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

3. 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

4. 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

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

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

7. ICCS screening tool: CMT

8. 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

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

10. 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

12. 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

14. Low diuresis V Large MVV