Treatment of Nocturnal Enuresis

Initial Assessment and Diagnosis

• The American Academy of Child and Adolescent Psychiatry recommends a thorough evaluation to determine the underlying pathophysiological mechanism of nocturnal enuresis, including a detailed voiding history and screening for sleep disorders 1, 5
• The American Urological Association suggests evaluating for constipation, as it can contribute to enuresis, and assessing fluid intake patterns 4
• Urinalysis is recommended to rule out infection, diabetes, or kidney disease, according to the American Academy of Child and Adolescent Psychiatry 1, 6

Treatment Algorithm

• The American Academy of Child and Adolescent Psychiatry recommends behavioral modifications, including a regular daytime voiding schedule, evening fluid restriction, and voiding immediately before sleep, as first-line treatment for nocturnal enuresis 2
• Desmopressin is effective in patients with nocturnal polyuria, with approximately 30% full response rate and 40% partial response, according to the American Urological Association 2
• The American Academy of Child and Adolescent Psychiatry suggests using desmopressin plus an alarm for resistant cases, with caution to avoid excessive fluid intake and prevent hyponatremia 2

Monitoring and Follow-up

• Regular follow-up, ideally monthly, is recommended to sustain motivation and assess response to therapy, according to the American Urological Association 7
• The American Urological Association suggests assessing response after 1-2 months of therapy and continuing treatment for at least 2-3 months before attempting to wean 2

Common Pitfalls to Avoid

• Failing to screen for underlying medical conditions, such as sleep disorders or constipation, can lead to inadequate treatment, according to the European Urology association and the American Academy of Child and Adolescent Psychiatry 1, 5
• Inadequate duration of treatment before declaring failure can lead to unnecessary changes in therapy, according to the American Urological Association 7
• Excessive fluid intake while on desmopressin can increase the risk of hyponatremia, according to the American Urological Association 2