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No AccessJournal of UrologyReview Article1 Feb 2010

Evaluation of and Treatment for Monosymptomatic Enuresis: A Standardization Document From the International Children's Continence Society

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We provide updated, clinically useful recommendations for treating children with monosymptomatic nocturnal enuresis.

Materials and Methods:

Evidence was gathered from the literature and experience was gathered from the authors with priority given to evidence when present. The draft document was circulated among all members of the International Children's Continence Society as well as other relevant expert associations before completion.


Available evidence suggests that children with monosymptomatic nocturnal enuresis could primarily be treated by a primary care physician or an adequately educated nurse. The mainstays of primary evaluation are a proper history and a voiding chart. The mainstays of primary therapy are bladder advice, the enuresis alarm and/or desmopressin. Therapy resistant cases should be handled by a specialist doctor. Among the recommended second line therapies are anticholinergics and in select cases imipramine.


Enuresis in a child older than 5 years is not a trivial condition, and needs proper evaluation and treatment. This requires time but usually does not demand costly or invasive procedures.


  • 1 : The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society (ICCS). J Urol2006; 176: 314. LinkGoogle Scholar
  • 2 : Abnormal diurnal rhythm of plasma vasopressin and urinary output in patients with enuresis. Am J Physiol1989; 256: F664. Google Scholar
  • 3 : The efficacy of DDAVP is related to the circadian rhythm of urine output in patients with persisting nocturnal enuresis. Clin Endocrinol (Oxf)1998; 49: 793. Google Scholar
  • 4 : The day and night urine output of urine in enuresis. Arch Dis Child1959; 31: 439. Google Scholar
  • 5 : Diurnal plasma vasopressin and urinary output in adolescents with monosymptomatic nocturnal enuresis. Acta Paediatr1997; 86: 385. Google Scholar
  • 6 : Bladder dysfunction in children with refractory monosymptomatic primary nocturnal enuresis. J Urol1999; 162: 1049. LinkGoogle Scholar
  • 7 : Elevated sleep arousal thresholds in enuretic boys: clinical implications. Acta Paediatr1997; 86: 381. Google Scholar
  • 8 : Constipation a commonly unrecognized cause of enuresis. Am J Dis Child1986; 140: 260. Google Scholar
  • 9 : Attention deficit/hyperactivity disorder in children with nocturnal enuresis. J Urol2004; 171: 2576. LinkGoogle Scholar
  • 10 : Characteristics of primary nocturnal enuresis in adults: an epidemiological study. BJU Int2004; 93: 341. Google Scholar
  • 11 : Self-esteem before and after treatment in children with nocturnal enuresis and urinary incontinence. Scand J Urol Nephrol1997; 183: 79. Google Scholar
  • 12 : Differences in characteristics of nocturnal enuresis between children and adolescents: a critical appraisal from a large epidemiological study. BJU Int2006; 97: 1069. Google Scholar
  • 13 : Primary and secondary nocturnal enuresis: similarities in presentation. Pediatrics2005; 115: 956. Google Scholar
  • 14 : Clinical behavioral problems in day- and night-wetting children. Pediatr Nephrol1999; 13: 662. Google Scholar
  • 15 : Constipation in infants and children: evaluation and treatment: A medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr1999; 29: 612. Google Scholar
  • 16 : Manual for the Child Behavior Checklist/4-18 and 1991 Profile. Burlington, Vermont: University of Vermont1991. Google Scholar
  • 17 : Nocturnal enuresis and upper airway obstruction. Int J Pediatr Otorhinolaryngol2001; 59: 115. Google Scholar
  • 18 : Ultrasound bladder measurements in children with severe primary nocturnal enuresis: pretreatment and posttreatment evaluation and its correlation with treatment outcome. J Urol2008; 179: 1568. LinkGoogle Scholar
  • 19 : Simple behavioural and physical interventions for nocturnal enuresis in children. Cochrane Database Syst Rev2004; . CD003637. Google Scholar
  • 20 : A randomized, prospective, comparison study of polyethylene glycol 3350 without electrolytes and milk of magnesia for children with constipation and fecal incontinence. Pediatrics2006; 118: 528. Google Scholar
  • 21 : Alarm Interventions for Nocturnal Enuresis in Children (Cochrane Review): The Cochrane Library. Oxford: Update Software2007. Google Scholar
  • 22 : Exploring potential mechanisms in alarm treatment for primary nocturnal enuresis. Scand J Urol Nephrol2007; 41: 407. Google Scholar
  • 23 : Changes in nocturnal bladder capacity during treatment with the bell and pad for monosymptomatic nocturnal enuresis. J Urol1998; 160: 166. LinkGoogle Scholar
  • 24 : Prevention of relapse in full-spectrum home training for primary enuresis: a component analysis. Behav Ther1986; 17: 462. Google Scholar
  • 25 : Combined treatment with enuresis alarm and desmopressin for nocturnal enuresis. Acta Pædiatr1995; 84: 1014. Google Scholar
  • 26 : Evidence against a synergistic effect of desmopressin with conditioning in the treatment of nocturnal enuresis. J Pediatr2004; 144: 351. Google Scholar
  • 27 : Desmopressin for nocturnal enuresis. Cochrane Database Syst Rev2002; . CD002112. Google Scholar
  • 28 : Effect of 1-desamino-8-d-arginine vasopressin on prepulse inhibition of startle supports a central etiology of primary monosymptomatic enuresis. J Pediatr2007; 151: 571. Google Scholar
  • 29 : The influence of small functional bladder capacity and other predictors on the response to desmopressin in the management of monosymptomatic nocturnal enuresis. J Urol1996; 156: 651. LinkGoogle Scholar
  • 30 : The comparative safety of oral versus intranasal desmopressin for the treatment of children with nocturnal enuresis. J Urol2007; 178: 24. LinkGoogle Scholar
  • 31 : Antidiuretic effect and pharmacokinetics of oral 1-desamino-8-d-arginine vasopressin: 1. Studies in adults and children. J Clin Endocrinol Metab1986; 63: 129. Google Scholar
  • 32 : Desmopressin-resistant enuresis: pathogenetic and therapeutic considerations. J Urol1999; 162: 2136. LinkGoogle Scholar
  • 33 : Effectiveness of oxybutynin hydrochloride in the treatment of enuresis nocturna. Scand J Urol Nephrol1999; 33: 115. Google Scholar
  • 34 : Combination therapy with desmopressin and an anticholinergic medication for nonresponders to desmopressin for monosymptomatic nocturnal enuresis: randomized, double-blind, placebo-controlled trial. Pediatrics2008; 122: 1027. Google Scholar
  • 35 : Tolterodine versus oxybutynin in the treatment of urge incontinence: a meta-analysis. Am J Obstet Gynecol2001; 185: 56. Google Scholar
  • 36 : Tricyclic and related drugs for nocturnal enuresis in children. Cochrane Database Syst Rev2000; . CD002117. Google Scholar
  • 37 : Imipramine for therapy resistant enuresis: a retrospective evaluation. J Urol2004; 171: 2607. LinkGoogle Scholar
  • 38 : Death of two subjects due to imipramine and desipramine metabolite accumulation during chronic therapy: a review of the literature and possible mechanisms. J Forensic Sci1997; 42: 335. Google Scholar
  • 39 : Electro-acupuncture in the treatment of children with monosymptomatic nocturnal enuresis. Scand J Urol Nephrol2000; 34: 21. Google Scholar
  • 40 : Acupuncture therapy in the management of persistent primary nocturnal enuresis—preliminary results. Scand J Urol Nephrol2001; 35: 40. Google Scholar
  • 41 : Behavioral therapy for primary nocturnal enuresis. J Urol2004; 171: 408. LinkGoogle Scholar
  • 42 : Daytime bladder dysfunction in therapy-resistant nocturnal enuresis. A pilot study in urotherapy. Scand. J Urol Nephrol1999; 33: 49. Google Scholar
  • 43 : Low-calcium diet in hypercalciuric enuretic children restores AQP2 excretion and improves clinical symptoms. Am J Physiol Renal Physiol2002; 283: F895. Google Scholar
  • 44 : Desmopressin resistant nocturnal polyuria may benefit from furosemide therapy administered in the morning. J Urol2007; 178: 2635. LinkGoogle Scholar
  • 45 : Reboxetine in therapy-resistant enuresis: results and pathogenetic implications. Scand J Urol Nephrol2006; 40: 31. Google Scholar
  • 46 : Combination of the enuresis alarm and desmopressin: Second line treatment for enuresis nocturna. J Urol2008; 179: 1128. LinkGoogle Scholar