Nocturnal enuresis, disordered micturition that is associated with sleep, remains a “curious phenomenon”, an incompletely understood process that plagues many a child, sometimes resulting in life-altering emotional scars. A new review by Trygge Neveus1, an internationally recognised expert in bedwetting, provides an in-depth examination of all that is currently known about nocturnal enuresis. In this survey, the author discusses everything from the genetic basis of the disorder to the physiology of nocturnal urine production as well as detrusor function and dysfunction during sleep, CNS correlates of NE and the role of psychological factors. Disturbances in arousal are also felt to contribute significantly to the disorder, as affected children are usually hard to awaken. After assessing all of the various factors, Professor Neveus attempts to synthesise a “unifying model” of nocturnal enuresis. He proposes that consideration must go beyond the currently favoured ‘3 Circles Model’ of nocturnal enuresis which implicates the combination of nocturnal polyuria, detrusor overactivity and impaired arousal thresholds. It must also take into account the potential contributions of constipation, sleep disruption, CNS abnormalities, airway obstruction and behavioural disorders. He therefore concludes that, because of this heterogeneity, nocturnal enuresis likely comprises several conditions. As a consequence, research efforts should be focused on phenotyping the variants of nocturnal enuresis to individualise and optimise therapeutic regimens.
Neveus T. Pathogenesis of enuresis: Toward a new understanding. Intl J Urol. Version of Record online: 16 FEB 2017 | DOI: 10.1111/iju.13310
Article by Nina Davis on behalf of the Publications and Communications Committee