Adult Onset Nocturnal Enuresis: Identifying Causes, Cofactors and Impact on Quality of Life

Objectives: The objectives of the present study were: (i) Evaluate common co-pathologies associated with, and potentially contributing to adult onset Nocturnal enuresis (NE) in a tertiary referral population; and (ii) quantify its impact on QoL with validated questionnaires. Methods: Following Institutional Review Board approval, patients with adult onset NE were reviewed with history, physical examination, urodynamic studies, questionnaires: Overactive bladder questionnaire short-form (OAB-qSF), Urogenital Distress Inventory (UDI-6), AUA symptom score (AUA-SS) and Patient Global Impression scale (PGIS). Results: Between 2004 and 2016, 45 NE patients (19 male, 26 female) were identified. Twenty-five patients (56%) had an associated diagnosis of neurogenic bladder (NGB). Five (11%) reported no other LUTS or associated conditions. Forty (89%) had at least one of the following contributing factors: sedative use, OAB (bothersome symptoms based on UDI-6), voiding dysfunction (also based on UDI-6 or AUA-SS), abnormal UDS finding, and/or confirmed obstructive sleep apnea (OSA). Overall, 20% had two contributing factors, and 31% each had three and four factors. Among all patients, 76% reported sedative use and of 36 patients with UDS, 75% had abnormal findings. Of the 41 questionnaire respondents, mean AUA-SS among men was 22.5 (range 8-35) and mean UDI-6 score among women was 9.3 (range 2-16). Mean PGI-S score was 3.1 (range 1-4) and mean Health Related Quality of Life (HRQL) subscale, as part of the OAB-q SF was 44 (range 22-78). Conclusions: Nocturnal enuresis is associated with multiple possible co-factors in all populations with majority reporting use of sedating medications. NE is associated with significant symptom bother and impacts greatly on QoL.