Nocturnal Enuresis: a manifistation of urologic & non-urologic disease

List of diseases that could present with Nocturnal Enuresis (NE) in children in the intital visit or along the treated or untreated course (secondary NE):

A. Urinary System

1. Urinary Tract Infection (UTI)

2. Vesicoureteral Reflux (VUR)

3. Posterior Urethral Valves (PUV)

4. Neurogenic Bladder

5. Bladder Outlet Obstruction

6. Ectopic Ureter

7. Overactive Bladder

8. Chronic Kidney Disease (CKD)

9. Renal Tubular Acidosis

10. Polycystic Kidney Disease

B. Neurological Disorders

11. Spina Bifida Occulta

12. Tethered Cord Syndrome

13. Epilepsy

14. Cerebral Palsy

15. Brain or spinal cord tumors

C. Endocrine & Metabolic Disorders

16. Diabetes Mellitus

17. Diabetes Insipidus

18. Obstructive Sleep Apnea (OSA)

19. Hypothyroidism

20. Hypercalcemia

21. Adrenal Insufficiency

D. Psychiatric & Behavioral Disorders

22. Attention Deficit Hyperactivity Disorder (ADHD)

23. Anxiety Disorders

24. Stress-related Disorders

25. Depression

26. Autism Spectrum Disorder (ASD)

E. Cardiovascular and Systemic

27. Congestive Heart Failure

28. Sickle Cell Disease

29. Obesity (linked to OSA and bladder dysfunction)

Specifically important are neurologic causes of nocturnal enuresis, here are a list of types of Epilipsy that could present as a case of nocturnap enuresis:

1. Nocturnal Frontal Lobe Epilepsy (NFLE)

Mechanism: Seizures occur during non-REM sleep; frontal lobe involvement can affect bladder control.

Presentation: Clusters of brief motor seizures at night, often misdiagnosed as parasomnias.

Association with NE: Seizures may trigger involuntary bladder contractions or prevent arousal from sleep to void.

2. Benign Epilepsy with Centrotemporal Spikes (BECTS / Rolandic Epilepsy)

Age: Common in children 3–13 years old.

Features: Facial twitching, drooling, often during sleep.

NE Association: Less common but can occur during generalized seizure spread or due to disturbed sleep architecture.

3. Generalized Tonic-Clonic Seizures during Sleep (GTCS)

Mechanism: Full-body seizures occurring at night may lead to incontinence, including NE.

Differentiation: Often accompanied by postictal confusion and muscle soreness.

4. Juvenile Myoclonic Epilepsy (JME)

Age: Onset typically in adolescence (12–18 years).

Seizures: Myoclonic jerks, often in the morning; GTCS can occur during sleep.

NE Association: Rare, but possible if GTCS occurs nocturnally.

5. Temporal Lobe Epilepsy

Mechanism: Affects autonomic regulation; seizures may cause autonomic symptoms including bladder control loss.

Association: May trigger NE if seizures occur during sleep.

6. Lennox-Gastaut Syndrome

Age: Onset typically before age 8.

Seizure Types: Multiple types including tonic, atonic, and atypical absence seizures, many during sleep.

NE Association: Common due to frequent nocturnal seizures and impaired cognitive function.

7. Landau-Kleffner Syndrome (Acquired Epileptic Aphasia)

Age: 3–7 years.

NE Association: Not primary, but disturbed sleep and neurocognitive impairment can lead to secondary NE.

8. Electrical Status Epilepticus in Sleep (ESES) / Continuous Spike-Waves during Sleep (CSWS)

Mechanism: Abnormal EEG activity during sleep may affect sleep quality and bladder control.

NE Association: Rare but possible; often linked to neurodevelopmental regression

For further data about urologic diseases diagnosis and therapeutic options, follow our blog 

The Urologist

By:

Dr. Ahmed M. Bakr, MD, FEBU