Uppsala University Children's Hospital, 751 85 Uppsala, Sweden.
Pediatr Nephrol. 2011 Aug;26(8):1207-14. doi: 10.1007/s00467-011-1762-8. Epub 2011 Jan 26.
Nocturnal polyuria, nocturnal detrusor overactivity and high arousal thresholds are central in the pathogenesis of enuresis. An underlying mechanism on the brainstem level is probably common to these mechanisms. Enuretic children have an increased risk for psychosocial comorbidity. The primary evaluation of the enuretic child is usually straightforward, with no radiology or invasive procedures required, and can be carried out by any adequately educated nurse or physician. The first-line treatment, once the few cases with underlying disorders, such as diabetes, kidney disease or urogenital malformations, have been ruled out, is the enuresis alarm, which has a definite curative potential but requires much work and motivation. For families not able to comply with the alarm, desmopressin should be the treatment of choice. In therapy-resistant cases, occult constipation needs to be ruled out, and then anticholinergic treatment-often combined with desmopressin-can be tried. In situations when all other treatments have failed, imipramine treatment is warranted, provided the cardiac risks are taken into account.
夜间多尿、夜间膀胱过度活动和高唤醒阈值是遗尿症发病机制的核心。这些机制可能在脑干水平存在共同的潜在机制。遗尿症患儿有更高的发生精神共病的风险。遗尿症患儿的初步评估通常很简单，不需要进行放射学或侵入性检查，任何受过适当教育的护士或医生都可以进行。一旦排除了少数存在潜在疾病（如糖尿病、肾脏疾病或泌尿生殖系统畸形）的病例，一线治疗方法就是遗尿报警器，它具有明确的治疗潜力，但需要大量的工作和动力。对于不能遵守报警器治疗的家庭，应该选择去氨加压素。在治疗抵抗的情况下，需要排除隐性便秘，然后可以尝试抗胆碱能治疗——通常与去氨加压素联合使用。在所有其他治疗方法都失败的情况下，如果考虑到心脏风险，可以使用丙咪嗪治疗。
