Nocturnal enuresis: a review of the efficacy of treatments and practical advice for clinicians.

Nocturnal enuresis (NE) is a common developmental symptom which, in a nonsupportive environment, might have negative effects on the growth of positive self-concept in children. A careful history and physical examination helps to establish a rapport with the child and family and can rule out important organic disease. Constipation might be a contributing factor and should be relieved when present. Treatments are available that can result in either a cure or symptomatic relief for approximately 80% of children older than 7 years. Children with monosymptomatic NE respond best to conditioning alarms or, as second-line therapy, to one of two classes of pharmaceuticals: desmopressin acetate or tricyclic antidepressants. Anticholinergic drugs might have a role in diurnal enuresis, but their role in NE with daytime symptoms is not yet established. Therapies such as hypnosis and dietary restriction have some promise but require additional study and are not recommended at the present time. Combined therapy with desmopressin and conditioning alarms might be helpful for some of the more resistant cases but also needs additional study. The management of NE requires an investment of time but is quite rewarding, because families that have had success are very grateful. Treatment might assist children in developing positive self-concept. The next decade promises new developments in our understanding of NE.