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Nocturnal enuresis: what is happening?
1Department of General Paediatrics, Royal Children's Hospital, Parkville Melbourne, Victoria, Australia.
Insights
Primary nocturnal enuresis, or bedwetting at night, affects many children and has psychological impacts. Treatment options include bedwetting alarms and desmopressin nasal spray, while imipramine is falling out of favor.
Area of Science:
- Pediatrics
- Urology
- Sleep Medicine
Background:
- Primary nocturnal enuresis is a common childhood condition with significant psychological effects.
- It has a familial tendency and complex inheritance.
- Pathophysiology involves poor arousal, nocturia from reduced vasopressin, and decreased bladder capacity.
Purpose of the Study:
- To review the pathophysiology and treatment of primary nocturnal enuresis.
- To highlight the role of bedwetting alarms and desmopressin.
- To discuss the declining use of imipramine.
Main Methods:
- Literature review of primary nocturnal enuresis.
- Discussion of current treatment modalities.
- Analysis of treatment efficacy and safety.
Main Results:
- Bedwetting alarms are the primary treatment.
- Desmopressin nasal spray is effective for short-term and medium-term use, especially in alarm-resistant cases.
- Imipramine use is decreasing due to high relapse rates and overdose risks.
Conclusions:
- Primary nocturnal enuresis requires a multifaceted understanding of its causes.
- Desmopressin offers a valuable therapeutic option, often alongside alarms.
- Safer and more effective treatments are preferred over imipramine.
Abstract:
Primary nocturnal enuresis is common and has considerable psychological ramifications for children as they get older. It is a familial condition with complex inheritance patterns. The pathophysiology of the condition appears to be related to poor arousal from sleep, nocturia due to deficient vasopressin release in sleep and possibly a decrease in functional bladder capacity especially at night. The mainstay of treatment is the bed-wetting alarm. In recent years, desmopressin nasal spray has found a clinical niche as a short-term solution for children attending school camps or sleeping over at friends' houses and as treatment in the medium term for those unresponsive to treatment with a bed-wetting alarm. It may also be used as an adjunct to the use of the alarm. Treatment with imipramine is increasingly in disfavour because the relapse rate is unacceptably high and fatal overdose is a real possibility.