Tryggve Nevéus1, Eliane Fonseca2, Israel Franco3, Akihiro Kawauchi4, Larisa Kovacevic5, Anka Nieuwhof-Leppink6, Ann Raes7, Serdar Tekgül8, Stephen S Yang9, Søren Rittig10. 1. Department of Women's and Children's Health, Uppsala University, Uppsala, 75185, Sweden. Electronic address: tryggve.neveus@kbh.uu.se. 2. University of Rio de Janeiro State, Souza Marques School of Medicine, Pediatric Urodynamic Unit, Rio de Janeiro, Brazil. 3. Yale New Haven Children's Bladder and Continence Program, Yale-New Haven Hospital, New Haven, CT, 06520, USA. 4. Department of Urology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan. 5. Michigan State University, Department of Pediatric Urology, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA. 6. Department of Medical Psychology and Social Work, Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, Utrecht, 3508 AB, The Netherlands. 7. Department of Pediatric Nephrology, Ghent University Hospital, C. Heymanslaan 10, Gent, 9000, Belgium. 8. Hacettepe University, Department of Pediatric Urology, Ankara, Turkey. 9. Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi University, New Taipei, Taiwan. 10. Department of Pediatrics, Skejby Sygehus, Aarhus University Hospital, Aarhus N, 8200, Denmark.
Abstract
BACKGROUND: Enuresis is an extremely common condition, which, although somatically benign, poses long-term psychosocial risks if untreated. There are still many misconceptions regarding the proper management of these children. AIM: A cross-professional team of experts affiliated with the International Children's Continence Society (ICCS) undertook to update the previous guidelines for the evaluation and treatment of children with enuresis. METHODS: The document used the globally accepted ICCS terminology. Evidence-based literature served as the basis, but in areas lacking in primary evidence, expert consensus was used. Before submission, a full draft was made available to all ICCS members for additional comments. RESULTS: The enuretic child does, in the absence of certain warning signs (i.e., voiding difficulties, excessive thirst), not need blood tests, radiology or urodynamic assessment. Active therapy is recommended from the age of 6 years. The most important comorbid conditions to take into account are psychiatric disorders, constipation, urinary tract infections and snoring or sleep apneas. Constipation and daytime incontinence, if present, should be treated. In nonmonosymptomatic enuresis, it is recommended that basic advice regarding voiding and drinking habits be provided. In monosymptomatic enuresis, or if the above strategy did not make the child dry, the first-line treatment modalities are desmopressin or the enuresis alarm. If both these therapies fail alone or in combination, anticholinergic treatment is a possible next step. If the child is unresponsive to initial therapy, antidepressant treatment may be considered by the expert. Children with concomitant sleep disordered breathing may become dry if the airway obstruction is removed.
BACKGROUND:Enuresis is an extremely common condition, which, although somatically benign, poses long-term psychosocial risks if untreated. There are still many misconceptions regarding the proper management of these children. AIM: A cross-professional team of experts affiliated with the International Children's Continence Society (ICCS) undertook to update the previous guidelines for the evaluation and treatment of children with enuresis. METHODS: The document used the globally accepted ICCS terminology. Evidence-based literature served as the basis, but in areas lacking in primary evidence, expert consensus was used. Before submission, a full draft was made available to all ICCS members for additional comments. RESULTS: The enuretic child does, in the absence of certain warning signs (i.e., voiding difficulties, excessive thirst), not need blood tests, radiology or urodynamic assessment. Active therapy is recommended from the age of 6 years. The most important comorbid conditions to take into account are psychiatric disorders, constipation, urinary tract infections and snoring or sleep apneas. Constipation and daytime incontinence, if present, should be treated. In nonmonosymptomatic enuresis, it is recommended that basic advice regarding voiding and drinking habits be provided. In monosymptomatic enuresis, or if the above strategy did not make the child dry, the first-line treatment modalities are desmopressin or the enuresis alarm. If both these therapies fail alone or in combination, anticholinergic treatment is a possible next step. If the child is unresponsive to initial therapy, antidepressant treatment may be considered by the expert. Children with concomitant sleep disordered breathing may become dry if the airway obstruction is removed.
Authors: Ana Cecília de Sena Oliveira; Bruno da Silva Athanasio; Flávia Cristina de Carvalho Mrad; Monica Maria de Almeida Vasconcelos; Maicon Rodrigues Albuquerque; Débora Marques Miranda; Ana Cristina Simões E Silva Journal: Pediatr Nephrol Date: 2021-05-19 Impact factor: 3.714
Authors: Shaogen Zhong; Lichi Zhang; Mengxing Wang; Jiayao Shen; Yi Mao; Xiaoxia Du; Jun Ma Journal: Front Psychiatry Date: 2022-08-22 Impact factor: 5.435