[Further development of 'Enuresis nocturna' guidelines for children with persistent problems]

Area of Science:

• Pediatric Urology
• Sleep Medicine

Context:

• Persistent bedwetting (nocturnal enuresis) affects many children.
• Previous treatments may have failed due to unidentified contributing factors.

Purpose:

• To outline an individualized approach for achieving dryness in children with persistent bedwetting.
• To guide the selection of appropriate treatments based on specific patient needs and factors.

Summary:

• A micturition diary is crucial for identifying individual factors and needs.
• The enuresis alarm is the preferred initial treatment, requiring proper guidance.
• Desmopressin is suitable for nocturnal polyuria or when alarms are unfeasible.
• Combination therapy (desmopressin and alarm) is effective for rapid results or non-responsive cases.
• Daytime voiding issues suggest small bladder capacity or detrusor instability, managed with bladder training and/or anticholinergics.

Impact:

• Provides a structured, evidence-based strategy for managing persistent nocturnal enuresis.
• Emphasizes personalized care, improving treatment outcomes and patient quality of life.
• Offers guidance on utilizing pharmacological and behavioral interventions effectively.