Management and treatment of nocturnal enuresis-an updated standardization document from the International Children's Continence Society

被引:187
作者
Neveus, Tryggve [1 ]
Fonseca, Eliane [2 ]
Franco, Israel [3 ]
Kawauchi, Akihiro [4 ]
Kovacevic, Larisa [5 ]
Nieuwhof-Leppink, Anka [6 ]
Raes, Ann [7 ]
Tekgul, Serdar [8 ]
Yang, Stephen S. [9 ]
Rittig, Soren [10 ]
机构
[1] Uppsala Univ, Dept Womens & Childrens Hlth, S-75185 Uppsala, Sweden
[2] Univ Estado Rio De Janeiro, Souza Marques Sch Med, Pediat Urodynam Unit, Rio De Janeiro, Brazil
[3] Yale New Haven Med Ctr, Yale New Haven Childrens Bladder & Continence Pro, New Haven, CT 06520 USA
[4] Shiga Univ Med Sci, Dept Urol, Seta Tsukinowa Cho, Otsu, Shiga 5202192, Japan
[5] Michigan State Univ, Childrens Hosp Michigan, Dept Pediat Urol, 3901 Beaubien Blvd, Detroit, MI 48201 USA
[6] Univ Med Ctr Utrecht, Wilhelmina Childrens Hosp, Dept Med Psychol & Social Work, Urol, POB 85090, NL-3508 AB Utrecht, Netherlands
[7] Ghent Univ Hosp, Dept Pediat Nephrol, C Heymanslaan 10, B-9000 Ghent, Belgium
[8] Hacettepe Univ, Dept Pediat Urol, Ankara, Turkey
[9] Buddhist Tzu Chi Univ, Taipei Tzu Chi Hosp, Dept Urol, New Taipei, Taiwan
[10] Aarhus Univ Hosp, Dept Pediat, Skejby Sygehus, DK-8200 Aarhus N, Denmark
关键词
Enuresis; Desmopressin; Enuresis alarm; Anticholinergics; Antidepressants; Comorbidity; DESMOPRESSIN LYOPHILISATE MELT; PERIODIC LIMB MOVEMENTS; URINARY-INCONTINENCE; SLEEP; THERAPY; ADOLESCENTS; IMIPRAMINE; OUTPUT; ALARM; CONSTIPATION;
D O I
10.1016/j.jpurol.2019.12.020
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Background Enuresis is an extremely common condition, which, although somatically benign, poses long-term psychosocial risks if untreated. There are still many misconceptions regarding the proper management of these children. Aim A cross-professional team of experts affiliated with the International Children's Continence Society (ICCS) undertook to update the previous guidelines for the evaluation and treatment of children with enuresis. Methods The document used the globally accepted ICCS terminology. Evidence-based literature served as the basis, but in areas lacking in primary evidence, expert consensus was used. Before submission, a full draft was made available to all ICCS members for additional comments. Results The enuretic child does, in the absence of certain warning signs (i.e., voiding difficulties, excessive thirst), not need blood tests, radiology or urodynamic assessment. Active therapy is recommended from the age of 6 years. The most important comorbid conditions to take into account are psychiatric disorders, constipation, urinary tract infections and snoring or sleep apneas. Constipation and daytime incontinence, if present, should be treated. In nonmonosymptomatic enuresis, it is recommended that basic advice regarding voiding and drinking habits be provided. In monosymptomatic enuresis, or if the above strategy did not make the child dry, the first-line treatment modalities are desmopressin or the enuresis alarm. If both these therapies fail alone or in combination, anticholinergic treatment is a possible next step. If the child is unresponsive to initial therapy, antidepressant treatment may be considered by the expert. Children with concomitant sleep disordered breathing may become dry if the airway obstruction is removed.
引用
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页码:10 / 19
页数:10
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