Enuresis nocturna treatment and consequences state of the art

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Presentation transcript:

Enuresis nocturna treatment and consequences state of the art J.Vande Walle

Before 1989 Nocturnal enuresis Was a benign condition Not harming anybody Selflimiting.. since it disappeared spontaneously Not necessary to treat, except in rare cases And if there was a cause..it was generally accepted that it had to be a psychological cause

Inability to awaken when this occurs Nocturnal enuresis is caused by a mismatch between nocturnal urine volume and nocturnal bladder capacity + Inability to awaken when this occurs

Dysfunctional voiding Nocturnal diuresis < bladder volume Polyuria Normal BV Small Bladder < normal diuresis Dysfunctional voiding monosymptomatic ???

Treatment aspects of nocturnal enuresis part1 Johan Vande Walle Pediatric Uro-Nephrological Centre UGent / UZGent 3 / 8 /2012

ICCS screening tool: CMT

ICCS screening tool: diaries 4 Days (weekend/holiday) Time Volume of drinks (ml) Volume of urine (ml) Leakage of urine? 7 consecutive nights Time going to bed Time getting up Dry or wet night? Volume of nocturia void Diaper weight in the morning (nett) Volume of first morning void Bowel movement during the day? nocturnal urine production

HOW TO TREAT ? Practical guidelines J. Vande Walle, S.Bauer, S Tekgull, J Evans, S Rittig, P Eggert; Eur J Pediatrics 2012

Step 1 Step 1 Urotherapy advice In NMNE In MNE / NO evidence Step 2 based on clinical management tool Practical guidelines J. Vande Walle, Rittig et al; Eur J Pediatrics 2012

screening Evidence for MNE or NMNE Identify comorbidity maybe interfering with response-rate Combined disorder Constipation/ encopresis History of UTI, uropathy, day time symptoms ADHD, ADD, autism Mentally and motoric disability Sleeping disorders (snorring, waking up, restless legs ) Practical guidelines J. Vande Walle, Rittig et al; Eur J Pediatrics 2012

Low diuresis V Large MVV