Recommendations based on clinical practice guidelines on the definition, diagnosis and treatment of monosymptomatic enuresis in pediatric patients

Abstract

Introduction: Enuresis is a relatively frequent multifactorial condition that can significantly affect the quality of life of patients and their families. Therefore, the health care personnel must be updated and trained in the identification and correct management of this disorder. Having stated the above, the Colombian Association of Pediatric Nephrology (Asociación Colombiana de Nefrología pediátrica (ACONEPE)) and the Colombian Society of Urology Sociedad Colombiana de Urología (SCU) chapter of pediatric urology, committed to the health of the pediatric population, joined efforts to generate recommendations applicable to the Colombian context, which can be implemented in a practical, comprehensive and unified manner at the different levels of medical care for the patients with monosymptomatic enuresis. Objective: To generate recommendations on the definition, diagnosis and treatment of primary monosymptomatic enuresis in pediatric patients, based on clinical practice guidelines. Materials and methods: A systematic review of the clinical practice guidelines produced between 2010 and December 2, 2020; the electronic databases Medline (Pubmed), and Embase were consulted, as well as those of developer and compiler agencies of clinical practice guidelines (CPGs) and Ministries of Health. The selection of the evidence that supported the recommendations was based on the criteria defined by the Ministry of Health and the Institute for Health Technology Assessment of Colombia. The clinical practice guidelines (CPG) were rated by a paired application of the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool by a clinical expert and a methodological expert. The information (recommendations) of the guides was analyzed by the development group, considering the relevance of the recommendation to answer the questions, the validity and the implementability in the Colombian context. Preliminary recommendations were submitted for review and approval by an external panel, initially through a virtual consultation and later in a formal consensus session. Agreement was defined as the approval of at least 80% of the experts. The strength of the recommendations was graded as strong or conditional, considering the quality of the evidence, the risk-benefit ratio, equity in access, and associated costs. Both the developer group and the consulted panel declared their conflicts of interest. Results: From three selected CPGs with an AGREE score in domain 3 and 6 greater than 60%, 54 recommendations distributed in the categories of definition, diagnosis, treatment and follow-up of monosymptomatic enuresis were formulated. The review panel was made up of seven experts on the subject. The recommendations were approved with scores between 85.7% and 100%. Conclusions: The recommendations proposed and endorsed by experts on the subject will guide clinical decision-making regarding the care of patients with monosymptomatic enuresis, guaranteeing people-centered care, with high quality standards, and the generation of safety policies, health and wellness for multidisciplinary care teams.