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Enuresis

What's new

Added 2023 EAU/ESPU and 2022 AAFP guidelines for the evaluation and management of enuresis.

Background

Overview

Definition
Enuresis is the involuntary or intentional discharge of urine after the age at which bladder control is expected, typically beyond 5 years of age.
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Pathophysiology
The pathophysiology of enuresis is multifactorial and not fully understood. However, it is believed to involve a delay in the maturation of the mechanisms controlling urination during sleep. This includes a maturational deficit in motor performance, particularly for repetitive hand and finger movements, and a possible maturational deficit of the motor cortex circuitry and related cortical areas. Disturbances in the circadian rhythm of arginine-vasopressin, leading to excess urine production during sleep, are also common in children with enuresis. Additionally, immaturity of the brainstem may be involved in the pathogenesis of enuresis.
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Epidemiology
The prevalence of nocturnal enuresis is estimated at 6-10% at age 7, decreasing to 2% by age 15, and further to 0.5-2% in adulthood. Boys are twice as affected as girls.
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Disease course
Clinically, enuresis presents with bedwetting that is inappropriate for the child's developmental age, typically occurring at least twice a week for 3 consecutive months. It often occurs early at night, primarily in sleep stage 2 and deep sleep.
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Prognosis and risk of recurrence
The prognosis of enuresis is generally good, as the condition often resolves with time. However, the persistence of enuresis can lead to psychological distress and impaired QoL.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of enuresis are prepared by our editorial team based on guidelines from the European Association of Urology (EAU/ESPU 2023) and the American Academy of Family Physicians (AAFP 2022). ...
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Diagnostic investigations

Voiding diary: as per EAU/ESPU 2023 guidelines, use voiding diaries or questionnaires to exclude daytime symptoms.
B
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  • Urine tests

Medical management

Management of comorbidities
As per AAFP 2022 guidelines:
Treat daytime LUTS and constipation before initiating nocturnal enuresis therapy.
B
Evaluate patients with enuresis and obstructive sleep apnea by a pediatric otorhinolaryngologist for consideration of adenotonsillectomy.
A

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  • Indication for treatment

  • Desmopressin

Nonpharmacologic interventions

Enuresis alarm
As per EAU/ESPU 2023 guidelines:
Offer enuresis alarm therapy in motivated and compliant families.
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Offer supportive measures in conjunction with other treatment modalities.
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