatremia; these should also be individually addressed. ^!Multifactorial NE is difficult to treat and best controlled by multimodal approaches and addressing all contributing etiologies., For example, empirically patients with spinal cord injury and neo-bladder after radical pelvic surgeries are managed by low-dose desmopressin, oxybutynin 5 mg three times a day, and catheterization before sleep. BPH: benign prostatic hyerplasia; OSA: obstructive sleep apnea.

Fig. 4

Treatment steps for idiopathic nocturnal enuresis.