Primary and secondary nocturnal enuresis: similarities in
presentation.
Robson WL, Leung AK, Van Howe R.
Tawam Hospital, Box 15258, Al Ain, United Arab Emirates. lanerobson@msn.com.
OBJECTIVE: To determine the differences or similarities in the clinical
presentation between patients with primary and secondary nocturnal enuresis.
METHODS: A total of 170 patients with nocturnal enuresis were assessed at a
busy tertiary care pediatric voiding dysfunction clinic at the University of
Oklahoma Health Sciences Center. Patients with primary nocturnal enuresis
(PNE) were compared with patients with secondary nocturnal enuresis (SNE) for
a variety of clinical features, including gender, age when first voiding on
their own, age on presentation, infrequent voiding, frequent voiding, urgency,
daytime wetting, nocturia, urinary tract infection, constipation,
vesicoureteral reflux, attention-deficit/hyperactivity disorder, uroflow
results, and ultrasound evidence of a postvoid residual. RESULTS: The only
significant difference between the patients with PNE and those with SNE was in
the prevalence of constipation. Constipation was significantly associated with
PNE (74.59% vs 57.54%; odds ratio: 2.17; 95% confidence interval: 1.07-4.41).
When adjusted for a history of constipation, the age at which a child began to
void on his or her own became statistically significant. Patients with SNE
started to void on their own at 2.13 years (SD: 0.61), an average of 0.22
years earlier than those with PNE, who started to void on their own at 2.35
years.
CONCLUSIONS: PNE and SNE likely share a common pathogenesis. Symptoms
of daytime voiding dysfunction are common in patients with PNE and SNE.
Daytime voiding habits might influence how the central nervous system responds
at night to a full or contracting bladder.