Enuresis nocturna: New concepts in pathophysiology

Abstract

Although nocturnal enuresis was first described centuries ago, there is still a lot unknown about its pathophysiology. The functional bladder capacities, diurnal vasopressin levels, urine osmolalities and urine output of enuretic and normal children were compared. We have concluded that enuretics have normal bladder capacities insufficient for increased nocturnal urine volumes because of loss of diurnal variation in serum vasopressin levels and related decrease in urinary osmolalities.

Nocturnal Polyuria in Older People: Pathophysiology and Clinical Implications

“…In normal children with a mean age of 7 years, the daytime rate of urine production is two to three times that of the nighttime period 9,10 . Delay or failure of the circadian rhythm to develop during childhood is associated with the presence of nocturnal enuresis 9–11 . In adulthood, the ratio of daytime to nighttime urine production is usually >2:1, so that about 25% or less of daily urine output occurs during sleep 2 .…”

“…This rhythm seems to be linked to the wake‐sleep cycle rather than to the time of day 36 . The circadian rhythm becomes established during childhood and delay in its maturation is often associated with enuresis 10,11 . With advanced age, there seems to be blunting of the nocturnal phase of AVP secretion so that daytime and nighttime blood levels of the hormone are similar 6,17,37 …”

Functional bladder capacity and urine osmolality in children with primary monosymptomatic nocturnal enuresis

“…In children with NE, a reduction in osmolality at night is accompanied by increased or normal urine volume [13,16,26,27].…”

Nocturia: A new perspective on an old symptom

“…By the age of 7 years, healthy children have a daytime rate of urine production which is two to three times that of the night-time period (14,15). By adulthood, 25% of daily urine output occurs during the night (16).…”