Comparative Clinical and Functional Profiles of Monosymptomatic and Non-monosymptomatic Primary Enuresis in Children

Introduction Primary nocturnal enuresis is a common pediatric condition, classified into monosymptomatic (MPE) and non-monosymptomatic (NMPE) based on the presence of daytime lower urinary tract symptoms (LUTS). Distinguishing between these two forms is essential, as it directly influences management strategies. This study aimed to compare the clinical, functional, and psychological characteristics of children with MPE and NMPE. Materials and methods A comparative observational study was conducted over two years, including children aged five to 15 years who presented with primary nocturnal enuresis. Clinical evaluation was performed using a structured questionnaire and a seven-day voiding diary. Functional bladder capacity (FBC) and nocturnal urine production were assessed. Patients were classified as MPE or NMPE according to the International Children's Continence Society criteria. Results A total of 171 children were included, of whom 86 (50.3%) were classified as MPE. The NMPE group was significantly younger than the MPE group (7.36 ± 2.02 vs. 9.12 ± 2.36 years, t = 5.19, p < 0.001). A significant male predominance was noted in the MPE group (67.4% vs. 44.4%, χ² = 8.97, p = 0.003; Cramér's V = 0.23). Nocturnal enuresis severity was higher in the MPE group, with 56.9% of children having 3 or more wet nights per week, whereas 67.1% of children in the NMPE group had fewer than one wet night per week (χ² = 85.67, p < 0.001; Cramér's V = 0.71). FBC was significantly reduced in the NMPE group (χ² = 120.15, p < 0.001; Cramér's V = 0.84). In contrast, MPE showed a strong association with nocturnal polyuria (59.3% vs. 1.2%; χ² = 68.25, p < 0.001; Cramér's V = 0.62). Both groups experienced a considerable psychological impact, with no significant differences noted between them. Conclusions NMPE represents a more complex bladder dysfunction phenotype, whereas MPE appears to be primarily associated with nocturnal urinary overproduction. Both phenotypes were associated with substantial psychosocial burden. Differentiating these subtypes is essential for individualized management strategies.