Which statement is true regarding enuresis?

Choice A reason: Enuresis, particularly the nocturnal type, is characterized by the involuntary discharge of urine during sleep. Most children or adolescents with this condition do not perceive the sensory input of a full bladder and typically remain asleep throughout the entire voiding episode. They often only become aware of the event upon awakening in the morning or when discovered by a caregiver. Choice B reason: In most cases of primary nocturnal enuresis, the child does not awaken immediately after the event. Unlike nightmares or sleep terrors that cause sudden arousal, enuresis is often associated with deep sleep stages where the arousal threshold is very high. The failure to awaken in response to bladder distension is a central component of the disorder's clinical presentation. Choice C reason: Epidemiological data consistently shows that enuresis is significantly more common in males than in females, with ratios often cited as 2:1. While the prevalence decreases with age in both genders, the higher incidence in boys is a well-documented clinical fact in pediatric psychiatry and urology, making the statement that it is more common in females incorrect. Choice D reason: The vast majority of enuresis cases are "functional" rather than "organic," meaning they are not caused by a structural or physiological abnormality of the urinary tract. Most cases are related to developmental delays in bladder control, low nocturnal antidiuretic hormone secretion, or high arousal thresholds. Comprehensive medical evaluations usually reveal normal anatomy and renal function in these clients.