Nocturnal enuresis in children

Review Article

Abstract

Nocturnal enuresis, defined as urinary incontinence during sleep at least twice weekly for three consecutive months in children over 5 years old, is a common childhood condition that significantly impacts both children and their families. This review examines the classification, etiology, pathophysiology, evaluation, and treatment options for nocturnal enuresis. The condition is classified as either monosymptomatic or non-monosymptomatic, and primary or secondary, with primary enuresis accounting for 80% of cases. The pathophysiology involves three main mechanisms: nocturnal polyuria, high arousal threshold, and bladder dysfunction. Genetic factors play a significant role, with a strong familial component following an autosomal dominant pattern. Evaluation includes detailed medical history, voiding diary, physical examination, and basic laboratory tests. Treatment approaches are divided into non-pharmacological (including behavioral modifications, motivational therapy, and alarm therapy) and pharmacological interventions (primarily desmopressin, tricyclic antidepressants, and anticholinergic drugs). While alarm therapy shows the highest long-term success rates (65-75%), combination therapy may be necessary for treatment-resistant cases. This review emphasizes the importance of individualized treatment approaches and family support in managing childhood nocturnal enuresis effectively.