Primary enuresis

Abstract

Worldwide, about 10% of children (aged 6-7 years old) suffer from bedwetting; in other words, this condition is widespread but the impact is often underestimated. The training of family doctors very rarely included guidance with specific recommendations, the frequent approach being the expectation of spontaneous resolution. The purpose of this paper is to provide the family doctor, who takes care of the child, with a guideline in the management of nocturnal enuresis. Materials and method. The systematic review of existing practice guides and literature, articles and studies published between 2001 and 2021 (PubMed, Cochrane, BMJ, Elsevier, JAMA Network, The Lancet, New England Journal of Medicine, Springer Nature, Wiley), on primary nocturnal enuresis, led to the creation of a material that was the basis of this article. Discussion and conclusions. The initial assessment should include history, physical examination and urinalysis. Se­ve­ral conditions associated with enuresis need to be identified, evaluated and treated: constipation, obstructive sleep apnea, diabetes, diabetes insipidus, chronic kidney disease and psychiatric disorders. Treatment begins with counseling the child and parents about effective behavioral changes. First-line treatment includes bedside alarm therapy and desmopressin. The choice of therapy is based on the age of the child, the patterns of emptying at night and the wishes of the child and family. The recommendation to a pediatrician expert in the field is indicated for children with primary enuresis refractory to standard and combination therapies, as well as for children with some secondary cau­ses of enuresis, including urinary tract malformations, recurrent urinary tract infections or neurological disorders.