PEDIATRIC UROLOGY

Nocturnal Enuresis in Adolescents and Adults Is Associated With Childhood Elimination Symptoms
Bower WF, Sit FK, Yeung CK
Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
J Urol. 2006; 176 (4 Pt 2): 1771-5

• Purpose: Since nocturnal enuresis in adults and adolescents is rarely monosymptomatic, we identified the prevalence of childhood bladder and bowel dysfunction, and compared findings to those in a normative cohort.
• Materials and Methods: Childhood and current bladder and bowel dysfunction were investigated in 56 consecutive adolescents and adults attending a public nocturnal enuresis service and in 293 normative adults using a self-administered questionnaire. Analysis involved descriptive statistics, the chi-square and Kruskal-Wallis tests, and regression analysis with p <0.05 considered significant.
• Results: Adolescents and adults attending a public nocturnal enuresis service had significantly higher childhood scores than normative adults, and significantly more childhood urgency, frequency, urge incontinence, infrequent voiding and small volume, high urge voids. Infrequent bowel action and fecal soiling in childhood were also significantly more common in those with nocturnal enuresis than in controls. Adult symptoms of urge incontinence, general bowel symptoms and nocturnal enuresis were significantly more common in adults and adolescents with nocturnal enuresis. Significant associations were found between childhood symptoms and adult overactive bladder, and childhood emptying dysfunction and adult voiding dysfunction. Higher childhood scores in adults and adolescents with nocturnal enuresis correlated significantly with current adult symptoms of urge, urge leakage, stress incontinence, hesitancy, incomplete emptying and UTI within the last year.
• Conclusions: Significant childhood bladder and bowel symptoms along with more adult urge and bowel dysfunction were found in adults and adolescents with nocturnal enuresis. The association with adult urgency and urinary tract infection supports the likelihood of underlying bladder and or voiding dysfunction in unremitting nocturnal enuresis.
  
  
• Editorial Comment
  The authors report the results of two prospective questionnaire surveys, comparing adolescents and adults with nocturnal enuresis to those with a non-urological (ENT) problem. They find that older patients with nocturnal enuresis frequently have urge incontinence (45% vs. 8%) and may have bowel symptoms (16.4% vs. 12.6%). In addition, the adult patients with enuresis had markedly higher recollection of childhood problems like urgency, frequency and urge incontinence, as well as constipation and fecal soiling.
  This study is another in a growing literature suggesting that adults with voiding problems, often have a history of childhood voiding and bowel problems. Although we do not know the number of children who outgrow their childhood issues and never recur as adults, it is clear that a large number of adults with problems had childhood symptoms. This emphasizes the critical need for new innovative and effective treatment modalities for children with voiding problems.
  Also interesting is the finding that adults with continued nocturnal enuresis have a large likelihood of reporting symptoms of overactive bladder, despite often being labeled “monosymptomatic nocturnal enuresis.” This has several implications. First, it suggests that clinicians should look harder for an urge component in children with this condition. It is probably underlying in many, but may not be symptomatic as children can control their voids and fluid intake during the day. Second, it suggests a mechanism by which the clinician can approach adults with this condition. Both anticholinergic and alpha-adrenergic blockers can reduce overactive bladder symptoms and should be considered as adjuncts in behavioral management.

Dr. Barry A. Kogan
Chief and Professor of Urology and Pediatrics
Albany Medical College
Albany, New York, USA