Fazalur Rehman.
Nocturnal enuresis.
Pak Armed Forces Med J Jan ;55(4):327-34.

Nocturnal enuresis is a common problem seen by the primary care physician. It remains a source of considerable anxiety for the child, parents, and sometimes the pediatrician. In spite of several decades of research, no single explanation or classification of enuresis is sufficient. The nocturnal wetting episode occurs when the child does not awaken during sleep at a time when urine volume exceeds functional bladder capacity, due either to excess urine production, small bladder capacity, or both. This perspective requires the practitioner to take a careful history for polyuria, sleep dysfunction, and daytime bladder symptoms to devise the best treatment for each child. Although a spontaneous cure rate of 15% per year can be expected, intervention may benefit some children through earlier attained dryness and improved self-esteem. Behavior therapies, including alarm systems, have the best longterm results, but they require strong family commitment and do not offer immediate results. Medication has a better short-term cure rate than motivational/behavioral therapy, but relapse rates are high when drugs are discontinued. A combination of behavioral therapy and pharmacotherapy is reasonable if monotherapy fails. The ultimate goal is for the child to maintain nighttime dryness or to self-awaken to void at night.

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