Paediatric Enuresis: From Bench to Bedside

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Bedwetting – also called enuresis is defined as wetting during sleep, in a child over five years, in the absence of neurological or structural problems affecting the bladder. The International Children's Continence Society (ICCS) defined nocturnal enuresis as both a symptom and a condition of intermittent incontinence that occurs during periods of sleep. According to American Psychiatric Association, it must be clinically significant as manifested either by a frequency of twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational) or other important areas of functioning. The worldwide prevalence of enuresis among children aged 6–12 years is 1.4%–28%. Some of the risk factors for enuresis are lower socioeconomic class, family history of enuresis, living with single parent, step parents, conflicts in family, parents with health problems and poor scholastic performance. Moreover enuretic children may have a history of birth asphyxia, caesarean birth, low birth weight and absence of breastfeeding. Some key factors that play role in bedwetting are developmental delay, genetic predisposition, abnormal bladder reservoir function, abnormal circadian rhythm of antidiuretic hormone (AVP) secretion and bladder detrusor/sphincter dysfunction. Regarding treatment, treatment of coexisting conditions should occur simultaneously with treatment of enuresis. The efficacy and safety of different treatments for monosymptomatic nocturnal enuresis, including standard therapies, simple behavioural interventions, complex behavioural interventions, alarm therapy, desmopressin and other drugs, biofeedback therapy, electrical stimulation, acupuncture, herbal medicines, massage, and so on may vary in terms of efficacy & safety. Alarm is effective single therapy with lower relapse rate. But children with Nocturnal Polyuria (NP) are most likely to benefit from desmopressin since lower nocturnal vasopressin levels have been demonstrated in a large percentage of patients, making substitution with desmopressin, a synthetic analogue of AVP, a rational first-line treatment for children with Monosymptomatic Nocturnal Enuresis (MNE) and NP. If untreated, bedwetting can persist into adulthood and the negative impact of bedwetting on child and family is considerable. Effective treatment can alleviate this burden, allowing the child to enjoy normal social and emotional development. Early treatment (from 5–6 years) can prevent prolonged distress during formative years and should be initiated whenever the child is ready/wishes to be dry, especially if enuresis is severe (spontaneous resolution unlikely).

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