Nocturnal enuresis with spina bifida occulta: Does it interfere behavioral management success?

We aimed to investigate the incidence of spina bifida occulta (SBO) in patients with nocturnal enuresis (NE) and its effect on the success of behavioral interventions. We also aimed to identify predictive factors related to success of behavioral interventions.

A total of 163 patients with NE and 160 patients without NE were enrolled to study. Urinalysis, urine culture, biochemical evaluation, plain radiography and urinary system ultrasonography were performed before treatment. Patients with NE received behavioral interventions for 3 months. Response to behavioral interventions was analyzed according to the presence and absence of SBO. Possible predictive factors for treatment success were also evaluated.

Spina bifida occulta was detected in 47 (28.8 %) children at NE group and 24 (15.0 %) at control group (p = 0.138). Non-monosymptomatic NE was more prevalent in patients with SBO (p < 0.001), and response to the treatment was significantly lower (p = 0.037). Presence of SBO (OR 8.8, 95 % CI 3.1-25.6), NE severity (OR 7.2, 95 % CI 2.4-21.7) and NE frequency on 3-day voiding diary (OR 9.4, 95 % CI 3.7-24.3) were significantly related to the success.

The presence of SBO, severe NE and higher frequency of NE in voiding diary affect the response to behavioral interventions. Other treatment options such as medical treatment or enuresis alarm may be recommended for those patients.