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European Urology Focus Apr 2017Enuresis is a common and possibly underestimated condition. While 5-10% of school-aged children suffer from the condition, a lack of background knowledge may impede... (Review)
Review
CONTEXT
Enuresis is a common and possibly underestimated condition. While 5-10% of school-aged children suffer from the condition, a lack of background knowledge may impede timely child-adapted and successful therapy.
OBJECTIVE
To provide a comprehensive overview of the pathophysiology, diagnosis, and treatment of enuresis.
EVIDENCE ACQUISITION
Guideline and position papers from the European Society of Pediatric Urology, the European Association of Urology, and the International Children's Continence Society were acquired. PubMed was searched for literature on enuresis, and all papers published in the last 5 yr were considered. The most relevant information from the papers with the highest level of evidence was extracted and incorporated into the review.
EVIDENCE SYNTHESIS
An altered antidiuretic hormone profile, arousal failure, and delayed bladder maturation are the main pathophysiological factors in primary enuresis. Coexisting constipation, obstructive airway disease, attention deficit hyperactivity disorder, obesity, and genetic preconditions influence its prevalence. Diagnosis relies on history-taking and simple noninvasive examinations to differentiate monosymptomatic enuresis and patients with daytime symptoms. It is essential to exclude daytime voiding symptoms, overactive bladder, dysfunctional voiding, and urinary tract infections. Further imaging is indicated in complex cases with a suspicion of underlying congenital malformations or systemic or endocrine diseases and in children refractory to initial therapy. In secondary enuresis, psychological causes should also be taken into consideration. While desmopressin melt tablets and alarm systems constitute the mainstays of treatment in monosymptomatic enuresis, anticholinergics and urotherapy play an additional role in nonmonosymptomatic enuresis. For therapy-refractory cases, after a thorough re-investigation to identify any missed comorbidities and anatomical or functional causes of enuresis, combination therapy and stationary urotherapy might be promising options.
CONCLUSIONS
While enuresis seems to be an often underestimated condition in terms of the suffering that children and their families, there are efficacious therapy options once a correct and full diagnosis is made.
PATIENT SUMMARY
This article reviews primary and secondary nocturnal enuresis, which is the medical term for the condition whereby children wet their beds regularly after their first birthday. We describe the background of enuresis,including its complex underlying mechanisms, as well as diagnosis and treatment in the light of current scientific publications. We conclude that while enuresis seems to be an often underestimated condition in terms of the suffering that children and their families may undergo, there are efficacious therapy options once a correct and full diagnosis is made.
Topics: Antidiuretic Agents; Biofeedback, Psychology; Child; Cholinergic Antagonists; Deamino Arginine Vasopressin; Enuresis; Humans
PubMed: 28888814
DOI: 10.1016/j.euf.2017.08.010 -
Pediatric Clinics of North America Dec 2001The authors do not have all of the data about enuresis, and many children are subject to relapses or failure of treatment. There is no cause for despondency, however.... (Review)
Review
The authors do not have all of the data about enuresis, and many children are subject to relapses or failure of treatment. There is no cause for despondency, however. Enuresis is no longer a mystery. Good data exist about the natural history, epidemiology, and etiology of enuresis. In addition, multiple treatment modalities are available to practitioners. This article has sought to review the scientific literature and to relate the authors' experience with enuresis. The authors recommend a treatment program for children with monosymptomatic nocturnal enuresis that includes removal of caffeine from the diet. Enuretic children do not consume enough fluid, and the authors recommend that the daily fluid requirement be divided during the day: 40% in the morning, 40% in the afternoon, and 20% in the evening, with no restriction of fluid. Normalization of small functional bladder capacities may help to cure enuresis and has an effect on the efficacy of other therapies. Treatment of enuretics with antibiotics is effective in children with UTI, bacteriuria, or cystitis cystica. DDAVP has been shown to be effective in the treatment of enuresis, especially in children who have achieved a normal functional bladder capacity. Bladder alarm systems also offer a potential cure of enuresis, are inexpensive, and show a low relapse rate.
Topics: Behavior Therapy; Child; Child Development; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Humans; Physical Examination; Renal Agents; Urinary Bladder; Urodynamics; Vasopressins
PubMed: 11732125
DOI: 10.1016/s0031-3955(05)70386-2 -
Aktuelle Urologie May 2014Enuresis in childhood and adolescence is a common symptom that significantly affects the quality of life of the patients and their social environment. Advanced... (Review)
Review
Enuresis in childhood and adolescence is a common symptom that significantly affects the quality of life of the patients and their social environment. Advanced diagnostic and therapeutic measures have significantly improved the treatment of affected children in the last 10 years in Germany. With the help of an often sufficient non-invasive diagnostic assessment it is possible to assign the symptom to a diagnostic category. This category forms the basis for a successful therapy. A high level of motivation and willingness to cooperate of the children and their families are therapeutic premises. In present-day treatment of functional urinary incontinence urotherapy has the highest priority.
Topics: Adolescent; Child; Comorbidity; Diurnal Enuresis; Enuresis; Female; Humans; Male; Motivation; Patient Compliance
PubMed: 24902072
DOI: 10.1055/s-0034-1368420 -
Pediatric Clinics of North America Nov 1974
Review
Topics: Adolescent; Child; Child, Preschool; Diet Therapy; Electric Stimulation; Enuresis; Female; Humans; Imipramine; Male; Medical History Taking; Parent-Child Relations; Physical Examination; Psychophysiologic Disorders; Urinary Tract Infections; Urine; Urography
PubMed: 4610490
DOI: 10.1016/s0031-3955(16)33075-9 -
Pediatric Clinics of North America Jun 1987Enuresis is often familial, usually disappearing in adolescence, with only 1 per cent of children suffering from it into adulthood. Functional enuresis is considered to... (Comparative Study)
Comparative Study Review
Enuresis is often familial, usually disappearing in adolescence, with only 1 per cent of children suffering from it into adulthood. Functional enuresis is considered to be a variation in normal bladder control, rather than a disease, and most enuretic children do not exhibit any emotional problems. A small functional bladder capacity and a maturational delay appear to be the relevant causes, considering the high rate of spontaneous cure. Only some children with primary enuresis show evidence of emotional or behavioral problems. The physician caring for an enuretic patient should remember that in the absence of obvious clinical manifestations (which must be treated immediately) the best treatment for enuresis is giving reassurance, offering supportive counseling and allowing time for spontaneous remission. Only when the presence of enuresis interrupts the sequence of normal social, emotional, cognitive, or motor development, should the use of medication or devices be considered.
Topics: Adolescent; Adult; Age Factors; Child; Child, Preschool; Enuresis; Female; Humans; Male; Parent-Child Relations; Sex Factors
PubMed: 3295724
DOI: 10.1016/s0031-3955(16)36264-2 -
Scandinavian Journal of Urology and... 2005Treatment for childhood nocturnal enuresis emphasizes either a psychological or pharmacological approach. The enuresis alarm, in comparative studies, has emerged as the... (Review)
Review
OBJECTIVE
Treatment for childhood nocturnal enuresis emphasizes either a psychological or pharmacological approach. The enuresis alarm, in comparative studies, has emerged as the most effective psychological treatment. In this review we investigate both outcome rates and influential factors from recently published studies.
MATERIAL AND METHODS
A search of papers published between 1980 and 2002 in the English language involving at least 10 children in which the enuresis alarm was employed as a stand-alone intervention revealed 38 studies.
RESULTS
Heterogeneity in terms of inclusion and outcome parameters made comparison between studies problematic. The most frequently adopted definitions were "wet at least 3 times a week" in terms of severity at inclusion, "14 consecutive dry nights" as a success criterion and "> 1 wet night a week" as a relapse criterion. Success rates across all studies ranged from 30% to 87% and were influenced by the type of enuresis, the treatment duration and the success criteria adopted. In an homogenous subset of 20 studies, 65% success with alarm treatment was found. Further analysis revealed equivalence between different forms of alarm, pre- and within-treatment predictors of outcome and possible mode of action. Relapse rates (ranging between 4% and 55%) were reported in 20 studies, with an homogeneous subset indicating that 42% of children relapsed following alarm treatment.
CONCLUSIONS
The enuresis alarm is an effective intervention for children with nocturnal enuresis. There are a number of factors, both pre- and within-treatment, that appear to influence its effectiveness and may assist clinical decisions concerning its appropriateness for any particular child.
Topics: Behavior Therapy; Circadian Rhythm; Enuresis; Humans; Treatment Outcome
PubMed: 16257835
DOI: 10.1080/00365590500220321 -
Pediatric Annals Apr 2015Enuresis is a common pediatric problem that creates a lot of stress for both the child and his/her family. Unfortunately, many of these patients do not seek medical... (Review)
Review
Enuresis is a common pediatric problem that creates a lot of stress for both the child and his/her family. Unfortunately, many of these patients do not seek medical attention for evaluation and treatment. It is important in the care of the child with enuresis to understand the definitions of the disorder, routinely ask about bowel and bladder habits, clarify the nature of the wetting (daytime, nighttime, or both) in the child, and perform a thorough history and physical examination. Laboratory studies are often minimal. Treatment (behavioral or medicinal) is dependent on the type of enuresis present, and patient compliance. Successful management of enuresis has benefits to both the child and family.
Topics: Child; Child, Preschool; Cognitive Behavioral Therapy; Drug Therapy; Enuresis; Humans
PubMed: 25875977
DOI: 10.3928/00904481-20150410-03 -
Urology Aug 1996
Review
Topics: Bacteriuria; Enuresis; Humans; Urodynamics; Vasopressins
PubMed: 8753727
DOI: 10.1016/S0090-4295(96)00153-7 -
Pediatrics in Review Jun 1997The answer to nocturnal enuresis is nocturnal self-awakening. Enuresis alarms teach this skill and, therefore, have the highest cure rate and the lowest relapse rate of... (Review)
Review
The answer to nocturnal enuresis is nocturnal self-awakening. Enuresis alarms teach this skill and, therefore, have the highest cure rate and the lowest relapse rate of any intervention. An alarm costs the same as a 2-week supply of desmopressin. Alarms can be used anytime from age 5 onward if the child elects to use one. If an alarm alone is not successful, combining it with medication increases the cure rate. The ability to teach a family how to use an enuresis alarm is an important part of pediatric office practice.
Topics: Behavior Therapy; Child; Child, Preschool; Enuresis; Female; Health Care Costs; Humans; Male; Parenting; Self Concept
PubMed: 9167432
DOI: 10.1542/pir.18-6-183 -
Indian Journal of Pediatrics Mar 2003Nocturnal enuresis is a benign condition, yet needs treatment to relieve the child and parents of the accompanying anxiety and the stigma attached to it. It is defined... (Review)
Review
Nocturnal enuresis is a benign condition, yet needs treatment to relieve the child and parents of the accompanying anxiety and the stigma attached to it. It is defined as normal nearly complete evacuation of the bladder at a wrong place and time at least twice a month after the fifth year of life. The underlying cause of enuresis is functional and various proposed pathophysiological mechanisms like maturational delay, genetics, role of sleep, antidiuretic hormone, and bladder capacity are discussed. These factors have a bearing on the management. As no treatment plan is ideal, various treatment modalities currently available including good supportive care are elaborated and a plan of management discussed.
Topics: Enuresis; Humans; Vasopressins
PubMed: 12785298
DOI: 10.1007/BF02725593