Pediatric Urinary Dysfunction and Enuresis Management
Summary
Pediatric urinary dysfunction encompasses a spectrum of disorders affecting the lower urinary tract, including overactive bladder, underactive bladder, dysfunctional voiding and voiding postponement. Monosymptomatic nocturnal enuresis—bedwetting in the absence of daytime symptoms—affects up to 10 % of five‐year‐olds and declines with age, while non‐monosymptomatic enuresis often coexists with daytime incontinence and comorbidities such as constipation or behavioural disorders. Aetiological factors range from genetic predisposition and delayed bladder maturation to psychosocial stressors. Untreated dysfunction may lead to recurrent urinary tract infections, renal scarring and impaired self‐esteem. Diagnosis relies on detailed clinical history, bladder diaries, validated symptom scores (for example the Dysfunctional Voiding Symptom Score), non‐invasive investigations such as uroflowmetry and ultrasound measurement of post‐void residual volume, and, when indicated, urodynamic studies. First‐line management centres on urotherapy, which includes education about fluid intake, timed voiding, bladder retraining and pelvic floor exercises. Adjunctive interventions comprise enuresis alarms, behavioural modification, management of constipation and psychosocial support. Pharmacotherapy options include desmopressin for nocturnal polyuria, anticholinergic agents or β3‐agonists for overactivity and neuromodulation techniques for refractory cases. A multidisciplinary approach that integrates physical, psychological and social dimensions is essential to optimise outcomes and quality of life.
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Pediatric Urinary Dysfunction and Enuresis Management publication trend
The graph below shows the total number of articles in pediatric urinary dysfunction and enuresis management across all publications each year (not limited to Nature Index journals).
Technical terms
Lower urinary tract dysfunction (LUTD): A group of disorders characterised by abnormal bladder storage and voiding patterns in the absence of neurological disease.
Monosymptomatic nocturnal enuresis: Involuntary urination during sleep in children aged ≥5 years with no other lower urinary tract symptoms.
Urotherapy: A non‐pharmacological intervention combining education, behavioural modification and pelvic floor training to normalise bladder function.
Desmopressin: A synthetic analogue of antidiuretic hormone used to reduce nocturnal urine production.
Copeptin: A stable peptide derived from the precursor of vasopressin, serving as a surrogate biomarker for antidiuretic hormone activity.
References
- Copeptin improves prediction of treatment response in children with monosymptomatic nocturnal enuresis. European Journal of Endocrinology (2023).
- A systematic review and meta-analysis assessing the efficacy of Tuina for nocturnal enuresis in children. Frontiers in Pharmacology (2024).
- Continence Problems and Mental Health in Adolescents from a UK Cohort. European Urology (2023).
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