Adult enuresis--a symptomatic and urodynamic assessment

Adult onset nocturnal enuresis

PURPOSE

We determined the etiology and prognostic significance of adult onset enuresis with absent daytime incontinence. Adult onset nocturnal enuresis unassociated with daytime incontinence is uncommon and there is a paucity of information about its incidence, significance, evaluation and treatment. We present a retrospective evaluation of this condition based on a database review of more than 3,000 consecutive patients referred for the evaluation of lower urinary tract symptoms.

MATERIALS AND METHODS

A database of 3,277 consecutive patients was searched for adult onset nocturnal enuresis. Patients with daytime incontinence were excluded from study. Evaluation consisted of history, physical examination, American Urological Association symptom score, voiding diary, uroflowmetry, estimation of post-void residual urine, video urodynamics, cystoscopy and radiographic evaluation of the upper tract.

RESULTS

Of 3,277 patients 8 (0.02%) had adult onset nocturnal enuresis without daytime incontinence as a primary complaint. Average American Urological Association symptom score was 12.6 (range 3 to 25), average maximum urine flow was 8.5 ml. per second (range 5 to 15) and average post-void residual urine volume was 350 ml. (range 50 to 489). All patients were men with severe prostatic or vesical neck obstruction as well as bilateral or unilateral hydronephrosis in 63%, a bladder diverticulum in 38%, vesicoureteral reflux in 50% and low bladder compliance in 50%. Transurethral prostatic resection was recommended to all patients but only 5 agreed. The other 3 cases were managed by alpha-adrenergic antagonists, including 2 by adjunctive clean intermittent self-catheterization. In all patients who underwent transurethral prostatic resection symptoms resolved, as did hydronephrosis when present.

CONCLUSIONS

Adult onset nocturnal enuresis with absent daytime incontinence is a serious symptom that usually heralds significant urethral obstruction, and a high incidence of bladder diverticulum, hydronephrosis and vesicoureteral reflux. It demands urological investigation and aggressive therapy.

Primary nocturnal enuresis: a urodynamic study spanning three generations

The familial incidence of primary nocturnal enuresis is well recognised. Twin studies suggest there to be a significant genetic component to the aetiology of this disorder. However, family studies to date have been based on symptomatic enquiry alone although detrusor instability is a recognised feature of primary noctural enuresis in 70-80% of cases. For the first time we describe a family of adults with urodynamically proven instability spanning three generations. The pattern of inheritance lends support to the proposition that such detrusor instability is transmitted as an autosomal dominant characteristic.

Indomethacin suppository to treat primary nocturnal enuresis: double-blind study

The prostaglandin synthesis inhibitor indomethacin (used as a suppository) was compared to placebo in the treatment of primary nocturnal enuresis in a double-blind crossover study. There were 12 girls and 7 boys between 6 and 15 years old. Indomethacin (50 to 100 mg.) was significantly more effective than placebo in the treatment of primary enuresis.

Evaluation of the excretory urogram in adult enuresis

Excretory urograms in 216 primary enuretic adult males aged between 18 and 20 years were retrospectively evaluated. In no patient was there a finding considered relevant to the complaint. It is considered that, in the absence of urinary infection or other urological complaint in a patient with normal neurological status, excretory urography is a non-contributory examination in the investigation of adult male enuresis.

Mazindol for nocturnal enuresis

Sixteen adult enuretics who had failed to respond to simple conventional treatment of their symptoms have been investigated and treated with mazindol. Sixty-three per cent have been made dry and improvement achieved in a further 31%.