Treatment Modalities of Nocturnal Enuresis: Recent Recommendations

Abstract

Background: Enuresis is a clinical condition with a multifactorial etiology that generates great impacts on social relationships, self-esteem, family relationships, and even the academic life of children and adolescents with nocturnal enuresis. The pathogenesis of this condition is understood through three mechanisms: high thresholds for arousal to full bladder signs, nocturnal polyuria, and nocturnal detrusor hyperactivity. Three conditions are felt to contribute to nocturnal enuresis; impaired sleep arousal threshold, nocturnal polyuria and detrusor over activity. This knowledge helps the practitioner understand the different treatment modalities available for their enurеtic patient. Importantly, experts recognize that a significant portion of monosymptomatic enuresis patients likely have underreported or underdiagnosed daytime symptoms, thus explaining the overlapping therapeutic efficacy in many patients. 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.