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Clinical management of nocturnal enuresis

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Abstract

Nocturnal enuresis (NE) is a common health problem. Approximately 10% of 7-year-old children wet the bed regularly during sleep. Enuresis can be categorized into monosymptomatic (MEN) and nonmonosymptomatic (NMEN) forms. MEN occurs without any other symptoms of bladder dysfunction. NMEN is associated with dysfunction of the lower urinary tract with or without daytime incontinence. The rate of comorbid gastrointestinal, behavioral, and emotional disorders is elevated depending upon the subtype of NE. A careful clinical history is fundamental to the evaluation of enuresis. Diagnostic procedures include medical history and psychological screening with questionnaires, bladder and bowel diary, physical examination, urinalysis, ultrasound, and examination of residual urine. The mainstay of treatment is urotherapy with information and psychoeducation about normal lower urinary tract function, the underlying cause of MEN, disturbed bladder dysfunction in the child with NMEN and instructions about therapeutic strategies. Alarm therapy and the use of desmopressin have been shown to be effective in randomized trials. Children with NMEN first need treatment of the underlying daytime functional bladder problem before treatment of nocturnal enuresis. In patients with findings of overactive bladder, besides urotherapy, anticholinergic drugs may be useful.

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Abbreviations

LUT:

Lower urinary tract

MNE:

Monosymptomatic nocturnal enuresis

NE:

Nocturnal enuresis

NMNE :

Nonmonosymptomatic nocturnal enuresis

OAB:

Overactive bladder

ODD:

Oppositional defiant disorder

PNE:

Primary nocturnal enuresis

SNE:

Secondary nocturnal enuresis

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Authors and Affiliations

  1. Pediatric Nephrology, University Children’s Hospital Münster, Waldeyerstrasse 22, 48149, Muenster, Germany

    Eberhard Kuwertz-Bröking

  2. Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany

    Alexander von Gontard

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  1. Eberhard Kuwertz-Bröking
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Correspondence to Eberhard Kuwertz-Bröking.

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1. d; 2. e; 3. b; 4. e; 5. d

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Kuwertz-Bröking, E., von Gontard, A. Clinical management of nocturnal enuresis. Pediatr Nephrol 33, 1145–1154 (2018). https://doi.org/10.1007/s00467-017-3778-1

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