Mostafa Diaaeldin, Shaker Hasan, Badr Abdallah, Abuelnaga Mohamed
Urology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Faculty of Medicine, El Demerdash Hospital, Cairo, Egypt.
Neurourol Urodyn. 2025 Jan;44(1):212-219. doi: 10.1002/nau.25618. Epub 2024 Oct 30.
Enuresis refers to urinary incontinence during sleep in children over 5 years of age. The pathogenesis of enuresis is complex. It is related to low functional bladder capacity, nocturnal bladder overactivity, and high arousal threshold, and it is also related to the immaturity of the central nervous system. Also, it was related to nocturnal polyuria and decreased nocturnal urine osmolality. There are many clinical observations that link nocturnal enuresis with developmental delay in language and physical growth. Vitamin D is important for the critical biological actions involving neural function and development. It is involved in the regulation of nerve growth factor synthesis. It also has a neuroprotective effect. It not only plays a vital role in skeletal growth but also has other critical biological actions in neural development and function. Furthermore, Vitamin D deficiency was linked to increased urinary output, which raised the question of whether Vitamin D levels are linked to nocturnal polyuria and decreased nocturnal urine osmolality. It was observed in the mice model study that Vitamin D is a negative regulator of the renin-angiotensin system, and its deficiency leads to abnormal thirst and increased water intake by mice with Vitamin D deficiency and as much as twice urinary output than normal mice.
To evaluate the relationship between Vitamin D deficiency and nocturnal enuresis and to study the correlation between Vitamin D deficiency and urine osmolality, which is an indirect indicator of ADH deficiency.
This is a case-control study that started in February 2020 and ended in August 2020 in our tertiary hospital. The study included 60 children with primary monosymptomatic nocturnal enuresis selected randomly and 60 healthy children as a control group. We compared Vitamin D levels, nocturnal polyuria, and nocturnal urine osmolality among both groups.
In our study, there was a statistically significant difference between both groups regarding serum Vitamin D values. The results of the serum Vitamin D level showed that 63.3% of cases with nocturnal enuresis had low Vitamin D levels with a mean range (18.8 ± 7.1) compared with 41.7% in the control group with a higher mean range (23.7 ± 9.6), and a p value of 0.002.
Our study indicates that there is a significant relationship between primary monosymptomatic nocturnal enuresis and serum Vitamin D deficiency in children. We also proved that Vitamin D level is correlated positively with nocturnal urine osmolality.
Clinical trials registration number: NCT06243042.
遗尿症是指5岁以上儿童睡眠期间的尿失禁。遗尿症的发病机制复杂。它与膀胱功能容量低、夜间膀胱过度活动及高觉醒阈值有关，也与中枢神经系统不成熟有关。此外，它还与夜间多尿及夜间尿渗透压降低有关。有许多临床观察将夜间遗尿症与语言和身体发育延迟联系起来。维生素D对涉及神经功能和发育的关键生物学作用很重要。它参与神经生长因子合成的调节。它还具有神经保护作用。它不仅在骨骼生长中起重要作用，而且在神经发育和功能方面也有其他关键生物学作用。此外，维生素D缺乏与尿量增加有关，这就提出了维生素D水平是否与夜间多尿及夜间尿渗透压降低有关的问题。在小鼠模型研究中观察到，维生素D是肾素-血管紧张素系统的负调节因子，其缺乏会导致维生素D缺乏的小鼠出现异常口渴和饮水增加，尿量比正常小鼠多两倍。
评估维生素D缺乏与夜间遗尿症之间的关系，并研究维生素D缺乏与尿渗透压之间的相关性，尿渗透压是抗利尿激素缺乏的间接指标。
这是一项病例对照研究，于2020年2月开始，2020年8月在我们的三级医院结束。该研究随机选取了60例原发性单纯性夜间遗尿症儿童，并选取60例健康儿童作为对照组。我们比较了两组的维生素D水平、夜间多尿情况及夜间尿渗透压。
在我们的研究中，两组血清维生素D值存在统计学显著差异。血清维生素D水平结果显示，63.3%的夜间遗尿症病例维生素D水平低，平均范围为（18.8±7.1），而对照组为41.7%，平均范围较高，为（23.7±9.6），p值为0.002。
我们的研究表明，儿童原发性单纯性夜间遗尿症与血清维生素D缺乏之间存在显著关系。我们还证明维生素D水平与夜间尿渗透压呈正相关。
临床试验注册号：NCT06243042。
