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Nocturnal enuresis—theoretic background and practical guidelines

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Abstract

Nocturnal polyuria, nocturnal detrusor overactivity and high arousal thresholds are central in the pathogenesis of enuresis. An underlying mechanism on the brainstem level is probably common to these mechanisms. Enuretic children have an increased risk for psychosocial comorbidity. The primary evaluation of the enuretic child is usually straightforward, with no radiology or invasive procedures required, and can be carried out by any adequately educated nurse or physician. The first-line treatment, once the few cases with underlying disorders, such as diabetes, kidney disease or urogenital malformations, have been ruled out, is the enuresis alarm, which has a definite curative potential but requires much work and motivation. For families not able to comply with the alarm, desmopressin should be the treatment of choice. In therapy-resistant cases, occult constipation needs to be ruled out, and then anticholinergic treatment—often combined with desmopressin—can be tried. In situations when all other treatments have failed, imipramine treatment is warranted, provided the cardiac risks are taken into account.

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Authors and Affiliations

  1. Uppsala University Children’s Hospital, 751 85, Uppsala, Sweden

    Tryggve Nevéus

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  1. Tryggve Nevéus
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Correspondence to Tryggve Nevéus.

Additional information

Answers to questions

1. B

2. C

3. D

4. D

Questions

Questions

(Answers appear following the reference list)

  1. 1.

    Should a 5-year-old child be actively treated for enuresis?

    1. a

      Yes, enuresis is a socially handicapping condition and should be treated early

    2. b

      Usually not, but this depends on whether he/she is bothered by the bedwetting or not

    3. c

      Yes, enuresis is defined as bedwetting in a child 5 years old or more

    4. d

      Yes, but treatment should start with desmopressin, since the child is probably too young to be motivated for alarm therapy

  2. 2.

    Why should imipramine not be a first-line therapy of enuresis?

    1. a

      We have insufficient evidence that it works

    2. b

      It is not curative

    3. c

      It is dangerous if overdosed

    4. d

      Enuresis is not a psychiatric disorder and should thus not be treated with antidepressants

  3. 3.

    Why is the enuresis alarm recommended as a first-line therapy in enuresis?

    1. a

      It is cheap

    2. b

      It is curative

    3. c

      It is evidence-based

    4. d

      All of the above

    5. e

      It is easy to use

  4. 4.

    Which of the following factors is not implicated by modern research as crucial in the pathogenesis of enuresis?

    1. a

      Uninhibited micturition reflex

    2. b

      Brainstem malfunction

    3. c

      Nocturnal polyuria

    4. d

      Neurosis

    5. e

      Upper airway obstruction

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Nevéus, T. Nocturnal enuresis—theoretic background and practical guidelines. Pediatr Nephrol 26, 1207–1214 (2011). https://doi.org/10.1007/s00467-011-1762-8

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