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Diagnosis and treatment of nocturnal enuresis in children

Korean Journal of Pediatrics 2008;51(11):1140-1146.
Published online November 15, 2008.
Diagnosis and treatment of nocturnal enuresis in children
Chang Hee Hong1, Minki Baek2, Seong Ho Lee3, Jeong Won Lee4, Ki-Soo Pai5
1Department of Urology, Yonsei University College of Medicine, Seoul, Korea
2Department of Urology, Konkuk University College of Medicine, Seoul, Korea
3Department of Urology, School of Medicine, Hallym University, Seoul, Korea
4Department of Pediatrics, Kangnam Sacred Heart Hospital College of Medicine, Hallym University, Seoul, Korea
5Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
야뇨증의 진단과 치료에 대한 최신지견
홍창희1, 백민기2, 이성호3, 이정원4, 배기수5
1연세대학교 의과대학 비뇨기과학교실
2건국대학교 의과대학 비뇨기과학교실
3한림대학교 의과대학 비뇨기과학교실
4한림대학교 의과대학 소아과학교실
5아주대학교 의과대학 소아과학교실
Ki-Soo Pai, Email: kisoopai@ajou.ac.kr
Nocturnal enuresis is a heterogeneous disorder with various underlying pathophysiological mechanisms and causes a mismatch between the nocturnal bladder capacity and the amount of urine produced during sleep at night. It is associated with a simultaneous failure of conscious arousal in response to the sensation of bladder fullness. Generally, a complete history and physical examination, with a specific focus on the genitourinary, gastrointestinal, and neurologic systems, is sufficient to evaluate a patient with enuresis. The therapeutic focus is directed toward a differential approach based on the underlying mechanism and toward combination therapies such as alarm devices and desmopressin as well as anticholinergic agents and desmopressin. Children with increased nocturnal urine production usually have a good response to desmopressin therapy. Patients with a small bladder generally show a poor response to desmopressin treatment, but they would benefit more from combination therapy with enuretic alarm, urotherapy, and antimuscarinic agents in addition to desmopressin. Different types of bladder dysfunction, which result in a small nocturnal bladder capacity, probably contribute significantly to the pathogenesis of nocturnal enuresis, particularly in those with treatment failure and refractory symptoms. Because different clinical subgroups may show different responses to treatment, it is necessary to distinguish these subgroups before a decision on the specific treatment protocol can be made.
Key Words: Enuresis, Pathophysiologic mechanisms, Combination therapy

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