Nocturnal enuresis

Abstract

The primary reason to diagnose and treat nocturnal enuresis is to achieve dryness. A secondary aim is to improve body image and/or low self-esteem associated with nocturnal enuresis. Primary outcome measures for therapy of nocturnal enuresis have been defined as follows: Short-term success: dryness for 14 consecutive nights Long-term success: dryness for 6 consecutive months Adverse treatment events Secondary outcome measures include psychological and quality-of-life assessments. Summary of evidence for these goals: Alarms achieve dryness for 14 consecutive nights during use in 50-75 % of enuretic children. Half of these maintain dryness when therapy stops. Desmopressin achieves dryness for 14 consecutive nights in approximately 20 % of treated children. Nearly all resume wetting when therapy stops. Desmopressin plus tolterodine was more effective than desmopressin plus placebo in one trial enrolling children with mono-symptomatic enuresis who failed desmopressin alone. Imipramine achieves dryness for 14 consecutive nights in 20-33 % of treated children. Approximately two-thirds relapse when treatment stops after 3 months. There are few data regarding efficacy of long-term medication use. Our review found no reports regarding 6-month dryness in treated patients. Children with enuresis have greater behavioral problems than non-bedwetters. However, successful treatment of enuresis is reported to not impact behavior significantly. One study reported improved self-concept with treatment.