Summary
Nocturnal enuresis is a symptom which causes distress in children and concern in parents. In order to prevent secondary emotional problems, enuresis deserves intervention. Treatment options can address several mechanisms. Urine production can be decreased by use of desmopressin treatment or fluid restrictions. Functional bladder size can be increased using imipramine treatment or bladder stretching exercises. While desmopressin and imipramine may have similar efficacy, desmopressin is a superior drug in terms of safety. Dryness also can be achieved by learning to wake at night using self-awakening programmes or enuresis alarms. Enuresis alarms continue to have the highest efficacy and the lowest relapse rate. Combined programmes using alarms and medication together can bring successful outcomes to most children.
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Aladjem M, Wohl R, Boichis H, Orda S, Lotan D, et al. Desmopressin in nocturnal enuresis. Archives of Disease in Childhood 57: 137–140, 1982
Baigrie RJ, Kelleher JP, Fawcell DP, Pengelly AW. Oxybutynin: is it safe? British Journal of Urology 62: 319–322, 1988
Bakwin H. Enuresis in twins. American Journal of Diseases of Children 21: 222–225, 1971
Berger RM, Maizels M, Moran GC, Conway JJ, Firlit CF. Bladder capacity (ounces) equals age (years) plus 2 predicts normal bladder capacity and aids in diagnosis of abnormal voiding patterns. Journal of Urology 129: 347–349, 1983
Birkásová M, Birkás O, Flynn MJ, Cort JH. Desmopressin in the management of nocturnal enuresis in children: a double-blind study. Pediatrics 62: 970–974, 1978
Blackwell B, Currah J. The psychopharmacology of nocturnal enuresis. In Kolvin I, et al. (Eds) Bladder control and enuresis, pp. 231–257, William Heinemann Medical Books, London, 1973
Buttarazzi PJ. Oxybutynin chloride (Ditropan) in enuresis. Journal of Urology 118: 46, 1977
De Jonge GA. Epidemiology of enuresis in bladder control and enuresis. In Kolvin et al. (Eds) pp. 39–46, Heinemann, London, 1973
Dimson SB. DDAVP and urine osmolality in refractory enuresis. Archives of Disease in Childhood 61: 1104–1107, 1986
Evans JHC. The efficacy of DDAVP in the treatment of nocturnal enuresis. In Meadow R (Ed.) Desmopressin in nocturnal enuresis. Proceedings of an International Symposium, London, 1989
Fordham KE, Meadow SR. Controlled trial of standard pad and bell alarm against mini alarm for nocturnal enuresis. Archives of Disease in Childhood 64: 651–656, 1989
Forsythe WI, Redmond A. Enuresis and spontaneous cure rate: study of 1129 enuretics. Archives of Disease in Childhood 49: 259–263, 1974
Forsythe WI, Butler RJ. Fifty years of enuretic alarms. Archives of Disease in Childhood 64: 879–885, 1989
Foxman B, Burciaga Valde ZR, Brook RJ. Childhood enuresis: prevalence, perceived impact and prescribed treatments. Pediatrics 77: 482–487, 1986
Fredericks CM, Anderson GF, Kreulen DL. A study of the anti-cholinergic and antispasmodic activity of oxybutynin (Ditropan) on rabbit detrusor. Investigative Urology 12: 317, 1975
Gillin JC, Rapoport JL, Mikkelsen EJ, Langer D, Vaskiver C, et al. EEG sleep patterns in enuresis: a further analysis and comparison with normal controls. Biological Psychiatry 17: 947–953, 1982
Hague M, Ellerstein NS, Gundy JH, Shelov SP, Weiss JC, et al. Parental perceptions of enuresis: a collaborative study. American Journal of Diseases of Children 135: 809–811, 1981
Herson VC, Schmitt BD, Rumack BH. Magical thinking and imipramine poisoning in two school-aged children. Journal of the American Medical Association 241: 1926–1927, 1979
Holt J, Borresen B. Enuresis nocturnal in school children in Bado. A therapeutic trial with a vasopressin analog: desmopressin and imipramine. Tidskkrift for den Norske Laegeforening 106: 651–654, 1986
Houts AC, Peterson JK, Whelan JP. Prevention of relapse in full-spectrum home training for primary enuresis: a components analysis. Behavior Therapy 17: 462–469, 1986
Kales A, Kales JD, Jacobson A, Humphrey FJ, Soldatos CR. Effects of imipramine on enuretic frequency and sleep stages. Pediatrics 60: 431–436, 1977
Klauber GT. Clinical efficacy and safety of desmopressin in the treatment of nocturnal enuresis. Journal of Pediatrics 114: 719–722, 1989
Kolvin I, Taunch J, Currah J, Garside RF, Nolan J, et al. Enuresis: a descriptive analysis and a controlled trial. Developmental Medicine and Child Neurology 14: 715–726, 1972
Lake CR, Mikkelsen EJ, Rapoport JL, Zavadil AP, Kopin IJ. Effect of imipramine on norepinephrine and blood pressure in enuretic boys. Clinical Pharmacology and Therapeutics 26: 647–653, 1979
Lovering JS, Tallett SE, McKendry JBJ. Oxybutynin efficacy in the treatment of primary enuresis. Pediatrics 81: 104–106, 1988
Marshall S, Marshall HH, Lyon RP. Enuresis: an analysis of various therapeutic approaches. Pediatrics 52: 813–817, 1973
Meadow SR. Management of nocturnal enuresis. In Meadow R (Ed.) Desmopressin in nocturnal enuresis. Proceedings of an International Symposium, London, pp. 16–21, 1989
Miller K, Goldberg S, Atkin B. Nocturnal enuresis: experience with long-term use of intranasally administered desmopressin. Journal of Pediatrics 114: 723–726, 1989
Mills JN. Diurnal rhythm in urine flow. Journal of Physiology 113: 528, 1951
Moffatt MEK. Nocturnal enuresis: psychologic implications of treatment and nontreatment. Journal of Pediatrics 114: 697–704, 1989
Nørgaard JP, Pedersen EB, Djurhuus JC. Diurnal antidiuretic hormone levels in enuretics. Journal of Urology 134: 1029–1031, 1985
Nørgaard JP, Rittig S, Djurhuus JC. Nocturnal enuresis: an approach to treatment based on pathogenesis. Journal of Pediatrics 114: 705–710, 1989
Olness K. The use of self-hypnosis in the treatment of childhood nocturnal enuresis: a report on forty patients. Clinical Pediatrics 14: 273–279, 1975
Parkin JM, Fraser MS. Poisoning as a complication of enuresis. Developmental Medicine and Child Neurology 14: 727–730, 1972
Post EM, Richman RA, Blackett PR, Duncan KP, Miller K. Desmopressin response of enuretic children. American Journal of Diseases of Children 137: 962–963, 1983
Rittig S, Knudsen UB, Nørgaard JP, Pedersen EB, Djurhuus JC. Abnormal diurnal rhythm of plasma vasopressin and urinary output in patients with enuresis. American Journal of Physiology 256: F664–F671, 1989a
Rittig S, Knudsen UB, Sorensen S, et al. Long-term double-blind cross-over study of desmopressin intranasal spray in the management of nocturnal enuresis. In Meadow R (Ed.) Desmopressin in nocturnal enuresis. Proceedings of an International Symposium, pp. 43-54, London, 1989b
Schmitt BD. New enuresis alarms: safe, successful, and child-operable. Contemporary Pediatrics 3: 77–84, 1986
Schmitt BD. Nocturnal enuresis: an update on treatment. Pediatric Clinics of North America 29: 21–36, 1982
Shapiro ST. Enuresis: treatment and overtreatment. Pediatric Nursing 11: 203–207, 1985
Starfield B. Increase in functional bladder capacity and improvements in enuresis. Journal of Pediatrics 72: 483–487, 1968
Sukhai RN, Mol J, Harris AS. Combined therapy of enuresis alarm and desmopressin in the treatment of nocturnal enuresis. European Journal of Pediatrics 148: 465–467, 1989
Thompson IM, Lauvetz R. Oxybutynin in bladder spasm, neurogenic bladder and enuresis. Urology 8: 452–454, 1976
Turner RK. Conditioning treatment of nocturnal enuresis: present status. In Kolvin L, et al. (Eds) Bladder control and enuresis, pp. 195–210, William Heinemann Medical Books, London, 1973
Wagner W, Johnson S, Walker D, Carter R, Wittner J. A controlled comparison of two treatments for nocturnal enuresis. Journal of Pediatrics 101: 302–307, 1982
Weider DJ, Hauri PJ. Nocturnal enuresis in children with upper airway obstruction. International Journal of Pediatric Otorhinolaryngology 9: 173–182, 1985
Willie S. Comparison of desmopressin and enuresis alarm for nocturnal enuresis. Archives of Disease in Childhood 61: 30–33, 1986
Wiseman HM, Guest K, Murray VS, Volans GN. Accidental poisoning in childhood: a multicentre survey, 2; the role of packaging in accidents involving medications. Human Toxicology 6: 303–314, 1987
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Schmitt, B.D. Efficacy and Safety of Drugs Available for the Treatment of Nocturnal Enuresis. Drug Invest 2 (Suppl 5), 9–16 (1990). https://doi.org/10.1007/BF03258236
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DOI: https://doi.org/10.1007/BF03258236