Nocturnal enuresis: pathogenesis and treatment.

Abstract

A new concept is put forward to explain the act of micturition and urinary continence. This depends mainly on, the presence of an intact, sound and strong internal sphincter, and, an acquired behavior gained by learning in early childhood how to maintain a high alpha-sympathetic tone, thus keeping the internal sphincter closed all the time. On desire, and at the appropriate time and place, this acquired high alpha-sympathetic tone is inhibited, thereby opening the internal sphincter and allowing voiding to occur. The aim of the study was to test the effects of giving an alpha-sympathomimetic drug, ephedrine hydrochloride to control nocturnal enuresis. Three hundred patients suffering from enuresis were evaluated by a systematic history, physical examination, urinalysis and urodynamic studies. They were divided into a study group of 150 and a control group of 150. The study group were given ephedrine hydrochloride tablets after lunch and before bedtime for 2 months. The control group were given one of the following: imipramine hydrochloride, desmoporessin, ritaline, cetiprin, or behavioral therapy. Immediate continence was gained by 86% of the study patients; 6.7% had slower gain of continence. In the control group there was a short-term success rate of 30%-70% while on treatment, and a high relapse rate of more than 90% after stopping the treatment. It was concluded that giving ephedrine hydrochloride will improve internal sphincter tone, thus preventing uncontrolled urination.