Nocturnal enuresis, commonly known as bedwetting, is a frequent condition that affects many children and can have a significant impact on their self-esteem, social life, and family stress. The causes of bedwetting can vary widely, ranging from deep sleep patterns and excess nighttime urine production to underlying medical conditions like constipation, urinary tract infections, or enlarged tonsils and adenoids (which can affect breathing during sleep).The main goal of this descriptive study is to understand the different types and the underlying causes of bedwetting among children attending the pediatric outpatient clinics at Assiut University Children's Hospital. By identifying these specific causes in the local population, healthcare providers can offer better, more targeted treatments and help reduce the stigma surrounding this condition.

During a single clinic visit, researchers will collect information through a structured interview with the parents and the child. The study involves a routine physical examination, including checking weight, height, and looking for physical signs of constipation or enlarged tonsils. Participants will also undergo standard tests to help pinpoint any medical causes, such as a urine test (urinalysis and culture), a basic ultrasound of the abdomen and pelvis, and potentially plain X-rays if issues like severe constipation or airway blockages are suspected.

The study aims to include at least 80 male and female children aged 5 years and older who have been experiencing bedwetting at least twice a week for three months or more.

This research is a descriptive, cross-sectional study conducted at the pediatric outpatient clinics of Assiut University Hospital. It assesses a single cohort of children presenting with nocturnal enuresis at a specific point in time to determine the prevalence, types, and associated causes of their condition, without longitudinal follow-up or comparison against a pre-defined control group.

Data collection utilizes a structured checklist derived from clinical guidelines, administered by the principal investigator during a single clinic visit for each subject. The assessment includes the following components:

• Comprehensive History Taking: A semi-structured interview will classify the enuresis as primary or secondary, and mono-symptomatic or poly-symptomatic. The history will systematically evaluate potential contributing factors, including constipation (utilizing the Bristol Stool Scale and Rome IV criteria), history of urinary tract infections (UTIs), symptoms of adenotonsillar hypertrophy (e.g., mouth breathing, snoring, observed sleep apnea), dietary habits (caffeine and fluid intake patterns), current medications, and family history.
• Physical Examination: Subjects will undergo a targeted physical examination, including anthropometric measurements (weight, height, BMI percentiles). An oral examination will grade tonsil and adenoid size using the Brodsky scale. Further screening includes an abdominal examination for fecal loading or palpable masses, a genitourinary inspection, and screening for spinal malformations (e.g., inspecting the sacral area for dimples or hair tufts indicative of spina bifida occulta).
• Routine Investigations: All participants will undergo same-day routine laboratory and imaging investigations, including urinalysis, urine culture and sensitivity, and an abdominal/pelvic ultrasound.
• Conditional/Advanced Investigations: Depending on clinical indications and the presence of "red flags," additional diagnostics may be ordered. These include plain X-rays (KUB for constipation/stones or lateral neck X-rays for adenoidal-nasopharyngeal ratio), MRI of the spine or brain for suspected neurological anomalies, urodynamics for suspected bladder dysfunction or outlet obstruction, and polysomnography for suspected obstructive sleep apnea.

Inclusion Criteria:

• Male and female children aged above 5 years.
• Presenting with nocturnal enuresis, defined as involuntary voiding during sleep for ≥2 nights/week for ≥3 months.
• Parents or caregivers providing informed consent, including child assent where applicable.

Exclusion Criteria:

• Children with known neurological disorders, such as epilepsy or cerebral palsy.
• Presence of an acute urinary tract infection (indicated by a positive urine culture requiring treatment).
• Children diagnosed with diabetes mellitus.
• Structural anomalies of the urinary system requiring immediate surgery, such as severe hypospadias.
• Families unwilling to participate or complete follow-up data collection.

The study population consists of male and female children aged 5 years and older who present with nocturnal enuresis at the pediatric outpatient clinics of Assiut University Children's Hospital in Assiut, Egypt. For the purpose of this study, nocturnal enuresis is defined as involuntary voiding during sleep occurring at least twice a week for a duration of at least three months. The target population includes patients presenting with both primary and secondary enuresis, as well as mono-symptomatic and poly-symptomatic forms. Children with known neurological disorders (such as epilepsy or cerebral palsy), diabetes mellitus, acute urinary tract infections requiring immediate treatment, or structural anomalies of the urinary system requiring immediate surgery are excluded from this population.