DIFFERENT THERAPEUTIC STRATEGIES OF NOCTURNAL ENURESIS IN CHILDREN: A REVIEW OF LITERATURE

Abstract

Aim The aims of this review are to provide a comprehensive overview of the management of Primary Monosymptomatic Nocturnal Enuresis (PMNE) first of all considering the advantages and disadvantages of the high-level-evidence treatment, then analysing other therapeutic strategies proposed in literature with lower-level-evidence. We also want to explore the most recent advances in the management with particular attention on the role of educational and motivational therapy both of the child and parents. Materials and methods The database MEDLINE (via Pubmed, http://www.ncbi.nlm.nih.gov/pubmed) was used to identify relevant studies published in worldwide between 2009 and March 2018. The studies were selected according the following inclusion criteria: PMNE and pediatric patients older than 5 years. Results Desmopressin and alarm are the two main treatments of PMNE. However a lot of other solutions can be considered for children not/partial responsive to the standard treatment, particularly oxybutynin, antidepressant such as imipramine, reboxetine and sertraline, biofeedback therapy, neural stimulation. laser acupuncture. Furthermore positive effects come from motivational therapy, behavioural intervention and voiding school. Conclusion Motivational therapy could represent the first safe and effective strategy proposed to uncomplicated and younger enuretic children. It also could be considered together with the other pharmacological and no-pharmacological approaches in order to increase the success rate. Finally, we evidence the need of a multifactorial tailored intervention, customized for each child and for each family context, in order to take care not only of the NE itself, but also of the concomitant comorbidities and the emotional/behavioural sphere.