Enuresis: Pathophysiology and treatment

Bedwetting is a common world-wide finding in school-age children (around 7% of 7-year-old children); it can be related to monosymptomatic nocturnal enuresis (MNE) in more than half of cases and to bladder dysfunction in the remainder. In most subjects, the diagnostic procedure is limited to patient and family history since physical examination is normal. The pathophysiology of MNE remains uncertain. It is likely that there are several kinds of MNE according to clinical features (polyuria? sleep disorders? response to desmopressin? psychopathological problems? primary/secondary trouble?) therefore leading to different therapeutic approaches. From a practical point of view, most patients respond well to either alarm system or desmopressin, which give significant results compared to placebo; tricyclic agents should be avoided because of their potential life-threatening adverse events. Further advances are expected in the pathophysiology and management of such a common disorder. (C) 1999 Harcourt Publishers Ltd.