Enuresis monosymptomatic

Five to ten percent of children with enuresis will suffer the condition as adults. It may also predispose to UUI in adults. In the enuretic population, 80% to 85% are monosymptomatic, 5% to 10% are polysymptomatic, and under 5% have an organic cause. The spontaneous annual cure rate (i.e., restoration of continence) ranges from 14% to 16% (exception at about 4 or 5 years of age, it may be as high as 30%). 

In the absence of an identified cause and comorbidities, monosymptomatic nocturnal enuresis is present which can be amenable to nonpharmacologic and pharmacologic therapies. Nonpharmacologic therapy should be utilized initially, provided that the patient and family are sufficiently motivated. Use of one nonpharmacologic method at a time is reasonable, provided that each is given an adequate trial period. If response is suboptimal after 6 months, a different method should be substituted or added. There is some evidence to... 

Oxybutynin has no significant effect in monosymptomatic nocturnal enuresis. Oxybutynin and related agents (see adult UI section of this chapter) should be used only if the patient has concurrent daytime urgency or frequency. 

Tullus, K., Bergstron, R., Fosdal, I., Winnergard, I., and Hjalmas, K. (1999) Efficacy and safety during long-term treatment of primary monosymptomatic nocturnal enuresis with desmopressin. Acta Paediatr. 88 1274-1278. 

Hjalmas K, Hanson E, Hellstrom AL, Kruse S, Sillen U. Long-term treatment with desmopressin in children with primary monosymptomatic nocturnal enuresis an open multicentre study. Swedish Enuresis Trial (SWEET) Group. Br J Urol 1998 82(5) 704-9. 

Rushton HG, Belman AB, Skoog S, et al. Predictors of response to desmopressin in children and adolescents with monosymptomatic nocturnal enuresis. Scand J Urol Nephrol 1995 173 109-111. 

Eller DA, Austin PF, Tanguay S, Homsy YL. Daytime functional bladder capacity as a predictor of response to desmopressin in monosymptomatic nocturnal enuresis. Eur Urol 1998 S33 25-29. 

Nervous system The safety of desmopressin in children with primary monosjmiptomatic nocturnal enuresis has been reviewed [86 ]. After 61 cases of seizures, including two deaths, the FDA asked that the prescribing information be changed in 2007 to state that desmopressin spray is no longer indicated for monosymptomatic nocturnal enuresis or in patients at risk of hyponatremia. The authors of the review concluded that hyponatremia often resulted from inappropriately high doses of desmopressin and usually occurs in the elderly people they supported continuing the use of desmopressin to treat monosymptomatic nocturnal enuresis imder appropriate medical supervision. Hyponatremia has been reported more commonly with the spray than with the oral formulation this may reflect differences in pharmacokinetics or more extensive evaluation of the spray. 

Van de Walle J, Van Herzeele C, Raes A. Is there still a role for desmopressin in children with primary monosymptomatic nocturnal enuresis A focus on safety issues. Drug Saf 2010 33(4) 261-71. 

Any attempt to make the important distinction between monosymptomatic nocturnal enuresis and incontinence based on the patient s history and clinical symptoms alone may fail and occult underlying functional disorders of the lower urinary tract may be overlooked. This may contribute to the different rates of success for a heterogeneous spectrum of therapeutic measures in different studies and may contribute to different statements regarding prognosis and associated disorders of enuresis. 

Distinction should be made between monosymptomatic enuresis nocturna and incontinence. Patients with persistent and severe monosymptomatic enuresis nocturna despite treatment should undergo kidney and bladder ultrasound and VCU as well, if there are positive ultrasound findings and/or a history of urinary tract infection. In wetting children (daytime with or without nighttime urinary incontinence) with urinary tract infection with/without urge, kidney and bladder ultrasound and a VCU have to be performed as well. Assessment of potential stool retention has to be part of the imaging studies. 

We do not perform VCU for monosymptomatic, primary nocturnal enuresis or initially in children with daytime and nighttime wetting in the absence of severe urge, urge incontinence or UTI. 

In primary monosymptomatic enuresis nocturna and in children with minor wetting before treatment and without irritative voiding symptoms and without urinary tract infection, VCU should not be performed. 

---