NEUROPHYSIOLOGICAL FOUNDATIONS OF NIGHT ENURESIS: MODERN DIAGNOSTIC APPROACHES AND CLINICAL SIGNIFICANCE

Abstract

Nocturnal enuresis is one of the clinical problems arising in childhood that affects social adaptation, sleep quality, and the child's psycho-emotional state. In its development, the interaction of bladder function, neurophysiological mechanisms regulating sleep and wakefulness, the level of maturity of the central nervous system, and neurohumoral regulation is of great importance. Evaluating nocturnal enuresis from a neurological perspective allows for the differentiation of functional disorders from organic neurological pathology, the identification of comorbidities, and the formation of a targeted diagnostic approach.

The article analyzes the neurophysiological mechanisms of nocturnal enuresis, features of neurological examination, differential diagnosis, and modern diagnostic approaches. The review was prepared based on international clinical recommendations, standardization documents from the International Society of Childhood Contiguity (ICCS), and an analysis of scientific literature dedicated to the diagnosis of nocturnal enuresis.

Three main mechanisms play an important role in the pathogenesis of nocturnal enuresis: nocturnal polyuria, decreased functional capacity of the bladder or excessive activity of the detrusor, and insufficient arousal response during sleep. During neurological examination, special attention should be paid to diurnal urinary incontinence, impaired urination, leg weakness, sensory changes, gait disorders, and stigmas in the lower part of the spine.

Diagnosis of nocturnal enuresis should include additional examinations based on medical history, urinary diary, targeted neurological examination, and clinical indications. In the absence of signs of neurological pathology, not all children require extensive instrumental examination.