Abstract
Enuresis, particularly in children during sleep, can be a debilitating condition, affecting the quality of life of the child and his or her family. The pathophysiology of nocturnal enuresis, though not clear, revolves around the inter-related mechanisms of overactive bladder, excessive nocturnal urine production, and sleep fragmentation. The first mechanism is more related to isolated nocturnal voiding, whereas the latter two are more related to nocturnal enuresis, in which circadian variations in arginine vasopressin hormone play a key role. A successful treatment would depend upon appropriately addressing the key factors precipitating nocturnal enuresis, necessitating an accurate diagnosis. Thus, advancements in diagnostic tools and treatment options play a key role in achieving overall success. This review summarizes recent advances in understanding the pathophysiology of nocturnal enuresis, diagnostic tools, and treatment options which can be explored in the future.
Highlights
Enuresis is a cause of social, psychological, and emotional distress and carries a significant clinical burden[1]
It commonly refers to nocturnal enuresis (NE), which is defined as involuntary voiding during sleep, at least once a month, when patients have been symptomatic for a minimum of three months[2]
The pathophysiology is unclear, NE is associated with a high arousal threshold and fragmented sleep, often associated with periodic limb movement disorder (PLMD)
Summary
Enuresis is a cause of social, psychological, and emotional distress and carries a significant clinical burden[1]. Transcutaneous electrical neural stimulation therapy (TENS), which is an established treatment option for hyperactive bladder and NMNE, has shown benefits in managing MNE as well In the latter group versus controls, this therapy significantly reduced the rate of wet nights (P = 0.02) and increased the rate of dry nights (P = 0.004) regardless of age or gender[45]. Urinary aquaporin 2, the major urine concentration factor, has come up as a biomarker of desmopressin treatment effectiveness during therapy This pediatric study in which patients were treated with 120 or 240 μg desmopressin orally disintegrating tablets was divided into responders and nonresponders.
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