Psychological stress and treatment outcomes in children with nocturnal enuresis: A single-center prospective cohort study

Sang Don Lee; So Won Kim; Yu Yeun Kang; Gi Bae Kim; Se Hyun Cha; Jae Min Chung

doi:10.1016/j.jpurol.2026.105876

Psychological stress and treatment outcomes in children with nocturnal enuresis: A single-center prospective cohort study

J Pediatr Urol. 2026 Mar 17:105876. doi: 10.1016/j.jpurol.2026.105876. Online ahead of print.

Authors

Sang Don Lee¹, So Won Kim², Yu Yeun Kang², Gi Bae Kim², Se Hyun Cha², Jae Min Chung³

Affiliations

¹ Department of Urology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Department of Urology, Pusan National University School of Medicine, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea.
² Pusan National University School of Medicine, Yangsan, South Korea.
³ Department of Urology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Department of Urology, Pusan National University School of Medicine, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea. Electronic address: busanuro@hanmail.net.

PMID: 41927377
DOI: 10.1016/j.jpurol.2026.105876

Abstract

Background: Nocturnal enuresis (NE) is frequently accompanied by emotional distress, including shame, anxiety, and social embarrassment. However, whether enuresis-related psychological stress influences treatment response remains unclear.

Objective: To determine the prevalence of NE-related psychological stress and to evaluate whether baseline emotional distress is independently associated with treatment outcomes in children.

Study design: In this prospective cohort study, 257 children with NE (mean age 7.8 ± 2.0 years) were enrolled. Psychological stress was assessed using a structured two-step interview focused on emotional responses directly attributable to NE. Children were classified as non-stress only if they denied both global distress and all predefined emotional domains (shame, upset, anger, depressive mood, anxiety/fear). All patients received standardized urotherapy, with pharmacological treatment added as clinically indicated. Treatment response was categorized according to ICCS definitions. Multivariate logistic regression analysis was performed adjusting for age, sex, NE type, and baseline enuresis frequency.

Results: Psychological stress was reported in 206 children (80.2%), with shame being the most frequently reported emotion (58.8%). Baseline clinical characteristics were comparable between groups. Treatment response rates at 3 months and final follow-up did not differ significantly between stress and non-stress groups. In multivariate analysis, psychological stress was not independently associated with treatment response (p = 0.770), whereas baseline enuresis frequency was independently associated with outcome (p = 0.039).

Discussion: Although emotional distress was highly prevalent, it was not independently associated with treatment response when standardized therapy was applied. However, given the use of a non-validated stress assessment tool and limited power to detect small effect sizes, a modest association cannot be entirely excluded.

Conclusion: Psychological stress is common in children with NE but was not independently associated with treatment response in this prospective cohort.

Clinical/translational applicability: Standardized treatment strategies for NE may be applied regardless of baseline emotional distress, while recognition and management of psychosocial burden remain important components of comprehensive care.

Keywords: Behavior therapy; Drug therapy; Nocturnal enuresis; Psychological stress; Treatment outcome.