Modern management of pediatric nocturnal enuresis: Evidence-based treatment and practical guidance

Area of Science:

• Pediatric Urology
• Developmental Pediatrics
• Sleep Medicine

Background:

• Nocturnal enuresis (NE) is a common pediatric condition with multiple causes, including bladder storage issues, altered water regulation, and arousal difficulties.
• Defined by the International Children's Continence Society, NE involves nighttime incontinence in children over 5 without neurological or urological diseases.
• Despite being often self-resolving, NE significantly impacts a child's psychosocial well-being and family life.

Purpose of the Study:

• To review the current understanding of pediatric NE pathophysiology, clinical assessment, and evidence-based treatments.
• To emphasize the importance of a mechanism-based approach for individualized management.
• To highlight the role of early identification and multidisciplinary support in improving patient outcomes.

Main Methods:

• Review of current scientific literature on pediatric nocturnal enuresis.
• Synthesis of evidence regarding neurophysiological and chronobiological mechanisms.
• Analysis of contemporary management strategies based on pathophysiological domains.

Main Results:

• NE pathophysiology involves a developmental delay in three key areas: nocturnal polyuria, reduced bladder capacity/detrusor overactivity, and impaired arousal.
• Effective management requires tailoring treatments to the specific underlying mechanism.
• Early intervention and comprehensive support are crucial for successful outcomes.

Conclusions:

• Pediatric NE is a complex condition with identifiable pathophysiological bases.
• Individualized, mechanism-based treatment strategies are essential for effective management.
• A family-centered, multidisciplinary approach improves long-term outcomes and quality of life for children with NE.