Brazilian consensus in enuresis–recomendations for clinical practice

Abstract

Introduction Enuresis, defined as an intermittent urinary incontinence that occurs during sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientific and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches. Materials and Methods The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document. Results and Discussion Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.

The effectiveness of parasacral transcutaneous electrical nerve stimulation in the treatment of monosymptomatic enuresis in children and adolescents: a systematic review

“…Additionally, a bladder and bowel diary, dry night diary, and a urinalysis (which includes a urine dipstick to detect glycosuria and leukocytosis) should be ordered ( 1 , 2 , 6 , 16 ). If children experience polyuria and polydipsia, it is recommended to test for diabetes insipidus ( 6 ). If there is suspicion of neurogenic or anatomical problems in the bladder, additional tests such as urodynamic evaluation may be necessary ( 16 ).…”

“…The exact etiology of enuresis is not yet fully understood. It is considered multifactorial (1,2,(6)(7)(8)(9)(10)(11). One of the main factors involved in the pathophysiology of enuresis are hereditary factors (1,2,(4)(5)(6).…”

Exploration of the Optimal Desmopressin Treatment in Children With Monosymptomatic Nocturnal Enuresis: Evidence From a Chinese Cohort

“…Patients without daytime symptoms are categorized as having monosymptomatic nocturnal enuresis (MNE) and desmopressin (dDAVP) is a firstline therapy for patients with MNE. The standard recommended dose for treating MNE is 0.2-0.4 mg tablets, and the literature strongly supports that the dose should be gradually increased until dryness is achieved (4)(5)(6). For partial responders and nonresponders, dDAVP is often increased by 0.2 mg increments to the maximal recommended dose until dryness is achieved.…”

Weak clinical effect of airway clearance on ADH and BNP concentration: mechanism or data collection BIAS

“…These episodes occur at a time when the child should, under normal circumstances, be able to control urination. In addition, although some causes are more common, such as lack of pelvic floor muscle control ( 2 ) and the presence of psychiatric disorders ( 3 ), there are also pathophysiological factors that can lead to the onset of nocturnal enuresis, such as obstruction of the upper airways ( 4 ).…”

“…that are activated in these situations. This increase in BNP, due to the pathophysiological condition of OSA, causes inhibition of the secretion of antidiuretic hormone (ADH), which regulates diuresis through the reabsorption of water in the collecting ducts ( 4 ).…”