The clinical features and predictive factors of nocturnal enuresis in adult men

Abstract

To characterise the clinical features and to discover predictive factors of adult males with nocturnal enuresis (NE). Patients and Methods A total of 43 eligible adult male patients (mean age was 57.8 years) were recruited prospectively over a 2-year period. After documentation of medical history, lower urinary tract symptoms (LUTS) were assessed using the International Consultation on Incontinence Modular Questionnaire-male LUTS (ICIQ-MLUTS), and a 3-day ICIQ-bladder diary (ICIQ-BD). Videourodynamic studies (VUDS) were conducted conforming to the International Continence Society standards. Univariate and multivariate linear regressions were performed to determine potential predictive factors. Results Patients with NE had a variety of LUTS and had a high incidence of obesity and comorbidities. On the ICIQ-BD, NE was associated with nocturnal polyuria (NP), reduced nocturnal bladder capacity (NBC), or a combination of both. Subgroup analysis indicated that patients with more frequent NE had: higher body mass index (BMI); more comorbidities; reduced daytime urinary frequency and urgency quality of life (QoL) sub-scores; and increased stress urinary incontinence (SUI) and nocturnal bedwetting sub-scores. Patients with reduced NBC only, had fewer NE episodes, while patients with NP, or with both NP and reduced NBC were more likely have frequent NE. Multivariate analysis confirmed that: BMI; neurogenic causes; sub-scores of SUI QoL and bedwetting domain; the presence of reduced NBC, and both NP and reduced NBC; and bladder outlet obstruction, were all independent predictive factors for the severity of NE. Conclusions NE n the adult male should be systemically assessed and treated, as obesity, neurogenic disorders, excessive urine production, bladder storage and emptying dysfunctions are risk factors. Bladder diaries and VUDS provide valuable information on potential pathophysiological causes, which could assist clinical evaluation and selection of focussed treatment.

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

“…There is a relatively high percentage of women with increased BMI (≥24 kg/m 2 ), which is associated with more frequent NE, consistently with our findings from that in men and reports from Song et al ( 6 ) and Madhu et al ( 18 ). As to the causes of secondary NE, we found that 11 out of 70 women had previous hysterectomy, although surgical onset only serves as a risk factor for NE episodes in the univariate analysis.…”

“…The overall incidence of daytime incontinence was 64.3% in women with NE, with 41.4% suffering from SUI, which was unsurprisingly higher than that in men due to gender difference ( 6 ). Importantly, we further corroborated that incontinence-related subjective symptom scores on ICIQ-FLUTS and USI are independent predictors for NE frequency ( 18 ).…”

“…Unlike NE in children, which may be owing to delayed maturation of arousal mechanisms or unestablished diurnal rhythm of vasopressin secretion, NE in adults is often associated with systemic diseases and LUTS, or secondary to surgeries and certain drugs, making the diagnosis and management more challenging ( 17 ). Our previous investigation in adult men with NE has identified a number of clinically significant risk factors using parameters derived from questionnaires, bladder diary, and urodynamics ( 6 ). In this parallel study, comparable approaches were used to analyze the features and risk factors of NE in adult women.…”

“…The diagnostic criteria for NE were in accordance with the International Continence Society (ICS) report and our previous publication ( 6 , 9 ). In brief, bedwetting occurs during the main sleep period, with a frequency of at least once per week and a symptom duration of 3 months or longer.…”

“…Recently, we did a comprehensive evaluation of NE in adult men, suggesting that obesity and deteriorated bladder emptying capability due to neurogenic deficiency or bladder outlet obstruction (BOO), as well as nocturnal polyuria (NP) with reduced nocturnal voided volumes (RNVVs) were independent risk factors for NE severity ( 6 ). However, women are prone to have a group of different lower urinary tract symptoms (LUTS) and systemic conditions, which may be related to NE giving a gender-specific pathophysiology and etiology.…”