Prevalence, risk factors, and psychosocial impacts of enuresis in Saudi primary school-aged children: a systematic review and meta-analysis.

Enuresis is a common yet often under-recognized childhood condition associated with substantial emotional and psychosocial consequences. Although multiple studies from Saudi Arabia have examined its prevalence and correlates, the available evidence remains fragmented and methodologically heterogeneous. This systematic review and meta-analysis aimed to synthesize existing data on the prevalence of nocturnal enuresis among Saudi primary school-aged children and to summarize associated risk factors and psychosocial impacts. A comprehensive search of PubMed, Scopus, Web of Science, and Google Scholar identified observational studies published up to October 2025 involving children aged 5-16 years. Seven studies comprising 5,369 participants met the inclusion criteria and were assessed for methodological quality using the Newcastle-Ottawa Scale. Pooled prevalence was estimated using a random-effects model. The overall pooled prevalence of nocturnal enuresis was 22% (95% CI: 17-27%), with substantial heterogeneity (I2=99.4%). Sensitivity analysis excluding a methodological outlier reduced the pooled prevalence to 14.2% (95% CI: 8.4-23.0%), indicating that prevalence estimates should be interpreted as a range rather than a single definitive value. Primary nocturnal enuresis accounted for approximately 71% of reported cases. Consistently reported risk factors included positive family history, younger age, psychosocial stressors, sleep disturbances, obesity, and recurrent urinary tract infections. Enuresis was also associated with significant psychosocial consequences, including embarrassment, reduced self-esteem, emotional distress, and impaired school performance. Overall, nocturnal enuresis remains a prevalent and under-addressed condition among Saudi primary school-aged children. The findings underscore the need for improved parental and clinical awareness, early identification, and supportive, non-punitive management approaches. Integrating clinical care with parental education and school-based health initiatives may help reduce stigma and mitigate the psychosocial burden of enuresis in this population.