The pathophysiological nature of the monosymptomatic primary nocturnal enuresis (PNE) in children is still the unresolved problem. The most hypotheses of pathogenesis of nocturnal enuresis are limited within anatomical, biochemical and physiological regulation of the urinary control. Based on our own observations as well as the data reported in the literature, we have concluded that in addition to described biological causes of this disorder, we should focus on the common clinical and developmental features observed in the majority of cases of the monosymptomatic primary nocturnal enuresis that could be united as “enuretic syndrome”. In attempt to move “outside of the box” of the urinary control we have put forward a hypothesis that enuresis is a specific compensatory syndrome which is self-developed by the child’s organism to “offset” the deviated sleep–wake mechanisms. This concept is based on the general “control system theory” and offers the explanations of the majority of symptoms. From the compensatory “offset” concept the treatment of PNE should be focused not on the suppression of the act of enuresis but on the stabilization of circadian sleep-wake mechanisms. Further investigations are needed to evaluate the validity of this concept.
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