Problemi correnti
L’enuresi notturna: inquadramento e gestione
Nocturnal enuresis: overview and management
Alba Martina Renzullo1, Simone Benvenuto1, Giulia Nait2, Marco Pennesi3
1Università di Trieste, 2Università di Verona, 3IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
Ottobre 2024 - pagg. 499 -504 | DOI: 10.53126/MEB43499
Abstract
Enuresis is the involuntary discharge of urine during sleep. It is a fairly common problem in paediatric age: approximately 1 child out of 5 is affected at 5 years of age, with a potential significant impact on their quality of life and family. Pathogenesis is multifactorial, resulting in a combination of genetic factors, delayed maturation of the central nervous system, night-time anti-diuretic hormone deficiency and, in case, coexisting conditions such as sleep and behavioural disorders. Adequate diagnosis and management can speed up resolution, which usually occurs spontaneously, and identify those cases underlying an organic cause. Diagnosis is clinical. Instrumental investigation (such as ultrasound or urodynamic tests) is reserved to selected cases. Treatment mainly involves behavioural approach alongside, in those in which this approach fails, nocturnal alarm and/or pharmacological therapy. Assessment of associated comorbidities is crucial (ex. constipation, sleep and behavioural disorders).
Riassunto
Con il termine enuresi si intende la perdita involontaria di urine durante il sonno. Si tratta di una condizione particolarmente frequente in età pediatrica: un bambino su 5 ne è affetto ai 5 anni d’età, con un potenziale impatto sulla sua qualità di vita e su quella della famiglia. La patogenesi è multifattoriale, con una variabile combinazione di fattori genetici, ritardo di maturazione del sistema nervoso centrale, carenza di ormone antidiuretico nelle ore notturne e talora condizioni predisponenti come i disturbi del sonno e i disturbi comportamentali. Un corretto inquadramento ed un’adeguata gestione possono accelerarne la risoluzione, peraltro di solito spontanea, e consentire altresì di non perdere i pochi casi che sottendono una condizione patologica organica di rilievo. La diagnosi è prettamente clinica. Le indagini strumentali (ecografia, esame urodinamico) sono riservate a casi selezionati. Il trattamento cardine è la terapia comportamentale cui potrà essere associata in caso di fallimento l’allarme notturno e/o una terapia farmacologica. Fondamentale, infine, il riconoscimento e delle comorbidità tipicamente associate alla condizione (stipsi, ipertrofia adenoidea, ADHD).
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Bibliografia
1. Nevéus T, von Gontard A, Hoebeke P et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society. J Urol 2006;176 (1):314-24. doi: 10.1016/S0022-5347(06) 00305-3.
2. Forsythe WI, Redmond A. Enuresis and spontaneous cure rate. Study of 1129 enuretis. Arch Dis Child 1974;49(4):259-63. doi: 10.1136/adc.49.4.259.
3. Bakker E, van Sprundel M, van der Auwera JC, van Gool JD, Wyndaele JJ. Voiding habits and wetting in a population of 4,332 Belgian schoolchildren aged between 10 and 14 years. Scand J Urol Nephrol 2002;36(5):354-62. doi: 10.1080/003655902320783863.
4. Sarici H, Telli O, Ozgur BC, Demirbas A, Ozgur S, Karagoz MA. Prevalence of nocturnal enuresis and its influence on quality of life in school-aged children. J Pediatr Urol 2016;12(3):159.e1-6. doi: 10.1016/j.jpurol.2015.11.011.
5. von Gontard A, Freitag CM, Seifen S, et al. Neuromotor development in nocturnal enuresis. Dev Med Child Neurol 2006;48(9):744-50. doi: 10.1017/S0012162206001599.
6. Bakwin H. Enuresis in twins. Am J Dis Child 1971;121(3):222-5. doi: 10.1001/archpedi.1971.02100140088007.
7. Fatouh AA, Motawie AA, Abd Al-Aziz AM, et al. Anti-diuretic hormone and genetic study in primary nocturnal enuresis. J Pediatr Urol 2013;9(6 Pt A):831-7. doi: 10.1016/j.jpurol.2012.11.009.
8. Rittig S, Schaumburg HL, Siggaard C, Schmidt F, Djurhuus JC. The circadian defect in plasma vasopressin and urine output is related to desmopressin response and enuresis status in children with nocturnal enuresis. J Urol 2008;179(6):2389-95. doi: 10.1016/j.juro. 2008.01.171.
9. Pedersen MJ, Rittig S, Jennum PJ, Kamperis K. The role of sleep in the pathophysiology of nocturnal enuresis. Sleep Med Rev 2020;49:101228. doi: 10.1016/j.smrv.2019. 101228.
10. Yeung CK, Diao M, Sreedhar B. Cortical arousal in children with severe enuresis. N Engl J Med 2008;358(22):2414-5. doi: 10.1056/NEJMc0706528.
11. Neveus T, Eggert P, Evans Jet al. International Children's Continence Society. Evaluation of and treatment for monosymptomatic enuresis: a standardization document from the International Children's Continence Society. J Urol 2010;183(2):441-7. doi: 10.1016/ j.juro.2009.10.043.
12. Schmitt BD. Seven deadly sins of childhood: advising parents about difficult developmental phases. Child Abuse Negl 1987;11(3):421-32. doi: 10.1016/0145-2134 (87)90015-9.
13. Sá CA, Martins de Souza SA, Villela MCBVA et al. Psychological Intervention with Parents Improves Treatment Results and Reduces Punishment in Children with Enuresis: A Randomized Clinical Trial. J Urol 2021;205(2):570-6. doi: 10.1097/JU. 0000000000001351.
14. Nevéus T, Fonseca E, Franco I et al. Management and treatment of nocturnal enuresis-an updated standardization document from the International Children's Continence Society. J Pediatr Urol 2020;16(1):10-9. doi: 10.1016/j.jpurol.2019.12.020.
15. M.L. Chiozza, M. Pennesi, L.Peratoner, Enuresi e desmopressina, Medico e Bambino 2002;21(5):318-22.
16. Pennesi M, Pitter M, Bordugo A, Minisini S, Peratoner L. Behavioral therapy for primary nocturnal enuresis. J Urol 2004;171 (1):408-10. doi: 10.1097/01.ju. 0000097497. 75022.e8.
17. Rushton HG. Nocturnal enuresis: epidemiology, evaluation, and currently available treatment options. J Pediatr 1989;114(4 Pt 2):691-6. doi: 10.1016/s0022-3476(89)80883-2.
18. Robson WL, Leung AK, Norgaard JP. The comparative safety of oral versus intranasal desmopressin for the treatment of children with nocturnal enuresis. J Urol 2007;178(1): 24-30. doi: 10.1016/j.juro.2007.03.015.
19. Lucchini B, Simonetti GD, Ceschi A, Lava SA, Faré PB, Bianchetti MG. Severe signs of hyponatremia secondary to desmopressin treatment for enuresis: a systematic review. J Pediatr Urol 2013;9(6 Pt B):1049-53. doi: 10.1016/j.jpurol.2013.02.012.
20. Glazener CM, Evans JH. Desmopressin for nocturnal enuresis in children. Cochrane Database Syst Rev 2002;(3):CD002112. doi: 10.1002/14651858.
21. Gökçe Mİ, Hajıyev P, Süer E, et al. Does structured withdrawal of desmopressin improve relapse rates in patients with monosymptomatic enuresis? J Urol 2014;192 (2):530-4. doi: 10.1016/j.juro.2014.01.094.
22. Chua ME, Silangcruz JM, Chang SJ et al. Desmopressin Withdrawal Strategy for Pediatric Enuresis: A Meta-analysis. Pediatrics 2016;138(1):e20160495. doi: 10.1542/peds. 2016-0495.
23. Yeung CK, Chiu HN, Sit FK. Bladder dysfunction in children with refractory monosymptomatic primary nocturnal enuresis. J Urol 1999;162(3 Pt 2):1049-54; discussion 1054-5. doi: 10.1016/S0022-5347(01)68062-5.
24. Cakiroglu B, Arda E, Tas T, Senturk AB. Alarm therapy and desmopressin in the treatment of patients with nocturnal enuresis. Afr J Paediatr Surg 2018;15(3):131-4. doi: 10.4103/ajps.AJPS_115_16.
25. Jabbour M, Abou Zahr R, Boustany M. Primary Nocturnal Enuresis: A Novel Therapeutic Strategy With Higher Efficacy. Urology 2019;124:241-7. doi: 10.1016/j.urology.2018.09.013.
26. Radvanska E, Kovács L, Rittig S. The role of bladder capacity in antidiuretic and anticholinergic treatment for nocturnal enuresis. J Urol 2006;176(2):764-8; discussion 768-9. doi: 10.1016/S0022-5347(06)00595-7.
27. Yu J, Yan Z, Zhou S, et al. Desmopressin plus anticholinergic agent in the treatment of nocturnal enuresis: a meta-analysis. Exp Ther Med 2017;14(4):2875-84. doi: 10.3892/ etm.2017.4897.
28. Santos JD, Lopes RI, Koyle MA. Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem. Can Urol Assoc J 2017;11(1-2Suppl1):S64-S72. doi: 10.5489/cuaj.4411.
29. Chase JW, Homsy Y, Siggaard C, et al. Functional constipation in children. J Urol 2004;171(6 Pt 2):2641-3. doi: 10.1097/01.ju. 0000109743.12526.42.
30. Burgers RE, Mugie SM, Chase J, et al. Management of functional constipa- 12 S. Guarino et al. tion in children with lower urinary tract symptoms: report from the Standardization Committee of the International Children’s Continence Society. J Urol 2013; 190(1):29-36. doi: 10.1016/j.juro.2013.01.001.
31. Burgers R, Liem O, Canon S, et al. Effect of rectal distention on lower urinary tract function in children. J Urol 2010;184(4 Suppl):1680-5. doi: 10.1016/j.juro.2010.03.120.
32. Umlauf MG, Chasens ER. Sleep disordered breathing and nocturnal polyuria: nocturia and enuresis. Sleep Med Rev 2003;7(5): 403-11. doi: 10.1053/smrv.2002.0273.
33. Khazaie H, Eghbali F, Amirian H, et al. Risk Factors of Nocturnal Enuresis in Children with Attention Deficit Hyperactivity Disorder, Shanghai Archives of Psychiatry 2018;30:doi: 10.11919/j.issn.1002-0829. 216088.
34. Shreeram S, He JP, Kalaydjian A, Brothers S, Merikangas KR. Prevalence of enuresis and its association with attention-deficit/hyperactivity disorder among U.S. children: results from a nationally representative study. J Am Acad Child Adolesc Psychiatry 2009;48(1):35-41. doi: 10.1097/CHI. 0b013e318190045c.
35. Kovacevic L, Wolfe-Christensen C, Rizwan A, Lu H, Lakshmanan Y. Children with nocturnal enuresis and attention deficit hyperactivity disorder: A separate entity? J Pediatr Urol 2018;14(1):47.e1-47.e6. doi: 10.1016/j.jpurol.2017.07.002.
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