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.