Review – Pediatric UrologyPrimary and Secondary Enuresis: Pathophysiology, Diagnosis, and Treatment
Introduction
Nocturnal enuresis is a frequent condition in children that is often undervalued and underestimated in terms of the suffering of both children and their families. Approximately 10% of all 7-yr-old children, 5% of all 10-yr-olds and 0.5–1% of adults are affected more than three times per week [1], [2]. It is reported that the rate of spontaneous resolution is approximately 15% per year. Boys are more often affected than girls [3], [4]. Besides its negative impact on the self-esteem of affected children, especially if the condition persists at older ages [5], enuresis is associated with poorer performance in school [1] and poorer quality of life among parents [6]. While historical reports address punishing and brutal treatment recommendations such as beating the affected child [7], current mainstays of treatment involve targeted behavioral and pharmacological interventions, relying on the hindsight that psychological problems in most enuretic children are consequences rather than the cause of the condition. However, there are recent reports suggesting that harmful practices in enuresis treatment are still applied in some communities [8]. Awareness of this common problem is often lacking in the direct surroundings of affected children [1], [9] and there is an urgent need for broad education of parents, teachers, and primary physicians. A consistently high number of publications over the last 20 yr indicates the ongoing scientific activity to further improve understanding of this condition and the quality of its treatment (Fig. 1). Global initiatives such as World Bed-wetting Day (www.worldbedwettingday.com) are aimed at promoting awareness and uniform high-standard treatment practices.
Section snippets
Evidence acquisition
Here we present a narrative review, with a comprehensive yet concise overview of the pathophysiology, diagnosis, and treatment of enuresis in light of recent literature from the authors’ point of view on this important and timely topic. Information from the literature was extracted nonsystematically, with a focus on original papers on the many topics covered as well as guidelines and position statements by the leading associations in the field of pediatric urology.
Guideline and position papers
Definitions
As defined by the ICCS, enuresis consists of wetting in discrete portions while asleep by a child who has passed his or her fifth birthday [2]. Enuresis, as well as daytime voiding conditions, is considered significant if it occurs more than once per month and at a frequency of at least three times per 3 mo. It is recommended to term enuresis as frequent if there are more than 3 episodes per week. If there are concomitant day time voiding symptoms (incontinence, frequency, urgency, low voided
Conclusions
Review of the literature on enuresis provides a comprehensive knowledge base confirming the importance of this problem and providing treating physicians with a large armamentarium of diagnostic and therapeutic tools. Given optimal management, the prospects for children with enuresis are optimistic, although there is good reason to consider enuresis a nontrivial problem.
Author contributions: Bernhard Haid had full access to all the data in the study and takes responsibility for the integrity of
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Cited by (46)
An evaluation of parental attitudes and attachment in children with primary monosymptomatic nocturnal enuresis: A case-control study
2023, Journal of Pediatric UrologyCitation Excerpt :If the child with monosymptomatic enuresis has never remained dry for a period of 6 months after toilet training and only exhibited a nocturnal voiding problem, the condition is defined as “Primary Monosymptomatic Nocturnal Enuresis (PMNE)” [2]. The prevalence of enuresis is around 10% among children in the 7-year age group, around 5% among children in the 10-year age group, and around 0.5–1% among adults [3]. Enuresis, which is more common among boys when compared to girls, results from multifactors including genetic factors, waking disorder, nocturnal polyuria, increased detrusor activity, low urinary bladder capacity at night and obstructive sleep apnea [4,5].
Obesity in children and adolescents: epidemiology, causes, assessment, and management
2022, The Lancet Diabetes and EndocrinologyA randomised, double-blind, placebo-controlled clinical trial found that a novel herbal formula Urox® (Bedtime Buddy®) assisted children for the treatment of nocturnal enuresis
2021, PhytomedicineCitation Excerpt :There are two classifications of NE: monosymptomatic enuresis which occurs with no other lower urinary tract symptoms, and non-monosymptomatic enuresis which features additional, mainly daytime, lower urinary tract symptoms (Vande Walle et al. 2021). Current prevalence data suggests between 5 and 20% of children over 5 years old internationally experience NE (Haid and Tekgül 2017; Hamed et al., 2017; Sarici et al., 2016; Huang et al., 2011), although the prevalence could be higher in the community than indicated by current documented figures (Thurber 2017). Factors such as age, daytime incontinence, encopresis, social concerns, delayed age of walking, positive parental history of enuresis, and sibling history of enuresis may increase the risk, or predict the likelihood, that a child will develop NE (Hamed et al., 2017; Sarici et al., 2016; Sureshkumar et al., 2009).
Determinants of bedwetting trajectories between 4 and 7 years – A birth cohort analysis
2021, Journal of Pediatric UrologyAlarm therapy for nocturnal enuresis in children: A literature review
2024, International Journal of Urological Nursing