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Expert consensus on the management of nocturnal enuresis in children
1Department of Nephrology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China. shenqian@shmu.edu.cn.
Insights
This expert consensus updates guidelines for childhood nocturnal enuresis (NE), offering standardized diagnosis and management strategies. It emphasizes individualized care to improve outcomes for affected children.
Area of Science:
- Pediatrics
- Urology
- Evidence-Based Medicine
Background:
- Childhood nocturnal enuresis (NE) significantly impacts children's well-being.
- Previous guidelines from 2014 require updating due to new clinical data and international standards.
Purpose of the Study:
- To revise and standardize the clinical management of childhood NE in China.
- To provide an updated, evidence-based framework for diagnosis and treatment.
Main Methods:
- Developed using the Delphi method by a multidisciplinary expert panel.
- Consensus achieved through iterative voting with ≥90% agreement.
- Based on a synthesis of current evidence and accumulated clinical experience.
Main Results:
- Presents 18 key recommendations for NE management.
- Updates diagnostic criteria for children aged ≥5 years.
- Classifies NE into monosymptomatic (MNE) and nonmonosymptomatic (NMNE).
- Outlines comprehensive evaluation, basic management, and first-line treatments (desmopressin, alarm therapy).
- Includes strategies for treatment-resistant cases and NMNE management.
Conclusions:
- Provides a practical, evidence-based framework for childhood NE diagnosis and management.
- Aims to harmonize clinical practice and promote individualized patient care.
- Seeks to improve patient outcomes through standardized recommendations.
Background:
Nocturnal enuresis (NE) is a common condition in childhood that can adversely affect children's physical and psychological health. Since the publication of the "Expert Consensus on the Management of Monosymptomatic Nocturnal Enuresis in Chinese Children" in 2014, substantial clinical experience has been accumulated and international guidelines have been updated, necessitating a revision to standardize and improve clinical management.
Methods:
This consensus was developed by the Chinese Cooperative Group for the Management of Pediatric Nocturnal Enuresis, the Pediatric Nephrology Committee of the Chinese Medical Doctor Association using the Delphi method. A core writing group of nine experts drafted statements based on a synthesis of current evidence. These were subjected to iterative voting by 42 multidisciplinary panelists to achieve consensus, defined as ≥ 90% agreement.
Results:
The consensus provides 18 key recommendations. It updates the diagnostic criteria for children aged ≥ 5 years with at least one involuntary void per month for three months. It emphasizes classification into monosymptomatic (MNE) or nonmonosymptomatic (NMNE) NE based on daytime lower urinary tract symptoms. Recommendations cover comprehensive evaluation (history, physical exam, voiding diary), basic management (education, lifestyle), and first-line treatment (desmopressin for nocturnal polyuria, alarm therapy for reduced bladder capacity). Strategies for treatment-resistant cases, management of NMNE (prioritizing daytime symptoms), and the role of primary care and traditional Chinese medicine are outlined.
Conclusions:
This expert consensus provides an updated, evidence-based, and practical framework for the diagnosis and management of childhood NE. It aims to harmonize clinical practice, promote individualized care, and improve patient outcomes through standardized recommendations.
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