Adult male enuresis (AME)—defined as involuntary bedwetting after falling asleep—is rarely the chief complaint among patients referred for refractory lower urinary tract symptoms (LUTS). Nevertheless, unrecognized AME may contribute to substantial psychosocial distress and reduced quality of life. This study aimed to evaluate the prevalence of AME in this specific population, identify associated clinical predictors, and construct a predictive nomogram.

In this single-center, cross-sectional observational study, we recruited adult men (≥18 years) who underwent urodynamic evaluation for refractory LUTS at a tertiary referral hospital. All participants completed a structured questionnaire on demographics, comorbidities, and LUTS severity, including any episodes of bedwetting after falling asleep. Logistic regression was used to assess independent associations between AME and potential predictors. Model calibration was evaluated using the Hosmer-Lemeshow goodness-of-fit test. A nomogram was constructed based on significant predictors, and its discriminative ability was assessed using the area under the receiver operating characteristic (ROC) curve (AUC). We also compared lifestyle and psychological outcomes between participants with and without AME using independent-samples t-tests with Bonferroni correction for multiple comparisons.

Among 493 participants (mean age 61.1±16.5 years), 101 (20.5%) reported AME, despite primarily presenting with daytime LUTS. In multivariable analysis, AME was independently associated with neurological disease (odds ratio [OR] 2.22, 95% CI 1.20–4.09; p=0.011), stress urinary incontinence (OR 1.39, 95% CI 1.18–1.64; p<0.001), and urgency urinary incontinence (OR 1.29, 95% CI 1.09–1.54; p=0.004). The logistic model showed acceptable calibration (Hosmer-Lemeshow p=0.288), and the nomogram (Fig 1) demonstrated moderate discrimination (AUC=0.771). Participants with AME reported significantly higher lifestyle and psychological burden, including lower motivation, greater anxiety and emotional distress, reduced daily and family functioning, and less frequent travel (all Bonferroni-adjusted p<0.05).

AME is prevalent among adult men with refractory LUTS, despite not being their primary symptom. It is closely associated with neurological comorbidities and incontinence subtypes. The nomogram may facilitate early clinical recognition, while the observed lifestyle and psychological impairments highlight the need for comprehensive evaluation beyond standard LUTS assessment.

Enuresis is common yet frequently overlooked in adult men referred for refractory LUTS. Routine screening for nocturnal symptoms and use of predictive tools may enable timely identification and guide personalized management strategies.