[Nocturnal enuresis in children--how to diagnose, how to treat?].

The aim of this article is to review International Children's Continence Society guidelines on the recommended diagnostic evaluation and therapy for children with nocturnal enuresis. Nocturnal enuresis (NE) is the condition describing the symptom of wetting during sleep above the age of 5 years. NE is one of the most common disorders among children. Enuresis is characterised as monosymptomatic nocturnal enuresis (MNE) if there are no additional voiding problems. Children with other daytime symptoms (daytime incontinence, urgency, frequency) and nocturnal enuresis are said to have non-monosymptomatic nocturnal enuresis (NMNE). A careful medical history, including bladder diary, physical examination, urinalysis, an ultrasound of the urinary tract system will usually provide sufficient information for the physician to arrive at a diagnosis. Urodynamic, radiologic and endoscopic evaluation are not necessary in children with monosymptomatic nocturnal enuresis. Two first line treatment options of MNE are currently recommended: nonpharmacologic treatment and pharmacologic treatment (desmopressin). Nonpharmacologic treatment of enuresis includes motivational therapy, bladder-training exercises, fluid and food intake and enuresis alarm. Before using alarm treatment or desmopressin, simple therapeutic interventions should be considered. Children with nocturnal poliuria and normal bladder capacity will be more sensitive to desmopressin.