The Clinical Features and Predictive Factors of Nocturnal Enuresis in Adult Men

Objectives: To characterize the clinical features and to discover predictive factors of adult male with nocturnal enuresis (NE).

Subjects and methods: Forty-three eligible adult male subjects (mean age was 57.8 years), were recruited prospectively over a 2-year period. After documentation of medical history, lower urinary tract symptoms (LUTS) were assessed using the International Consultation on Incontinence Modular Questionnaire - male LUTS (ICIQ-MLUTS), and a 3-day International Consultation on Incontinence Modular Questionnaire - bladder diary (ICIQ-BD). Video-urodynamics were conducted conforming to the International Continence Society standards. Univariate and multivariate linear regression was performed to determine potential predictive factors.

Results: Men with NE demonstrated a variety of LUTS, and had a high incidence of obesity and comorbidities. On ICIQ-BD, NE was associated with nocturnal polyuria (NP), reduced nocturnal bladder capacity (NBC), or the combination of both. Subgroup analysis indicated that subjects with more frequent NE had: higher BMI; more comorbidities; increased daytime urinary frequency and urgency; worse quality of life (QoL), stress incontinence, and worse nocturnal bedwetting scores; and larger 24hr and nocturnal urine volumes. Men with reduced NBC only, had fewer NE episodes, while patients with NP only, or with both NP and reduced NBC were more likely to suffer from frequent NE. Multivariate analysis confirmed that: BMI; neurogenic causes; sub-scores of stress incontinence, QoL and bedwetting domain; the presence of reduced NBC, and both NP and reduced NBC; and bladder outlet obstruction, are all independent predictive factors for the severity of NE.

Conclusions: NE in the adult male should be systemically assessed and treated, since obesity, neurogenic disorders, excessive urine production, bladder storage and emptying dysfunctions are risk factors. Bladder diaries and video-urodynamics provide valuable information on potential pathophysiological causes which could assist clinical evaluation and selection of focused treatment.