الفهرس 
Neurophysiology of MicturationOnly 14 pages are availabe for public view
 |  | from | 78 |  |  |
| | | from | 78 | | |
Abstract
Nocturnal enuresis (NE) is a common problem that can cause much distress to affected families.
Enuresis is classified into primary and secondary, primary accounts for 80% of cases of enuresis.
It has no clear etiology; it is hypothesized to be related to genetics, sleep arousal dysfunction, maturational delay, stress, poor toilet training, and occasionally organic causes.
It occurs three times more often in boys than in girls, also there are variations according to place and age, It is classified according to symptomatology into monosymptomatic (uncomplicated) enuresis which is without lower urinary tract symptoms other than nocturia and nonmonosymptomatic (polysymptomatic) enuresis which is with lower urinary tract symptoms (e.g., increase or decrease in voiding frequency, daytime wetting, urgency, hesitancy, straining, weak or intermittent stream, post urination dribbling, or sensation of incomplete emptying.Genetically, a locus for enuresis is on chromosome 13 (ENUR 1) and another (ENUR 2) is on chromosome 12, although the relationship of either locus to the pathophysiology of enuresis remains unknown.
In normal children, the circadian rhythm of urine production results in a nocturnal reduction in diuresis to approximately 50% of daytime levels, immaturity or delay in establishing a normal circadian rhythm of vasopressin secretion by the central nervous system (CNS), may be associated with nocturnal enuresis.
The fact that most children who have enuresis become dry in time with or without intervention supports maturational delay as a factor in MNE. A defect in arousal mechanisms to full bladder capacity probably plays a role in monosymptomatic nocturnal enuresis.
Abnormal bladder function, especially detrusor instability and small capacity, has long been associated with primary nocturnal enuresis. However, the exact role remains controversial.