Nocturnal enuresis—theoretic background and practical guidelines

Abstract

Nocturnal polyuria, nocturnal detrusor overactivity and high arousal thresholds are central in the pathogenesis of enuresis. An underlying mechanism on the brainstem level is probably common to these mechanisms. Enuretic children have an increased risk for psychosocial comorbidity. The primary evaluation of the enuretic child is usually straightforward, with no radiology or invasive procedures required, and can be carried out by any adequately educated nurse or physician. The first-line treatment, once the few cases with underlying disorders, such as diabetes, kidney disease or urogenital malformations, have been ruled out, is the enuresis alarm, which has a definite curative potential but requires much work and motivation. For families not able to comply with the alarm, desmopressin should be the treatment of choice. In therapy-resistant cases, occult constipation needs to be ruled out, and then anticholinergic treatment—often combined with desmopressin—can be tried. In situations when all other treatments have failed, imipramine treatment is warranted, provided the cardiac risks are taken into account.

Capacidad vesical funcional mediante ultrasonido en pacientes con enuresis primaria monosintomática

“…Arnell et al, en un estudio multicéntrico reportó el 52% de los pacientes tenían familiares de primer grado con afectación 13 . Existen tres mecanismos etiopatogénicos sustentados científicamente que pueden explicar la enuresis: poliuria nocturna, hiperactividad nocturna del detrusor y umbrales altos de excitación 14 . La teoría de que la disminución de la capacidad vesical funcional puede ser la causa de la enuresis primaria no es nueva y la revisión de la literatura aporta datos controversiales, algunos la han medido con diarios miccionales (registro de volumen y frecuencia de micción) y pocos reportes existen con medición por ultrasonido 2,7,8 .…”

“…La capacidad vesical funcional (CVF) disminuida así como disfunción del vaciamiento y marcada hiperactividad del detrusor son causas de falla al tratamiento y síntomas refractarios 1,2 . A la fecha existen tres mecanismos fisiopatológicos que explican la enuresis: poliuria nocturna, hiperactividad nocturna del detrusor y umbrales altos de excitación, éstos dos últimos se pueden relacionar a disminución de la capacidad vesical 3,4 . Así mismo existen estudios que han demostrado que en niños con enuresis la capacidad vesical se encuentra disminuída hasta en el 50% de los casos, sin embargo, los reportes son inconsistentes y dependen de la variabilidad inter-individual de cada paciente.…”

High Concurrence of Nocturnal Enuresis and Associated Factors among South Chinese Children

“…Possible factors contributing to NE include nocturnal polyuria, nocturnal detrusor over-activity, and high arousal thresholds [20]. In this study, 63.3% wetted after midnight, which may reflect the circadian rhythm of anti-diuretic hormone (ADH) and bladder filling in the second half of the night [21].…”

Noktürnal enürezis

“…Stretching of the bladder and detrusor contraction are considerably strong awakening signals (25). Therefore, epidemiological studies have shown that enuretic children are "deep sleepers" as many families have also emphasized.…”