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Management and treatment of nocturnal enuresis-an updated standardization document from the International Children's
Tryggve Nevéus1, Eliane Fonseca2, Israel Franco3
1Department of Women's and Children's Health, Uppsala University, Uppsala, 75185, Sweden.
Insights
Updated guidelines recommend active enuresis (bedwetting) treatment from age six. Key treatments include desmopressin or alarms, with constipation and psychiatric issues addressed. Consult experts for complex cases.
Area of Science:
- Pediatrics
- Urology
- Child Psychology
Background:
- Enuresis is common, with potential long-term psychosocial impacts if untreated.
- Misconceptions persist regarding effective management of childhood enuresis.
- International Children's Continence Society (ICCS) guidelines require updating.
Purpose of the Study:
- To update international guidelines for evaluating and treating childhood enuresis.
- Provide evidence-based recommendations and expert consensus for enuresis management.
- Standardize terminology and treatment approaches globally.
Main Methods:
- Utilized globally accepted ICCS terminology.
- Based recommendations on evidence-based literature and expert consensus.
- Incorporated feedback from all ICCS members on draft guidelines.
Main Results:
- Routine blood tests, radiology, or urodynamics are unnecessary for uncomplicated enuresis.
- Active therapy for enuresis is advised from age six.
- Treat comorbid conditions like constipation, UTIs, psychiatric disorders, and sleep apnea.
- First-line treatments include desmopressin or enuresis alarms for monosymptomatic enuresis.
- Anticholinergics and antidepressants are options for refractory cases.
- Addressing sleep-disordered breathing can resolve enuresis.
Conclusions:
- Updated guidelines offer a structured approach to childhood enuresis evaluation and treatment.
- Emphasizes treating comorbidities and utilizing age-appropriate therapies.
- Promotes standardized, evidence-based care for improved patient outcomes.
Background:
Enuresis is an extremely common condition, which, although somatically benign, poses long-term psychosocial risks if untreated. There are still many misconceptions regarding the proper management of these children.
Aim:
A cross-professional team of experts affiliated with the International Children's Continence Society (ICCS) undertook to update the previous guidelines for the evaluation and treatment of children with enuresis.
Methods:
The document used the globally accepted ICCS terminology. Evidence-based literature served as the basis, but in areas lacking in primary evidence, expert consensus was used. Before submission, a full draft was made available to all ICCS members for additional comments.
Results:
The enuretic child does, in the absence of certain warning signs (i.e., voiding difficulties, excessive thirst), not need blood tests, radiology or urodynamic assessment. Active therapy is recommended from the age of 6 years. The most important comorbid conditions to take into account are psychiatric disorders, constipation, urinary tract infections and snoring or sleep apneas. Constipation and daytime incontinence, if present, should be treated. In nonmonosymptomatic enuresis, it is recommended that basic advice regarding voiding and drinking habits be provided. In monosymptomatic enuresis, or if the above strategy did not make the child dry, the first-line treatment modalities are desmopressin or the enuresis alarm. If both these therapies fail alone or in combination, anticholinergic treatment is a possible next step. If the child is unresponsive to initial therapy, antidepressant treatment may be considered by the expert. Children with concomitant sleep disordered breathing may become dry if the airway obstruction is removed.