[The overactive bladder during childhood: when and how should it be treated?]

Area of Science:

• Pediatric Urology
• Childhood Lower Urinary Tract Dysfunction

Context:

• Enuresis is a prevalent urinary symptom in children, with primary nocturnal enuresis affecting 80% of cases.
• A significant subset experiences daytime incontinence, frequency, and urgency, indicative of overactive bladder (OAB) in childhood, excluding other pathologies.

Purpose:

• To delineate the diagnostic approaches and therapeutic strategies for childhood enuresis and overactive bladder.
• To highlight the pathophysiology of detrusor hyperactivity stemming from bladder control maturation arrest.

Summary:

• Distinguishing between enuresis and OAB in children is typically achieved through non-invasive diagnostics.
• Video urodynamic studies may be required if initial treatments prove ineffective.
• Treatment modalities include urotherapy (bladder training, timed voiding, drink protocols) and anticholinergic medications for detrusor instability.

Impact:

• Provides a framework for diagnosing and managing common pediatric lower urinary tract symptoms.
• Emphasizes the importance of differentiating enuresis subtypes for targeted and effective interventions.
• Informs clinical practice regarding the role of urotherapy and pharmacotherapy in pediatric bladder dysfunction.