Pathophysiology

The vast majority of children with enuresis have normal urodynamics, including nocturnal bladder capacity. Functional bladder capacity can be estimated using the formula: age in years +2 equals to the ounces of capacity. In some children, there appears to be a relationship between developmental immaturity (motor and language milestones) and enuresis, but the mechanism is unknown. There is evidence that affected individuals have an attenuated vasopressin circadian rhythm (females more so than

males) with lower vasopressin plasma concentrations. Drugs like lithium, clozapine, risperidone, valproic acid, selective serotonin reuptake inhibitors, and theophylline can rarely cause and aggravate enuresis. Psychological factors are clearly contributory in only a minority of individuals. The most frequent example of this is secondary enuresis precipitated by a stressor such as divorce, school trauma, sexual abuse, or hos-pitalization. In rare cases, the family may be so dysfunctional that the child has never been properly toilet-trained.

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