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      Primary Nocturnal Enuresis: A Review


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          Nocturnal enuresis or bedwetting is the most common type of urinary incontinence in children. It has significant psychological effects on both the child and the family. Enuresis nocturna is defined as the inability to hold urine during the night in children who have completed toilet training. It is termed as being “primary” if no continence has ever been achieved or “secondary if it follows at least 6 months of dry nights. The aim of this review was to assemble the pathophysiological background and general information about nocturnal enuresis.

          Evidence Acquisition

          This review was performed by evaluating the literature on nocturnal enuresis published between 1970 and 2015, available via PubMed and using the keywords “nocturnal enuresis,” “incontinence,” “pediatric,” “review,” and “treatment.”


          Children with nocturnal enuresis produce urine at higher rates during the night, and may have lower bladder capacities. Some children with nocturnal enuresis may also have daytime urgency, frequency, and urinary incontinence. Treatment includes aggressive treatment of accompanying constipation or urinary tract infections, behavioral changes, and medical therapy. Alarm therapy remains the first-line treatment modality for primary nocturnal enuresis. High rates of patient compliance and relapse mean that alternative treatments remain on the agenda.


          Nocturnal enuresis is a common problem that has multifaceted effects on both the child and the family. Due to multiple etiologic factors, nocturnal enuresis is still not clearly defined.

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          Most cited references45

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          Evaluation of and treatment for monosymptomatic enuresis: a standardization document from the International Children's Continence Society.

          We provide updated, clinically useful recommendations for treating children with monosymptomatic nocturnal enuresis. Evidence was gathered from the literature and experience was gathered from the authors with priority given to evidence when present. The draft document was circulated among all members of the International Children's Continence Society as well as other relevant expert associations before completion. Available evidence suggests that children with monosymptomatic nocturnal enuresis could primarily be treated by a primary care physician or an adequately educated nurse. The mainstays of primary evaluation are a proper history and a voiding chart. The mainstays of primary therapy are bladder advice, the enuresis alarm and/or desmopressin. Therapy resistant cases should be handled by a specialist doctor. Among the recommended second line therapies are anticholinergics and in select cases imipramine. Enuresis in a child older than 5 years is not a trivial condition, and needs proper evaluation and treatment. This requires time but usually does not demand costly or invasive procedures. Copyright 2010 American Urological Association. Published by Elsevier Inc. All rights reserved.
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            Nocturnal enuresis: an international evidence based management strategy.

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              Differences in characteristics of nocturnal enuresis between children and adolescents: a critical appraisal from a large epidemiological study.

              To evaluate any differences in the characteristics of primary nocturnal enuresis (PNE) between younger enuretic children and adolescents. In all, 21 000 questionnaires designed to determine the presence or absence of bed-wetting, diurnal incontinence, frequency of wetting, systemic illness, and family history, were sent to children aged 5-19 years from 67 kindergartens, primary schools and secondary schools randomly selected by a computer from different areas in Hong Kong. In addition, questions were asked to evaluate when and how the parents became aware that bed-wetting is a significant medical problem deserving attention in children after the age of 5 years. Of the 21,000 questionnaires distributed, 16 512 (78.6%) were completed. Among the respondents, 512 children (302 boys, 210 girls) had PNE; of these, 106 (20.7%) also had daytime incontinence. There was a marked reduction in the overall prevalence of PNE with advancing age. At 5 years old, 16.1% of children had PNE (20.7% boys, 10.8% girls; at age 9 and 19 years, 3.14% and 2.2% of children had PNE, respectively. However, this reduction was significantly more apparent among those with mild enuretic symptoms (wet 10 years had daytime urinary incontinence than had enuretic children aged 10 years and adolescents have significantly more daytime urinary symptoms and incontinence. The previously reported low prevalence of PNE in Hong Kong was probably due to parental indifference to the problem.

                Author and article information

                Nephrourol Mon
                Nephrourol Mon
                Nephro-urology Monthly
                31 May 2016
                July 2016
                : 8
                : 4
                : e35809
                [1 ]Hisar Intercontinental Hospital, Department of Urology, Istanbul, Turkey
                [2 ]Maltepe University Medical School, Department of Pediatric Surgery, Istanbul, Turkey
                Author notes
                [* ]Corresponding author: Basri Cakiroglu, Hisar Intercontinental Hospital, Department of Urology, Istanbul, Turkey. Tel: +90-2165241300, Fax: +90-2165241323, E-mail: drbasri@ 123456gmail.com
                Copyright © 2016, Nephrology and Urology Research Center

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

                : 26 December 2015
                : 30 April 2016
                Review Article

                nocturnal enuresis,incontinence,pediatric,review,treatment
                nocturnal enuresis, incontinence, pediatric, review, treatment


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