Not only enuresis: do not disregard organic disorders

Area of Science:

• Pediatric Urology
• Pediatric Neurology
• Medical Imaging

Background:

• Nocturnal enuresis (NE) is common in children, classified as primary or secondary, and monosymptomatic (MNE) or non-monosymptomatic (NMNE).
• Secondary NMNE, characterized by recent onset incontinence and lower urinary tract symptoms (LUTS), necessitates evaluation for organic etiologies.
• A 7-year-old female presented with secondary NMNE, including daytime incontinence, enuresis, and encopresis, unresponsive to initial medical treatment.

Discussion:

• The patient's symptoms persisted despite standard treatment with desmopressin (dDAVP) and oxybutynin.
• Spinal magnetic resonance imaging (MRI) revealed significant abnormalities: hydrosyringomyelia (D6-D10), lipoma of the terminal filum, and a synovial cyst (L5-S1).
• These findings underscore the importance of advanced imaging in diagnosing organic causes of secondary NMNE.

Key Insights:

• Secondary non-monosymptomatic nocturnal enuresis can be indicative of serious underlying spinal cord pathology.
• Diagnostic delay in secondary NMNE may result from focusing solely on conventional treatments without considering organic causes.
• Early identification of spinal abnormalities through MRI is crucial for effective management of refractory pediatric enuresis.

Outlook:

• Further research should focus on the correlation between specific spinal pathologies and the presentation of secondary NMNE.
• Developing standardized diagnostic algorithms for secondary NMNE, incorporating neuroimaging, is essential.
• Investigating the long-term outcomes of surgically or conservatively managed spinal abnormalities in pediatric enuresis patients is warranted.