2, 6 For example, empirically patients with spinal cord injury and neo-bladder after radical pelvic surgeries are managed by low-dose desmopressin, oxybutynin 5 mg three times a day, and catheterization before sleep. !Multifactorial NE is difficult to treat and best controlled by multimodal approaches and addressing all contributing etiologies. #Although in nocturnal diuresis due to overproduction, desmopressin is treatment of choice, one should be cautioned in patients with kidney and liver disease, water intoxication, and hyponatremia these should also be individually addressed. 12 ^Higher severity of enuresis in hemolytic disorders is associated with increased admission therefore, efforts to manage chronic disease may help manage and better treat NE. *Possible explanation for decreasing nocturnal enuresis (NE) after mid-urethral sling placement is prevention of urinary leakage to proximal urethra and stress induced overactivity. 6 In selected adult cases (infrequent bed wetting, normal sonography, and cystometric capacity greater than 300 cc), it may have a contributive role. 25ĭespite successful results in children, behavioral therapy is not as effective in adults. Although it is effective, high cost and time commitment commonly deter its use. 2Īdapted dry behavioral therapy (ADBT) is a cognitive behavioral and prompted voiding therapy that includes close observation during sleep, waking up frequently during the night (every hour), alarm use, and day-time timed voiding. 13, 24 Unfortunately, compliance with enuresis alarm systems is low in the adult population, with a high withdrawal rate 4, 6 however, when desmopressin failed to control enuresis, adding an alarm system has been reported to increase the response rate by 33%. Furthermore, timed voiding has a limited role in elderly patients with NE due to decreased adaptive conditioning skills and effect on sleep disturbances. In cases with bladder outlet obstruction, posterior urethral valve and urethral stricture have been the most common findings (6.7%) 11Īlthough there is data to support timed voiding every two hours and alarm systems for NE in children 24 there is no data in young adults. Urodynamic studies have less value in PNE 6, 11 To evaluate upper tract damages and lower tract efficiency in urine elimination 2įindings in SNE detrusor over activity, hypo-compliant bladder and silent bladder outlet obstruction 2

Ultrasound of upper and lower urinary tract and post voiding residue To reveal daytime hidden symptoms, nocturnal polyuria, and maximum functional bladder capacity 6, 24 To screen silent obstruction or hypocontractile bladder 2 In patients with inadequate results with essential assessments Lower urinary tract symptoms, past medical and surgical history and medications 1įocused neurological examination, digital rectal examination and bulbocavernous reflex 1

Nocturnal urinary incontinence