Bedwetting: Guidelines for primary care

Abstract

Introduction: Nocturnal enuresis (NE) is the most common paediatric urologic problem in Primary Care (PC). The prevalence is 6% to 10% among 7-year-olds. It may significantly alter both children and their families quality of life. The family physician should be aware of the problem and should be able to manage it properly. Objectives: To review and systematize the recently published data about the management of NE in children; to define a decision algorithm and the indications to refer to Secondary Care (SC). Methods: We searched the Medline, Cochrane and Portuguese Medical Index Publications to find articles published between 2000 and 2005. Review articles, systematic reviews, clinical trials, meta-analyses, clinical guidelines and Portuguese original studies were included. Relevant articles related to the previous ones were also obtained. SORT taxonomy was used. Results: The initial management of NE requires a clinical history, a directed physical examination and urinalysis. When NE represents a problem for the child, treatment should be offered. Counselling, Information and Positive Reinforcement should be the first intervention; in the absence of positive results we can use the Alarm or Desmopressin as therapeutic options. There is clinical evidence that Alarm should be the first therapeutic option, because of its higher probability of long-term success; however, significant motivation by the child and their families is required. Although Desmopressin has a more immediate effect, it also has higher relapse rates. When monotherapy does not result, the association of Alarm with Desmopressin is also an option. Polysymptomatic NE and no therapeutic success cases should be referred to SC. Conclusion: Children with Monosymptomatic NE can be treated by their Family Physician. An evidence based clinical decision algorithm in PC is proposed.