Evaluation of and Treatment for Monosymptomatic Enuresis: A Standardization Document From the International Children's Continence Society

TLDR

Monosymptomatic nocturnal enuresis is a common pediatric condition that can be managed by primary care physicians or trained nurses, and the draft recommendations were circulated among ICCS members and other experts before finalization. The document aims to update and provide clinically useful recommendations for treating children with monosymptomatic nocturnal enuresis, based on literature evidence and expert experience. The recommendations were developed through literature review and expert consensus, with primary evaluation using history and voiding chart, primary therapy of bladder advice, enuresis alarm, and/or desmopressin, and specialist referral for resistant cases. Second‑line therapies include anticholinergics and, in selected cases, imipramine; enuresis in children over five requires thorough evaluation and treatment, which is time‑consuming but generally inexpensive and non‑invasive.

Abstract

We provide updated, clinically useful recommendations for treating children with monosymptomatic nocturnal enuresis.Evidence was gathered from the literature and experience was gathered from the authors with priority given to evidence when present. The draft document was circulated among all members of the International Children's Continence Society as well as other relevant expert associations before completion.Available evidence suggests that children with monosymptomatic nocturnal enuresis could primarily be treated by a primary care physician or an adequately educated nurse. The mainstays of primary evaluation are a proper history and a voiding chart. The mainstays of primary therapy are bladder advice, the enuresis alarm and/or desmopressin. Therapy resistant cases should be handled by a specialist doctor. Among the recommended second line therapies are anticholinergics and in select cases imipramine.Enuresis in a child older than 5 years is not a trivial condition, and needs proper evaluation and treatment. This requires time but usually does not demand costly or invasive procedures.