The Evaluation and Treatment of Adult Nocturnal Enuresis

Nocturnal enuresis is less common in adults than in childhood and is a significant cause of social and psychological debility and distress to patients, who may delay seeking treatment for fear of stigma. There is often an absence of significant underlying anatomical or functional pathology in patients with isolated nocturnal enuresis. A careful clinical assessment including a frequency-volume urine chart, post-voiding residual, and video-urodynamic assessment will identify the most appropriate treatment pathway by casting light on underlying pathophysiological abnormality. This will help direct the appropriate use of therapy whether it is desmopressin to reduce dieresis or an anticholinergic directed at detrusor overactivity. There is currently debate over the benefit of behavioral modification therapy, alarm systems and recently the role of posterior tibial nerve stimulation therapy in adult patients suffering from nocturnal enuresis. Adult onset nocturnal enuresis can be a sign of chronic retention and warrants urgent urological assessment and treatment.