Nocturnal Enuresis Treatment: New Perspectives

Nocturnal enuresis (NE) is a very frequent problem, characterized by involuntary voiding during sleep in individuals aged five years or more, after exclusion of organic causes. This set of associated symptoms may lead to deterioration of bladder function, upper urinary tract and, in extreme cases, even renal failure. The prevalence of voiding dysfunctions is as high as 10% of the world's pediatric population. This commentary discusses the etiology, pathophysiology, and current approaches to therapeutic management of NE. Different studies have shown associations with genetic predisposition, hormonal and metabolic factors, and central nervous system maturation delay. The major pathogenetic mechanisms include nocturnal polyuria, detrusor over activity, and disturbed sleep. Psychologic and behavioral abnormalities seem to be a result, rather than a cause, of NE. We highlight the need for this condition not to be understood as an isolated phenomenon but as a combination of several possible factors in a particular child. Bedwetting is only part of a complex set of changes in children’s lives, which leads to important functional impairments and psychosocial disorders, often ignored by the family and even by the health professionals. The scenario of associated disorders demonstrates the need for a comprehensive approach.