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Current trends, diagnosis, and treatment of enuresis
1Institute of Experimental Clinical Research, University of Aarhus, Skejby Hospital, Denmark.
Insights
Monosymptomatic nocturnal enuresis, or bedwetting, is now understood as a condition primarily caused by nighttime urine overproduction or reduced bladder capacity. Further research may lead to new subgroups for this common childhood issue.
Area of Science:
- Pediatrics
- Urology
- Child Psychology
Background:
- The understanding of monosymptomatic bedwetting has evolved significantly over recent decades.
- Early concepts focused on psychological factors and general enuresis, with less emphasis on specific physiological causes.
Purpose of the Study:
- To review the historical evolution of the concept of monosymptomatic bedwetting.
- To delineate current diagnostic criteria and identify distinct pathophysiological subgroups.
- To highlight the primary etiological factors in monosymptomatic nocturnal enuresis.
Main Methods:
- Literature review and conceptual analysis of studies on monosymptomatic bedwetting.
- Examination of the role of bladder pathology versus functional capacity.
- Focus on the relationship between nocturnal urine production and bladder capacity.
Main Results:
- Monosymptomatic bedwetting is now viewed as an umbrella diagnosis for children without daytime urinary issues.
- Two primary subgroups are identified: those with high nocturnal urine production and normal bladder capacity, and those with high nocturnal urine production and a small bladder capacity.
- Bladder pathology plays a minor role compared to the mismatch between nocturnal urine production and bladder capacity.
Conclusions:
- Monosymptomatic bedwetting is best understood as a functional issue related to nocturnal fluid balance.
- Current evidence supports at least two distinct pathophysiological subgroups within this diagnosis.
- Ongoing research into genetic factors may lead to further refined subgrouping and personalized treatment approaches.
Abstract:
This survey describes the evolution of our concept of monosymptomatic bedwetting over the last decades. It takes you briefly through psychology and enuresis. The minor role of bladder pathology is described ending up with focusing on the mismatch between bladder capacity at night-time and urine production. Monosymptomatic bedwetting should currently be regarded as an umbrella diagnosis allocated to children where daytime urinary problems have been excluded. Within the diagnosis of monosymptomatic bedwetting we can nowadays identify at least two groups. One is related to children who have a large night-time urine production and a normal bladder capacity, and the other is related to children who have a large night-time production, but a bladder capacity too small for the normal urine production. The genetic aspects are currently investigated. The results and this kind of research will probably end up in a further subgrouping.