Last update: 24/03/2023, Dr. Miguel B. Royo Salvador, Medical Board number 10389. Neurosurgeon y Neurologist.
The involuntary release of urine is a condition characterized by an impelling and sudden urge to urinate, but an inability to hold urine. This is an alteration during the bladder-filling phase that can occur alone (primary), as well as in numerous conditions (secondary).
Primary/Monosymptomatic Nocturnal Enuresis is defined as an involuntary, intermittent and repeated release of urine during sleep, due to the inability to control sphincters in children over 5 years of age, who have never been continent before.
On the other hand, urinary incontinence is defined as the involuntary release of urine in adults. Leakages can occur when sneezing, laughing, with exertion or physical exercise.
Different types of urinary incontinence are described:
To determine a diagnosis of Primary Nocturnal Enuresis in children, or Primary Urinary Incontinence in adults, urine leakages must be entirely involuntary and objectively demonstrable.
In order to confirm that the disorder is primary, exams must aim at identifying and ruling out secondary causes – such as a neurogenic bladder and spinal cord abnormalities, urinary infections, presence of posterior urethral valve in male infants and ectopic ureter in young girls – through:
The Filum System® method, based on the scientific findings on the etiology of several conditions and on the observation of several cases diagnosed of Filum Disease with nocturnal enuresis or urinary incontinence, recommends that brain and spine MRIs be done, once the urine leakage has been confirmed to be primary (both in children and adults).
The symptom of primary nocturnal enuresis or urinary incontinence is the involuntary release of urine during the patient’s sleep or during wakefulness respectively.
The quantity or density of the leakage, as well as the frequency, may vary in each case. The leakages may occur especially with efforts, such as coughing and sneezing, physical activities or sexual intercourse.
Urinary release occurs when the bladder pressure is greater than the urethral pressure. There are many theories on the origin of primary nocturnal enuresis or primary urinary incontinence in adults, although none of them is entirely conclusive.
Its main causes are
The main risk factors for this condition in general are:
Regarding the primary nocturnal enuresis in children, according to several studies it is most common in:
Enuresis or urinary incontinence, both in children and adults, can generate a problem:
For all this, the patient’s condition can get complicated due to the worsening of his/her quality of life..
There are measures that can help delay the onset of urinary incontinence, as well as prevent it:
SEspecially for adult patients, the following treatments can also be indicated:
– According to the Filum System®:
Patients with a diagnosis of Filum Disease often present primary nocturnal enuresis and/or urinary incontinence. For this reason, this phenomenon is being studied and we recommend that possible Filum Disease signs be checked in these patients, to allow the application of the indicated neurosurgical treatment.
In 1993, with the publication of Dr. Royo-Salvador’s doctoral thesis, a relation is established between the filum terminale-induced caudal traction of the entire nervous system and several conditions, including the Filum Disease, that are considered to be caused by this traction. Since then, a new treatment has been designed – an etiological treatment, or related to the cause – as by surgically sectioning the filum terminale, it is possible to eliminate the caudal medullary traction force that is responsible for the pathological mechanism.
In the sectioning of the filum terminale we apply a minimally invasive technique, that is usually indicated to be performed as soon as possible in all cases of Filum Disease, since it involves minimum risks and stops the progression of the disease.
1. It eliminates the medullary traction caused by a too short or too tense ligament.
2. With ICSEB’s minimally invasive surgical technique, surgical time is 45 minutes. Few hours of hospitalization. Local anaesthesia. Short postoperative period with no limitations. No admission to the Intensive care unit. No blood transfusions.
3. Its application implies a 0% mortality rate, with no sequelae.
4. It improves symptoms and stops the progression of conditions associated with the Filum Disease.
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