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The impact of a history of childhood nocturnal enuresis on adult nocturia and urgency

S. Akashi and K. Tomita

Acta Paediatrica, International Journal of Paediatrics, Volume 103, Issue 9, September 2014, Pages e410-e415

Commented by Prof Antonella Giannantoni
Some recent studies have shown that lower urinary tract symptoms (LUTS) in adults are associated with urinary disturbances during childhood and that children with nocturnal enuresis (NE) often come from families in which an history of NE is present. In this study, the authors investigated the association between childhood NE with nocturia and urgency as an adult. 1124 men and 1431 women aged 30–79 years, who were parents and grandparents of children with NE, completed a questionnaire concerning the age when nocturnal enuresis resolved, the presence of underlying diseases and the presence of any urgency and nocturia These adults were separated into two groups: those with a history of NE and those without a history of NE. In the statistical analysis, the chi-square test was used to compare frequencies, and logistic regression models were used to analyze risk factors. The authors found that the frequency and severity of nocturia, defined as two or more voids/night, and urgency was significantly higher, in both sexes, in the group of individuals with a history of nocturnal enuresis. Particularly, the frequency of nocturia and urgency was significantly increased in those adults in whom NE resolved at the age of 12 years or later. In addition the history of NE played a more significant role for the emergence of nocturia and urgency than diabetes mellitus, hypertension or neurological diseases. The results of the present study indicate that common pathogenetic mechanisms may be involved in both adult LUTS and nocturnal enuresis (i.e., decreased vasopressin secretion during sleep and reduced bladder capacity). These mechanisms can resolve partially during adulthood, but can deteriorate with aging. It should be important to assess whether early treatment of nocturnal enuresis in children can have a positive effect in reducing the risk to develop LUTS in adulthood. 

Commented by Prof. Philip van Kerrebroeck
This is an interesting and important article based on a review of questionnaires completed by 3649 parents and grandparents (1695 men and 1954 women, aged between 30 and 89 years) of children with nocturnal enuresis without underlying disease.

The aim of this study was to analyze risk factors for nocturia and urgency in this cohort. Data were collected in 2555 adults aged between 30 and 79 years. Of the total group, 1300 individuals (598 men and 702 women) aged between 30 and 49 years had a previous history of nocturnal enuresis. The questionnaire also documented the age at which nocturnal enuresis (defined as bedwetting during one or more nights a month) resolved for these 1300 individuals.

The overall conclusion is that individuals are more likely to have nocturia as an adult if their nocturnal enuresis resolved at age ≤12. 

The fact that more than 50% of the parents or grandparents of children with enuresis nocturna had a previous history of nocturnal enuresis, confirms the known risk for children or grandchildren of former enuretics to be confronted themselves with enuresis nocturna. 

An interesting question remains: to which extent is it possible to prevent adult nocturia and urgency by a pro-active and aggressive approach to enuresis nocturna in children? This would necessitate long-term follow-up studies and a comparison with historic series such as this one.

Abstract

AIM:

This study examined the association between a childhood history of nocturnal enuresis and nocturia and urgency as an adult.

METHODS:

A questionnaire was completed by 3649 parents and grandparents of children with nocturnal enuresis. The age range of the respondents was 30-89, and 54% were female. The questionnaire included the respondent's age, underlying disease, the age at which nocturnal enuresis was resolved and any current nocturia and urgency.

RESULTS:

The responses enabled us to analyse the risk factors for nocturia and urgency for the total sample, the history of nocturnal eneurisis for 2555 adults aged from 30 to 79 years and the age when nocturnal enuresis resolved for 1300 adults aged from 30 to 49 years. Respondents were significantly more likely to have nocturia and urgency as adults if they had a history of nocturnal enuresis and were aged ≥12 years when their nocturnal enuresis resolved.

CONCLUSIONS:

A childhood history of nocturnal enuresis, particularly nocturnal enuresis that resolved at ≥12 years old, was associated with an increased frequency of adult nocturia and urgency. The impact of previous nocturnal enuresis on adult nocturia and urgency presents a risk that is comparable to ageing and 

This article is also available at the Bedwetting Resource Centre, and it is commented by Professor Guy Bogaert:

"This is one of the three articles in 2014 addressing the persistence of night time voiding problems and a history of childhood nocturnal enuresis."