![]() ![]() Reasons for proactive management include the distress caused to child and family, difficulty of “sleeping over” on holiday or at friends’ houses, social withdrawal, reduced self-esteem, and potential disturbance of the child’s and the parents’ sleep architecture that may have an impact on daytime functioning and health. ![]() In children aged ≥5 years, enuresis is considered abnormal. In addition to these urinary/bladder storage characteristics, all children with enuresis experience impaired arousal from sleep which prevents waking to void in the toilet. “Small for age” bladder volume associated with OAB (overlaps with subtype of non-monosymptomatic enuresis (NMNE)-patients with lower urinary tract symptoms), reduced desmopressin response, and higher rates of response to the enuresis alarmĪ combination of both forms is possible, and such patients generally respond well to combined therapy with desmopressin and an alarm. Underlying NP associated with low overnight vasopressin levels, decreased urinary osmolality, and poor likelihood of a desmopressin response A simplified screening process enables identification of two archetypes of enuresis: The pathophysiology of enuresis is complex, involving the central nervous system (several neurotransmitters and receptors), circadian rhythm (sleep and diuresis), and bladder function derangements. Overactive bladder (OAB): all children with complaints of urgency and frequency with or without incontinenceĪ full glossary of all relevant terminology and definitions can be found in the 2006 ICCS standardization paper Non-monosymptomatic enuresis: Enuresis with other, mainly daytime, lower urinary tract symptoms Nocturnal polyuria (NP): Overproduction of urine at night, defined as nocturnal urine output exceeding 130% of EBC for age Monosymptomatic enuresis: Enuresis with no other lower urinary tract symptoms Maximum voided volume (MVV ): The largest volume of urine voided in a 24-h period, as documented in a bladder diary kept over 3–4 days, excluding first morning voidsĮnuresis: Intermittent incontinence while asleep in a child >5 years of age This guideline is intended as a practical supplement to the recent ICCS standardization report and provides direction and tools (e.g., checklists, flowcharts, and diaries) for MDs to use in children with enuresis and their parents, by outlining minimum evaluation criteria, initial treatment options, and indications for referral to a specialist center/doctor.Ĭomorbidity factors: Factors proven to be associated with increased incidence of enuresis and/or increased therapy resistanceĮxpected bladder capacity (EBC): Calculated as in milliliters The recommendations have been reviewed and endorsed by committees representing the American Academy of Pediatrics, European Society for Paediatric Urology (ESPU), European Society for Paediatric Nephrology, and the ICCS. Recommendations are based on the International Children’s Continence Society (ICCS) standardization document on monosymptomatic enuresis (MNE), empirical evidence, and discussions of leading experts in pediatric urology and nephrology during a consensus meeting in 2009. This manuscript aims to present an international consensus on a practical, rational approach to the diagnosis and management of bedwetting in the primary care setting. Conclusion: This guideline, endorsed by major international pediatric urology and nephrology societies, aims to equip a general pediatric practice in both primary and secondary care with simple yet comprehensive guidelines and practical tools (i.e., checklists, diary templates, and quick-reference flowcharts) for complete evaluation and successful treatment of enuresis. This should yield greater success than first-line treatment. The second strategy includes several additional evaluations including completion of a voiding diary, which requires extra time during the initial consultation and two office visits before treatment or specialty referral is provided. The first is a basic assessment covering only the essential components of diagnostic investigation which can be carried out in one office visit. We outline two alternative strategies to determine the most appropriate course of care. Non-monosymptomatic enuresis is often a more complex condition these patients may benefit from referral to specialty care centers. ![]() Once comprehensive history taking and evaluation has eliminated daytime symptoms or comorbidities, monosymptomatic enuresis can be managed efficaciously in the majority of patients. Therefore, patient care is neither optimal nor efficient, which can have a profound impact on affected children and their families. Despite the high prevalence of enuresis, the professional training of doctors in the evaluation and management of this condition is often minimal and/or inconsistent. ![]()
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