Kreitz B G, Aker P D
Canadian Memorial Chiropractic College, Toronto, Ontario.
J Manipulative Physiol Ther. 1994 Sep;17(7):465-73.
A comprehensive review of the literature concerning the etiology, diagnosis, and the natural history of primary nocturnal enuresis is presented. Contemporary treatment options are discussed in light of the documented annual remission rate of this disorder.
Articles reviewed were obtained by conducting a computer-aided search of papers indexed in Medline and the Index to Chiropractic Literature from 1989 to 1993. In addition, the Chiropractic Research Abstracts Collection and bibliographies from pertinent articles were manually searched.
Primary nocturnal enuresis affects some 200,000 children and their families throughout Canada. Twenty percent of children wet the bed at age 5, 10% at age 10, and only about 1% at age 15. The documented natural history of the disorder reveals that for those affected, 10% to 20% exhibit spontaneous resolution per year. Contemporary treatment options center on three factors that play primary roles in the etiology of this condition: functional bladder capacity, patient conditioning and the circadian rhythm of nocturnal ADH secretion.
The success of each therapeutic option must, in part, be attributed to the natural history of enuresis, as well as any educational or placebo aspects of treatment. Conditioning therapy utilizing the urine pad alarm may be the most reasonable initial mode of intervention. Spinal manipulative therapy has been shown to possess an efficacy comparable to the natural history.
对有关原发性夜间遗尿症的病因、诊断及自然病史的文献进行全面综述。根据该疾病已记录的年缓解率探讨当代的治疗选择。
通过对1989年至1993年在医学在线数据库（Medline）和脊椎按摩文献索引中索引的论文进行计算机辅助检索获得所综述的文章。此外，还手动检索了脊椎按摩研究摘要集和相关文章的参考文献。
原发性夜间遗尿症影响着加拿大约200,000名儿童及其家庭。20%的儿童在5岁时尿床，10%在10岁时尿床，而在15岁时只有约1%尿床。该疾病已记录的自然病史表明，对于那些受影响的人，每年有10%至20%会自然痊愈。当代的治疗选择集中在该病症病因中起主要作用的三个因素上：功能性膀胱容量、患者条件作用以及夜间抗利尿激素分泌的昼夜节律。
每种治疗选择的成功部分必须归因于遗尿症的自然病史以及治疗的任何教育或安慰剂方面。使用尿垫警报的条件疗法可能是最合理的初始干预方式。脊椎推拿疗法已被证明具有与自然病史相当的疗效。
