Evaluation and treatment of nonmonosymptomatic enuresis

Area of Science:

• Pediatrics
• Urology
• Child Health

Background:

• Up to one-third of patients with enuresis exhibit daytime urinary symptoms suggesting lower urinary tract (LUT) dysfunction.
• International consensus identifies children with enuresis and LUT dysfunction as having non-monosymptomatic enuresis (NMSE), previously known as diurnal enuresis.

Purpose of the Study:

• To highlight the significance of identifying and managing lower urinary tract (LUT) dysfunction in children with enuresis.
• To emphasize the diagnostic role of voiding and elimination history in differentiating enuresis subtypes.
• To outline a therapeutic approach for non-monosymptomatic enuresis (NMSE).

Main Methods:

• Utilizing research evidence and international consensus to define NMSE.
• Employing a thorough voiding and elimination history as the primary diagnostic tool.
• Structuring therapy to address underlying LUT dysfunction, constipation, and behavioral comorbidities before targeting enuresis itself.

Main Results:

• An adequate voiding and elimination history is crucial for distinguishing between monosymptomatic enuresis (MSE) and NMSE.
• Addressing underlying LUT dysfunction, constipation, and comorbid behavioral issues often leads to improvement or resolution of enuresis.
• Specific medical or behavioral therapies for enuresis are considered if symptoms persist after managing underlying conditions.

Conclusions:

• Non-monosymptomatic enuresis (NMSE) is characterized by daytime urinary symptoms linked to LUT dysfunction.
• Therapeutic strategies for NMSE should prioritize the treatment of underlying LUT dysfunction and related conditions.
• Enuresis management requires a comprehensive approach that addresses both the primary symptom and associated functional issues.