Current practices and challenges in managing bedwetting: A multinational survey of pediatricians

Primary nocturnal enuresis (PNE) is a prevalent disorder among children and adolescents that can lead to significant physiological and psychological consequences if left untreated. Our study aimed to evaluate current practices in PNE management by surveying pediatricians to understand contemporary approaches and identify areas needing improvement.

An anonymous survey comprising 24 questions was distributed electronically to pediatricians affiliated with the Georgia Chapter of the American Academy of Pediatrics and practicing pediatricians in Argentina, Spain, and Brazil. Questions were focused on current practices, treatment preferences, perceived effectiveness, and the specific obstacles faced in managing PNE in children. Interventional therapies are defined as medical treatments (bedwetting alarms/devices). Non-interventional therapies were defined as behavioral modifications (fluid restriction, timed voiding, bladder training) and supportive therapy (positive reinforcement, reassurance).

A total of 234 pediatricians participated across four countries. Non-interventional therapies predominated as first-line management for children aged 5-7 years in all regions. Significant variation emerged in older age groups, with interventional therapies more commonly used in the United States and Spain, while referral to specialists was more frequent in Argentina and Brazil (p < 0.001). 43.1% of pediatricians reported delaying treatment initiation due to concerns regarding the limited effectiveness of current therapies.

The current dissatisfaction with available treatments underscores the necessity for improved therapeutic approaches. Further research is needed to determine the factors contributing to variation in PNE management across countries.