| خلاصه مقاله | Introduction: Nocturnal Enuresis (NE) is defined as spontaneous voiding during sleep at
least twice a week in a child five years or older. NE has an age-related prevalence that is
about 15-20% at five years of age (M/F=1) declining to 1-3% at adolescence (M/F=2).
Discussion: NE is an especially common problem with the potential to have an appreciable
negative impact on the emotional health of a child and his or her family. It is traditionally
subdivided into primary (PNE: 80%, bed-wetting in a child who has never been dry) and
secondary (SNE: 20%, bed-wetting in a child who has had at least six months of nighttime
dryness) forms. NE is also divided into monosymptomatic (MNE) and polysymptomatic
(PNE) forms. MNE is defined as present when the child does not have any associated voiding
symptom when awake such as frequency, urgency, daytime incontinence or encopresis.
NE is not simply a single disease, but should be regarded as a group of conditions with
different etiologies, including: a disorder of sleep arousal, a low nocturnal bladder capacity,
and nocturnal polyuria that their contribution together will result in nocturnal enuresis.
Constipation and cystitis are also common and often undiagnosed factors that significantly
affect bladder function and capacity. Treatment of any single patient should be aimed at those
conditions that are diagnosed as preliminary causes.
1- An enuresis alarm is effective in children with monosymptomatic nocturnal enuresis;
2- Dry-bed training and bladder training alone are not recommended to treat primary
nocturnal enuresis.
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3- Desmopressin (DDAVP) is mostly recommended for children with monosymptomatic
enuresis who have nocturnal polyuria and normal bladder capacity.
4- Anticholinergics are useful in children with urgency, restricted bladder capacity from
detrusor hyperactivity at night, and combined daytime wetting and nocturnal incontinence
and in children who do not respond to desmopressin (DDAVP).
5- Constipation should be treated with a laxative such as polyethylene glycol.
Conclusion: Multidimensional strategies: to improve arousal (by Behavioral therapy /
Bedwetting-alarm therapy), to reduce nocturnal polyuria, to resolve constipation, and to
increase functional bladder capacity can result in the resolution of nocturnal enuresis. |