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[An update on clinical and therapeutic aspects of nocturnal enuresis]
1Dipartimento di Pediatria, Università degli Studi di Padova, Italia.
Insights
Early treatment of nocturnal enuresis is crucial due to its negative psychological impact. Correct classification guides therapy, with desmopressin for monosymptomatic cases and combined therapy for symptomatic enuresis.
Area of Science:
- Pediatric Urology
- Child Psychology
Context:
- Nocturnal enuresis negatively impacts a child's self-esteem, autonomy, and social development.
- Accurate classification of enuresis into primary/secondary and monosymptomatic/symptomatic is essential for effective treatment.
Purpose:
- To outline the therapeutic strategies for nocturnal enuresis based on its classification.
- To detail medication dosages and treatment durations for improved outcomes.
Summary:
- Monosymptomatic nocturnal enuresis is treated with desmopressin (20-40 mcg), with tablet form available for those with rhinitis/asthma.
- Symptomatic enuresis requires combined desmopressin and oxybutynin therapy.
- Imipramine and other antidepressants are alternative treatments; alarm therapy is reserved for non-responders.
Impact:
- Establishes evidence-based treatment guidelines for pediatric nocturnal enuresis.
- Highlights the importance of psychological well-being in enuresis management.
- Aims to improve treatment success rates through appropriate drug selection and therapy duration.
Abstract:
Justification of early treatment of nocturnal enuresis is founded in the negative psychological impact on the child. In fact nocturnal enuresis delays early autonomy and socialisation by decreasing in self-esteem and self-confidence. Nocturnal enuresis classification is the preliminary step to correct therapy. Enuresis must be classified as primary (never acquired nocturnal control) or secondary (at least 6 months of dry nights). A child is also classified as having monosymptomatic enuresis if she/he experienced only night wetting and symptomatic enuresis if she/he experienced night wetting associated with diurnal voiding symptoms (urinated > or = 7 times a day, urgency, damp pants, squatting, holding the perineum, sitting on one heel). Monosymptomatic patients must be treated with desmopressin nasal spray at the daily dose of 20 micrograms at bed time. If the reduction of at least the 50% of the basal number of the wet nights is not achieved, the dosage must be increased until 40 micrograms. For patients affected by rhinitis or asthma, desmopressin is now available in tablets. In symptomatic patients desmopressin therapy must be associated to oxybutinin (5 mg x 2). Therapy interruption must be gradual with desmopressin reduction of 10 micrograms every 30 days. In symptomatic patients oxybutinin must be introduced only at bed time. The efficacy of the drugs depends on the therapy length. The highest percentage of success is obtained if the treatment is protracted for at least six months. Antidepressants are also used for nocturnal enuresis especially imipramine. The dosage varies between 0.5-1.5 mg/ kg/daily. As plasmatic levels are achieved only in 30% of treated patients, a 3-5 fold increase in suggested. Nevertheless these levels result in near toxic threshold concentration. Sporadic treatment purposes include amytriptiline, diclofenac sodicum, viloxsazine and methilphenidate if giggle incontinence is present. Non responders may be treated with alarm. If after 16 weeks of treatment no success is obtained alarm use must be interrupted.