The evaluation and treatment of therapy-resistant enuresis: a review

Area of Science:

• Pediatric Urology
• Nephrology
• Gastroenterology

Background:

• Persistent enuresis in children often involves nocturnal detrusor over-activity and high arousal thresholds.
• Standard treatments like alarm therapy and desmopressin may be ineffective in these cases.

Purpose of the Study:

• To outline the comprehensive evaluation and management strategies for therapy-resistant childhood enuresis.
• To identify underlying causes and guide treatment selection for complex enuresis cases.

Main Methods:

• Exclusion of underlying pathologies (e.g., kidney disease, UTI, neurogenic bladder).
• Assessment for daytime bladder issues and constipation.
• Utilizing bladder diaries and considering non-pharmacologic interventions.
• Exploring pharmacologic options including anticholinergics, desmopressin, and tricyclic antidepressants.

Main Results:

• Bladder diaries are crucial; other tests are seldom informative.
• Non-pharmacologic approaches include constipation management and habit training.
• Anticholinergic medication, often combined with desmopressin, is a first-line pharmacologic treatment.
• Tricyclic antidepressants offer a treatment option for refractory cases with strict safety measures.

Conclusions:

• Therapy-resistant enuresis requires a systematic approach to evaluation and management.
• A combination of non-pharmacologic and pharmacologic strategies can be effective.
• Careful consideration of treatment options and safety precautions is vital for successful outcomes.