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An interprofessional approach to managing children with treatment-resistant enuresis: an educational review
Patrina H Y Caldwell1,2, Melissa Lim3, Gail Nankivell3
1The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia. patrina.caldwell@health.nsw.gov.au.
Insights
Bedwetting, or enuresis, affects many children. This review explores why treatments fail and proposes an interprofessional approach to overcome treatment resistance in pediatric enuresis.
Area of Science:
- Pediatric Urology
- Clinical Pediatrics
- Child Health
Background:
- Enuresis (bedwetting) is common in children aged 5 years and older.
- Up to 50% of children with enuresis exhibit treatment resistance to standard interventions.
- Understanding causes of treatment failure is crucial for effective management.
Purpose of the Study:
- To provide insight into the causes of treatment resistance in pediatric enuresis.
- To offer practical suggestions for addressing treatment resistance.
- To promote an interprofessional approach for managing resistant enuresis.
Main Methods:
- Review of the pathophysiology and standard treatments for enuresis.
- Analysis of reasons for treatment failure in pediatric enuresis.
- Proposal of interprofessional (multidisciplinary and interdisciplinary) models for treatment resistance.
Main Results:
- Standard enuresis treatments can fail due to various underlying factors.
- Interprofessional approaches leverage diverse expertise to address treatment barriers.
- Both multidisciplinary and interdisciplinary models offer strategies for resistant cases.
Conclusions:
- Treatment resistance in enuresis necessitates exploring underlying causes beyond standard protocols.
- An interprofessional approach, integrating expertise from different disciplines, is key to managing resistant pediatric enuresis.
- Collaboration among clinicians enhances treatment efficacy when standard methods are insufficient.
Abstract:
Enuresis (intermittent urinary incontinence during sleep in a child aged ≥ 5 years) is commonly seen in paediatric practice. Despite the availability of effective interventions, treatment resistance is encountered in up to 50% of children. In this educational review we attempt to provide insight into the causes of treatment resistance, and offer practical suggestions for addressing this condition using an interprofessional approach. We explore the pathophysiology of and standard treatments for enuresis and discuss why standard treatments may fail. An interprofessional approach to treatment resistance is proposed which utilises the expertise of professionals from different disciplines to address the problems and barriers to treatment. The two interprofessional approaches include a multidisciplinary approach that involves the patient being sent to experts in different disciplines at different times to address their treatment resistance utilising the skills of the respective experts, and an interdisciplinary approach that involves a patient being managed by members of interdisciplinary team who integrate their separate discipline perspectives into a single treatment plan. Although an interdisciplinary approach is ideal, interdisciplinary teams may not be available in all circumstances. Understanding the roles of other disciplines and engaging clinicians from other disciplines when appropriate can still be helpful when treatment resistance is encountered.