J Korean Med Assoc.  2017 Oct;60(10):800-805. 10.5124/jkma.2017.60.10.800.

Management of patients with refractory nocturnal enuresis

• Kim SC

• KMID: 2393525
• DOI: http://doi.org/10.5124/jkma.2017.60.10.800

Abstract

There are two types of refractory nocturnal enuresis. The first type corresponds to patients who are refractory from initial success, and the second type refers to refractory nocturnal enuresis after long-term success, in patients who cannot discontinue medications for enuresis. In the former type, it is necessary to determine whether the timing of medications is appropriate, whether the usage of antidiuretics is appropriate, whether any lifestyle changes have taken place, and whether there are secondary causes of enuresis. In the latter type, enuretic alarm treatment should be considered initially, and it is then important to investigate whether a respiratory obstruction is present in patients with nocturnal polyuria, whether the patient is constipated, and whether patients with non-monosymptomatic nocturnal enuresis have lower urinary tract symptoms or attention deficit hyperactivity disorder.

Keyword

Nocturnal enuresis; Drug therapy; Drug resistance

MeSH Terms

Attention Deficit Disorder with Hyperactivity
Drug Resistance
Drug Therapy
Enuresis
Humans
Life Style
Lower Urinary Tract Symptoms
Nocturnal Enuresis*
Polyuria

Figure

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  Figure 1 Pathophysiology of nocturnal enuresis. (A) The Venn diagram using three causative factors of nocturnal enuresis. (B) New concept of Venn diagram to explain the pathophysiology of nocturnal enuresis which use the difference between bladder capacity and nocturnal urine volume. (C) The pathophysiology of nocturia.

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  Figure 2 The prevalence of nocturnal enuresis according to age. (A) The prevalence of nocturnal enuresis tends to decrease by about 15% per year without treatment until the age of 9 years. (B) There is no difference in prevalence after 9 years old. Natural healing can be expected until 9 years old, but it is hard to expect it after that time. Modified from Yeung CK, et al. BJU Int 2006;97:1069-1073 [7].

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  Figure 3 Relationship between time of desmopressin administration and drug effect. Desmopressin reduces urine for 4 to 5 hours from 1 hour after taking the drug. (A) If patients take the desmopressin after 8 p.m. in them who sleeps at 9 p.m., they will be able to fully exercise the effect of the drug because the time of the effect of the desmopressin is included during the sleeping time. (B) On the other hand, if patients take the desmopressin at 6 p.m., which is earlier than that, they will not be able to take all of effect of it because it takes effect during only 2 to 3 hours. Dotted line: night urine production in patient with nocturnal enuresis. Solid line: night urine production after desmopressin administration. Green box: desmopressin effect zone.

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  Figure 4 Refractory from long-term success. ANP, atrial natriuretic peptide; ADHD, attention deficit hyperactivity disorder.

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