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[The overactive bladder during childhood: when and how should it be treated?]
1Kontinenzzentrum, Schwarzwald-Baar-Klinikum, Röntgenstrasse 20, 78054 Villingen-Schwenningen. daniela.schultz-lampel@sbk-vs.de
Insights
Bedwetting, or enuresis, is common in children. Differentiating between primary nocturnal enuresis and overactive bladder (OAB) in childhood is key for effective treatment, often starting with urotherapy or medication.
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.
Abstract:
Enuresis is one of the most frequent urinary symptoms in children. 80% suffer from primary enuresis nocturna. 20% have urinary incontinence with additional symptoms of frequency, urgency and daytime incontinence, which is also defined in children as overactive bladder in absence of urinary tract infections, neurological, anatomical or further local pathology (OAB in childhood). The underlying pathophysiology is a maturation arrest of the bladder control resulting in detrusor hyperactivity. In most of the cases the differentiation between enuresis and OAB is easily possible with non-invasive primary diagnostic procedures. Invasive diagnostic tools like video urodynamic studies may become necessary when first-line therapy fails. The treatment options comprise bladder training with timed voiding and drink protocols (urotherapy) as well as pharmacologic relaxation of detrusor instability by anticholinergic drugs.
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