To the Editor.
—Despite Dr Resnick's excellent discussion in the Clinical Crossroads article on urinary incontinence,1 I think the patient's incontinence is much more complex. The voiding record of Mrs S revealed nocturnal enuresis.1 Burgio et al2 found that 2% of community-dwelling older adults had nocturnal enuresis; its prevalence was significantly greater among women compared with men (2.9% vs 1.0%, P<.001), and it was associated with poorer therapeutic outcomes, compared with the more common forms of daytime incontinence. These authors also found that enuresis was significantly related to symptoms of congestive heart failure, and subjects with mixed stress and urge incontinence during the day were most likely also to have nocturnal enuresis, compared with those with only 1 type of incontinence. Therefore, enuresis appears to be a special type of incontinence and is not as well understood in older patients.Even though Resnick argued that vasopressin
Reyes-Ortiz CA. Urinary Incontinence in Elderly Patients. JAMA. 1997;277(11):881-882. doi:10.1001/jama.1997.03540350031019