Mitos y realidades sobre la enuresis en pediatría.

Abstract

Nocturnal enuresis (NE) refers to nocturnal urinary incontinence that occurs at least once a month for three months in children aged five years old or older. NE is more common in males and is usually a primary and monosymptomatic NE. Primary NE is one in which a minimum continence of six months has not been achieved previously. Monosymptomatic NE is not associated with daytime nephro urological symptoms. NE is often associated with comorbidities such as constipation, sleep disorders or ADHD. Genetic predisposition, personal nephro urological history and psychosocial disorders are some of the risk factors for NE in children. Diagnosis is clinical and is based on a detailed medical history, complete physical examination, and voiding and drinking diaries. The differential diagnosis is very broad, encompassing other pathologies such as diabetes mellitus, urinary tract infection, nephro urological diseases, pinworms and neurological disorders. Complementary tests are not routinely indicated if the physical examination is normal and there are not warning signs. Treatment should be individualized and includes health education, motivational therapy, alarm devices, and drugs. Alarm devices are of choice and require patient and family involvement. Desmopressin is preferred in children with less than three wet nights per week, maximum voiding volume during day-time (MVVDT) greater than 75%, age greater than 9 years, or failure of the alarm system. The pediatrician will also need to solve psychological and social problems that may result from NE.