Rethinking monosymptomatic nocturnal enuresis as a developmental variation

Monosymptomatic nocturnal enuresis (MNE), defined as nocturnal bedwetting in children without daytime lower urinary tract symptoms, is a frequent concern in general pediatric practice. It is common in early childhood and typically resolves spontaneously with increasing age, indicating a strong maturational component. Nevertheless, MNE is often conceptualized as a pathological disorder requiring active medical intervention. This mini-review proposes that MNE may be more appropriately interpreted as a developmental variation reflecting delayed maturation of nocturnal arousal mechanisms rather than a primary structural disorder. From a developmental perspective, nocturnal urine production, bladder storage capacity, and sleep-arousal mechanisms mature at different rates, and enuresis occurs when arousal maturation lags behind other components. Current therapeutic approaches mainly provide symptomatic control or facilitate adaptation rather than correcting a structural abnormality. Reframing MNE within a developmental framework may help support reassurance, shared decision-making, and more balanced clinical discussions regarding management in routine pediatric practice. What is Known: • Monosymptomatic nocturnal enuresis (MNE) is generally regarded as a functional disorder related to delayed maturation of nocturnal continence mechanisms. • Multiple factors, including nocturnal urine production, bladder capacity, and sleep-arousal function, contribute to the pathophysiology of MNE. What is New: • This article proposes that MNE may be better understood as a developmental variation caused by temporal mismatch among continence-related maturation processes, particularly sleep-arousal maturation. • The developmental perspective presented here may help reduce unnecessary medicalization and promote a more individualized understanding of children with MNE.