Causes and Types of Nocturnal Enuresis in Children

This research is a descriptive, cross-sectional study conducted at the pediatric outpatient clinics of Assiut University Hospital. It assesses a single cohort of children presenting with nocturnal enuresis at a specific point in time to determine the prevalence, types, and associated causes of their condition, without longitudinal follow-up or comparison against a pre-defined control group.

Data collection utilizes a structured checklist derived from clinical guidelines, administered by the principal investigator during a single clinic visit for each subject. The assessment includes the following components:

• Comprehensive History Taking: A semi-structured interview will classify the enuresis as primary or secondary, and mono-symptomatic or poly-symptomatic. The history will systematically evaluate potential contributing factors, including constipation (utilizing the Bristol Stool Scale and Rome IV criteria), history of urinary tract infections (UTIs), symptoms of adenotonsillar hypertrophy (e.g., mouth breathing, snoring, observed sleep apnea), dietary habits (caffeine and fluid intake patterns), current medications, and family history.
• Physical Examination: Subjects will undergo a targeted physical examination, including anthropometric measurements (weight, height, BMI percentiles). An oral examination will grade tonsil and adenoid size using the Brodsky scale. Further screening includes an abdominal examination for fecal loading or palpable masses, a genitourinary inspection, and screening for spinal malformations (e.g., inspecting the sacral area for dimples or hair tufts indicative of spina bifida occulta).
• Routine Investigations: All participants will undergo same-day routine laboratory and imaging investigations, including urinalysis, urine culture and sensitivity, and an abdominal/pelvic ultrasound.
• Conditional/Advanced Investigations: Depending on clinical indications and the presence of "red flags," additional diagnostics may be ordered. These include plain X-rays (KUB for constipation/stones or lateral neck X-rays for adenoidal-nasopharyngeal ratio), MRI of the spine or brain for suspected neurological anomalies, urodynamics for suspected bladder dysfunction or outlet obstruction, and polysomnography for suspected obstructive sleep apnea.

Inclusion criteria

• Male and female children aged above 5 years.
• Presenting with nocturnal enuresis, defined as involuntary voiding during sleep for ≥2 nights/week for ≥3 months.
• Parents or caregivers providing informed consent, including child assent where applicable.

Exclusion criteria

• Children with known neurological disorders, such as epilepsy or cerebral palsy.
• Presence of an acute urinary tract infection (indicated by a positive urine culture requiring treatment).
• Children diagnosed with diabetes mellitus.
• Structural anomalies of the urinary system requiring immediate surgery, such as severe hypospadias.
• Families unwilling to participate or complete follow-up data collection.