Book Review: Medicine in America

A New Approach to Nocturnal Enuresis Incidence Causes Treatment by C R A Martin MB BS DPH LRCP MRCS FRSH DPA pp viii + 149 illustrated £1 2s 6d London: HKLewis 1966 Dr Martin's comprehensive review of the problems of childhood enuresis serves to emphasize our fundamental ignorance of its causes and treatment. The physiology of bladder function and urine formation are described in some detail, and the author discusses the incidence and pattern of bed wetting in the light of a field survey of some 10,000 school children in Birmingham including all social and intelligence levels. He shows that 10-9% of boys and 833% of girls in the age group 5-6 years wet their beds. The incidence is still 5-5% and 3-5% respectively at 11 years, and does not fall below 1 % until late adolescence. Social and environmental factors were also assessed and interesting racial differences in both incidence and parental attitudes were shown by studying a group of West Indian children within the survey. In young children bed wetting was much commoner than in their white contemporaries, but despite stricter parental discipline and a general punitive attitude they became 'dry' earlier. In a discussion of cases Dr Martin considers delayed development or functional interruption of higher control to be the most constant factor. He also advances the hypothesis that increased nocturnal excretion of urine from failure of antidiuretic hormone secretion may be an important associated factor. Attempts have been made to substantiate this idea by measurement of day and night urine volumes. Conventional therapy with drugs, bladder training and enuresis alarms are discussed. The great variability in results with different treatment serves only to emphasize the placebo effect of almost any treatment enthusiastically applied. Three series of children with intractable nocturnal enuresis were treated with vasopressin, given intramuscularly, or as a nasal spray, or sublingual tablets. Results were undoubtedly encouraging and the author suggests that this may prove a useful form of treatment, but improved methods of biochemical assay are needed before the hypothesis of antidiuretic hormone deficiency can be proved.