<p>Primary nocturnal enuresis (PNE) is a prevalent pediatric disorder often associated with cognitive-behavioral impairments, yet its neurobiological mechanisms remain poorly understood. In this study, we combined diffusion tensor imaging (DTI) and resting-state functional magnetic resonance imaging (rs-fMRI) to investigate the topological alterations in structural and functional brain networks among 49 children with PNE and 44 age- and sex-matched healthy controls (HC). Graph theoretical analysis revealed widespread disruptions in both structural and functional networks in the PNE group, with localized nodal abnormalities in the frontal and occipital lobes and basal ganglia. Notably, these alterations were correlated with both clinical severity of PNE (e.g., enuresis frequency) and inattention symptoms. Furthermore, while no significant group differences were observed in overall structural-functional network coupling, its strength was negatively correlated with inattention scores within the PNE group, suggesting a potential neural correlate of cognitive symptoms. Our findings suggest that PNE is associated with large-scale brain network disorganization, where aberrant nodal topology and associations between structural-functional network coupling and inattention symptoms may serve as neural correlates of both core symptoms and cognitive features. This multimodal framework contributes to the understanding of PNE as a neural circuit disorder and highlights potential imaging biomarkers for cognitive comorbidities.</p>