Neurourology and Urodynamics 23:54^57 (2004) Primary Nocturnal Enuresis Persistent to Adulthood, Functional Evaluation Bassem S. Wadie* Mansoura Urology & Nephrology Center, Mansoura, Egypt Introduction and Objectives: The incidence of nocturnal enuresis (NE) in adults (over 18 years of age) ranges from 0.5 to 2% for most authors. NE is a multifactorial disease. Lack of circadian rhythm of antidiuretic hormone (ADH) is one of the commonly accepted causes, however, disorders a¡ect- ing bladder function is another important pathophysiologic factor that has not been settled. The target of the present study is to de¢ne bladder function in adults having persistent NE. Methods: Fifty two adult patients were included. Mean age was 23.6  6.9 years. All of them had primary NE persistent to adulthood. No treatment was received within 2^7 days prior to the uro- dynamic examination. All of them had intact neuro-urological examination. Filling (in all patients) and voiding cystometry (in 29 patients) were carried out, using 8 F urodynamic and 8 F rectal catheters. Pressure £ow analysis was interpreted using Schafer’s nomogram. Results: Overall mean maximum cystometric capacity was 419.2  142 ml, mean bladder compliance was 51.3  39.7 ml/ cmH 2 O. In males (n ¼ 25), mean maximum cystometric capacity was 453  173 ml and compliance was 56  42 ml/cmH 2 O, while in females (n ¼ 27), mean capacity was 388  98 ml and compliance was 46.7  36.7 ml/cmH 2 O. Twenty patients had detrusor instability (38.5%). Twelve out of 27 (44.4%) females had instability while only 8 out of 25 (32%) males had the same ¢nding. Di¡erences relevant to maximum bladder capacity and compliance between the patients with and without instability were signi¢cant (P < 0.0001). Mean detrusor opening pressure was 55.3  25 cmH 2 O, mean detrusor pressure at maximum £ow and maximum detrusor pressure, were 53.5  21 and 78.9  35 cmH 2 O respectively. Conclusions: Urodynamic studies in adults with persistent NE reveals a relatively high incidence of instability, normal capacity and compliance. The presence of instability was associated with smaller bladder and poorer compliance and with diurnal ur- gency. Voiding bladder function in adult enuretics was found to be normal. Neurourol. Urodynam. 23:54 ^57, 2004. ß 2003 Wiley-Liss, Inc. Key words: adults;nocturnalenuresis;persistent;primary;urodynamics INTRODUCTION AND OBJECTIVES The incidence of nocturnal enuresis (NE) in children 5 years is around 15^20% [Norgaard et al., 1997], while in adults the incidence is not well agreed upon. In a report by Robertson et al. [1999], they estimated the incidence of mono- symptomatic nocturnal enuresis (MNE) to be 1% , while in a review by Norgaard et al. [1997], the incidence of NE in ado- lescents and adults was found to be 2^3%. The prevalence of NE in adults was estimated, through questionnaires, to be 0.5% overall [Hirasing et al., 1997] and 0.02% monosympto- matic only [Sakamoto and Blaivas, 2001]. NE is a multifactor- ial disease. Lack of circadian rhythm of antidiuretic hormone (ADH) of the posterior pituitary is the one that meets wide acceptance [Norgaard et al., 1997; Robertson et al., 1999]. Other factors interplayed in the causation of such a syndrome. The integrity of the arousal system of the CNS, CNS control of bladder function, disorders of bladder function, psychiatric factors were all blamed. The main objective of this study is to answer the question: whether or not in patients with NE per- sisting to adulthood, bladder dysfunction is a pathophysiolo- gic factor. PATIENTAND METHODS Between May 1998 and January 2002, 68 patients above the age of 18 were examined in the urodynamic unit of Urology & Nephrology Canter, Mansoura. Their mean age is 23.6  6.9 years (range 18^51 years). Twenty seven of them were females (mean age: 23.4  6.2 years) and 25 were males (mean age: 23.8  7.7 years) and all were referred by urology outpatient clinic. All the patients should ful¢ll the following criteria: over 18 years of age, neurologically free, bed-wet themselves more than twice per month, su¡ering from NE as the leading symp- tom that stimulated them to seek urologic care and are willing to undergo invasive urodynamic investigation. All the patients were asked to stop any treatment for their condition for at least 2 days before having urodynamic examination (some *Correspondence to: Bassem S. Wadie, Mansoura Urology & Nephrology Center, Mansoura, Egypt. E-mail: bwadie@netscape.net Received 1 May 2003; Accepted 21 August 2003 Published online inWiley InterScience (www.interscience.wiley.com) DOI 10.1002/nau.10161 ß 2003Wiley-Liss,Inc.