Nocturnal Enuresis in the Adult

Katz, Eric G; MacLachlan, Lara S.

doi:10.1007/s11934-020-00983-2

Cited by 11 publications

(7 citation statements)

References 34 publications

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“…The etiology of NE can be stratified into either primary (55.7%) or secondary (44.3%) onset, based on their past history. The former was further divided into primary persistent (8.6%) and primary recurrent (47.1%) according to their symptom continuity since childhood, while the latter could be classified as neurogenic (Parkinson's disease, Alzheimer's disease, encephalitis, spinal cord injury, and meningomyelocele), drug-related (anti-depressant, hypnotics, and sedatives), and surgery-related (hysterectomy, colorectal surgery, and pelvic floor reconstruction) causes of NE ( 5 , 16 ).…”

Section: Resultsmentioning

confidence: 99%

“…When it comes to adults, the overall incidence of NE is 0.02-2.3% according to multiple reports with slightly different diagnostic criteria (2)(3)(4). Despite being uncommon, NE should not be neglected, as it has a considerable negative impact on an individual's quality of life (QoL), self-esteem, mental health, and family relationships (5). However, our current knowledge is scarce, due to, x few publications with small sample sizes; y inconsistent definitions and criteria for patients with NE; and z lack of assessments of voiding pattern and urine output by bladder diary.…”

Section: Introductionmentioning

confidence: 99%

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The Clinical Features and Predictive Factors of Nocturnal Enuresis in Adult Women

Song

et al. 2022

Front. Med.

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ObjectiveOur current knowledge on nocturnal enuresis (NE) in adults is scarce due to its uncommon nature. The present study was designed to investigate symptom characteristics and risk factors of NE in adult women to improve the current clinical understanding and management of this rare disease.MethodsOver a 3-year period, we enrolled 70 adult women who complained of bedwetting, with a frequency of at least once per week and a symptom duration of 3 months or longer. Patients were excluded if they had known pregnancy, current urinary tract infection, untreated malignancies, anatomical abnormalities, and irregular sleep cycle. The International Consultation on Incontinence Modular Questionnaire—female lower urinary tract symptoms and bladder diary were employed to appraise lower urinary tract symptoms and voiding behavior. Urodynamics was performed to assess the bladder function. A linear regression analysis was applied to determine potential risk factors for NE frequency.ResultsAmong the recruited subjects, comorbidities and lower urinary tract symptoms were frequently reported. On bladder diary, patients commonly presented with nocturnal polyuria (NP), reduced nocturnal voided volumes (RNVVs), or both. Urodynamics revealed multiple dysfunctions, namely, detrusor overactivity (DO), urodynamic stress incontinence (USI), reduced compliance, bladder outlet obstruction, detrusor underactivity (DU), and simultaneous DO and DU. Patients with more frequent NE (≥4/week) demonstrated markedly increased body mass index, more comorbid conditions, worse incontinence symptoms, NP or NP plus RNVVs, reduced compliance, and poorer voiding possibly owing to DU. Whereas, RNVVs alone and worse overactive bladder-related parameters were associated with milder NE. Multivariate analysis indicated that frequency/urgency quality of life, incontinence symptom, NP + RNVVs, poor flow, increased bladder sensation, USI, and simultaneous detrusor overactivity plus DU were independent risk factors for NE severity.ConclusionNE in adult women may have both urological and non-urological pathophysiology. Imbalanced circadian urine production, jeopardized continence mechanisms, overactive bladder, and DU-induced poor voiding are major factors that contribute to the pathogenesis of NE in adult women. Focused treatments on restoring these functions should be individually considered.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Clinical Features and Predictive Factors of Nocturnal Enuresis in Adult Women

Song

et al. 2022

Front. Med.

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“…However, as water intake is difficult to control in most adults with PWS, desmopressin treatment should be avoided in adults with PWS. In cases of enuresis, patients should be comprehensively reviewed to find the exact mechanism(s) of enuresis and an alternative treatment to improve it [25].…”

Section: Discussionmentioning

confidence: 99%

Hyponatremia in Children and Adults with Prader–Willi Syndrome: A Survey Involving Seven Countries

Coupaye

Pellikaan

Goldstone

et al. 2021

JCM

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In Prader–Willi syndrome (PWS), conditions that are associated with hyponatremia are common, such as excessive fluid intake (EFI), desmopressin use and syndrome of inappropriate antidiuretic hormone (SIADH) caused by psychotropic medication. However, the prevalence of hyponatremia in PWS has rarely been reported. Our aim was to describe the prevalence and severity of hyponatremia in PWS. In October 2020, we performed a retrospective study based on the medical records of a large cohort of children and adults with PWS from seven countries. Among 1326 patients (68% adults), 34 (2.6%) had at least one episode of mild or moderate hyponatremia (125 ≤ Na < 135 mmol/L). The causes of non-severe hyponatremia were often multi-factorial, including psychotropic medication in 32%, EFI in 24% and hyperglycemia in 12%. No obvious cause was found in 29%. Seven (0.5%) adults experienced severe hyponatremia (Na < 125 mmol/L). Among these, five recovered completely, but two died. The causes of severe hyponatremia were desmopressin treatment for nocturnal enuresis (n = 2), EFI (n = 2), adrenal insufficiency (n = 1), diuretic treatment (n = 1) and unknown (n = 1). In conclusion, severe hyponatremia was very rare but potentially fatal in PWS. Desmopressin treatment for nocturnal enuresis should be avoided. Enquiring about EFI and monitoring serum sodium should be included in the routine follow-ups of patients with PWS.

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“…Furthermore, there is good evidence to support the provision of guidance on fluid intake and reduction of total daily fluid consumption (2 litres/day or 25% reduction from baseline), and this is considered a central recommendation for initial management. 14,17,[31][32][33][34] Small studies confirm that sodium intake correlates with diurnal leg edema and nocturnal urine volume. 35 Patients with high salt intake should reduce their daily sodium consumption in order to see a beneficial reduction of nocturnal voids.…”

Section: Behavioral and Lifestyle Contributors To Nocturiamentioning

confidence: 97%

Canadian Urological Association best practice report: Diagnosis and management of nocturia

Nguyen

Randhawa

Nadeau

et al. 2022

CUAJ

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relevant articles were also reviewed to identify any other relevant important studies. Quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. While there overall was a lack of high-quality evidence to inform aspects of this review, the strength of recommendations was supported by clinical principles, fundamental pathophysiology, and consensus expert opinion. BackgroundThe International Continence Society (ICS) defines nocturia as waking one or more times to void during the hours of sleep, with each void preceded and followed by sleep. 1 Although voiding even once at night is considered nocturia, some literature has shown that fewer than two voids per night does not result in significant patient bother. 2 However, the degree of bother experienced by individual patients will vary according to factors beyond just the number of voids per night. Nocturia is associated with impaired quality of life, 3 and even mortality. 4 This association of nocturia with mortality has been reported to be independent of bother, and should be noted even if patients are not bothered. 5 Patients therefore may benefit from assessment for nocturia even if they don't independently report nocturia, as bother is often what motivates patients to raise nocturia as an issue with their care providers.Depending on the patient population and definition of nocturia used, prevalence varies significantly. [6][7][8] From a Canadian survey of 1000 adults, prevalence, using the ICS definition of one or more episodes per night, was estimated to be 36.4% in all adults and 49.5% in adults over age 65. When defined as two or more episodes per night, prevalence was 9.1% in all adults and 23.8% in adults over the age of 65. 9 Nocturia by any definition increases with age, particularly in men (see Figure 1). 6,7,9 Normal renal function allows for a circadian production of urine, with concentration of urine at night. This function is age-dependent, typically established by age 3 to 5, and leads to decreased nocturnal urine volume. Arginine vasopressin (AVP, or antidiuretic hormone [ADH]) is released from the posterior pituitary and serves as the primary hormone regulating renal water excretion. Factors such as high serum osmolality, hypovolemia and angiotensin II stimulate AVP, leading to water reabsorption, whereas factors such as atrial natriuretic peptide (ANP/ANH), prostaglandin E2 (PGE2) and hypercalcemia inhibit AVP, leading to diuresis. 10 With aging, however, the circadian rhythm of release of these hormones is blunted, which can increase nocturnal urine production.Normal bladder function requires adequate bladder storage and emptying abilities. This requires coordination of multiple components, including the central and peripheral nervous systems, detrusor smooth muscle function, and urethral and pelvic floor function. In addition, the bladder urothelium seems to have a role in regulating urinary function and possibly contributing to AVP-mediated water homeostasis. 10 Important co...

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Nocturnal Enuresis in the Adult

Cited by 11 publications

References 34 publications

The Clinical Features and Predictive Factors of Nocturnal Enuresis in Adult Women

The Clinical Features and Predictive Factors of Nocturnal Enuresis in Adult Women

Hyponatremia in Children and Adults with Prader–Willi Syndrome: A Survey Involving Seven Countries

Canadian Urological Association best practice report: Diagnosis and management of nocturia

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