Rethinking monosymptomatic nocturnal enuresis as a developmental variation

Area of Science:

• Pediatric urology
• Developmental pediatrics
• Sleep medicine

Background:

• Monosymptomatic nocturnal enuresis (MNE) is common in children and often viewed as a functional disorder linked to delayed maturation.
• Factors like urine production, bladder capacity, and sleep arousal influence MNE.
• Current treatments focus on symptom management rather than underlying causes.

Purpose of the Study:

• To propose an alternative interpretation of MNE as a developmental variation.
• To highlight the role of delayed sleep-arousal maturation in MNE.
• To advocate for a reframed understanding to reduce medicalization.

Main Methods:

• Mini-review of existing literature on MNE pathophysiology and management.
• Developmental perspective analysis of continence mechanisms.
• Synthesis of current knowledge to propose a new framework.

Main Results:

• MNE may stem from a temporal mismatch in maturation of continence-related processes, especially sleep arousal.
• This developmental variation perspective challenges the view of MNE as a primary structural disorder.
• Reframing MNE can support reassurance and shared decision-making.

Conclusions:

• MNE is better understood as a developmental variation rather than a pathological disorder.
• A developmental framework emphasizes delayed arousal maturation as a key factor.
• This approach can lead to more individualized care and reduced unnecessary medical interventions for enuresis.