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Der Urologe

, Volume 52, Issue 1, pp 9–14 | Cite as

Primäre monosymptomatische Enuresis

Diagnostik und Therapie
  • J. SeiboldEmail author
  • S. Alloussi
  • T. Todenhöfer
  • A. Stenzl
  • C. Schwentner
Leitthema

Zusammenfassung

Nächtliches Einnässen ist eines der häufigsten Symptome im Kindesalter. In diesem Artikel werden neben einer einheitlichen Terminologie Basisdiagnostik und erweiterte Diagnostik dargelegt. In Abhängigkeit von den Befunden kann eine darauf abgestimmte Therapie erfolgen. Neben medikamentöser Therapie mit ADH oder dem Einsatz von Alarmgeräten zeigt auch die Kombination beider Ansätze gute Behandlungserfolge. Ein Ausschleichen der Therapie zeigt bessere Langzeitergebnisse im Vergleich zum abrupten Absetzen.

Schlüsselwörter

Harninkontinenz, kindliche Inkontinenz, intermittierende Hormon, antidiuretisches  Klingelgeräte 

Primary monosymptomatic enuresis

Diagnostics and therapy

Abstract

Nocturnal enuresis is one of the most common problems in childhood. In this article a standardized terminology for basic diagnostics additionally to extended diagnostics will be presented. Depending on the findings a specialized therapy can be performed. Besides drug therapy with antidiuretic hormone (ADH) sleep arousal devices can be used and the combination of both approaches also shows excellent results. At the end of therapy a protracted withdrawal shows better results than abrupt cessation.

Keywords

Incontinence, childhood Incontinence, intermittent Hormon, antidiuretic Arousal devices 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Alloussi SH, Murtz G, Eichel R et al (2009) Failure of monotherapy in primary monosymptomatic enuresis: a combined desmopressin and propiverine treatment regimen improves efficacy outcomes. BJU Int 103(12):1706–1712PubMedCrossRefGoogle Scholar
  2. 2.
    Alloussi SH, Murtz G, Lang C et al (2011) Desmopressin treatment regimens in monosymptomatic and nonmonosymptomatic enuresis: a review from a clinical perspective. J Pediatr Urol 7(1):10–20PubMedCrossRefGoogle Scholar
  3. 3.
    Bradbury MG, Meadow SR (1995) Combined treatment with enuresis alarm and desmopressin for nocturnal enuresis. Acta Paediatr 84(9):1014–1018PubMedCrossRefGoogle Scholar
  4. 4.
    Devlin JB, O’Cathain C (1990) Predicting treatment outcome in nocturnal enuresis. Arch Dis Child 65(10):1158–1161PubMedCrossRefGoogle Scholar
  5. 5.
    Eggert P, Kuhn B (1995) Antidiuretic hormone regulation in patients with primary nocturnal enuresis. Arch Dis Child 73(6):508–511PubMedCrossRefGoogle Scholar
  6. 6.
    Eiberg H (1995) Nocturnal enuresis is linked to a specific gene. Scand J Urol Nephrol 173(Suppl):15–17Google Scholar
  7. 7.
    Eiberg H, Berendt I, Mohr J et al (1995) Assignment of dominant inherited nocturnal enuresis (ENUR1) to chromosome 13q. Nat Genet 10(3):354–356PubMedCrossRefGoogle Scholar
  8. 8.
    Hjalmas K (1998) Nocturnal enuresis: basic facts and new horizons. Eur Urol 33(Suppl 3):53–57PubMedCrossRefGoogle Scholar
  9. 9.
    Hjalmas K, Arnold T, Bower W et al (2004) Nocturnal enuresis: an international evidence based management strategy. J Urol 171(6 Pt 2):2545–2561PubMedCrossRefGoogle Scholar
  10. 10.
    Houts AC, Berman JS, Abramson H et al (1994) Effectiveness of psychological and pharmacological treatments for nocturnal enuresis. J Consult Clin Psychol 62(4):737–745PubMedCrossRefGoogle Scholar
  11. 11.
    Lackgren G, Hjalmas K, van Gool J et al (1999) Nocturnal enuresis: a suggestion for a European treatment strategy. Acta Paediatr 88(6):679–690PubMedCrossRefGoogle Scholar
  12. 12.
    Lackgren G, Lilja B, Neveus T et al (1998) Desmopressin in the treatment of severe nocturnal enuresis in adolescents – a 7-year follow-up study. Br J Urol 81(Suppl 3):17–23PubMedGoogle Scholar
  13. 13.
    Lee T, Suh HJ, Lee HJ et al (2005) Comparison of effects of treatment of primary nocturnal enuresis with oxybutynin plus desmopressin, desmopressin alone or imipramine alone: a randomized controlled clinical trial. J Urol 174(3):1084–1087PubMedCrossRefGoogle Scholar
  14. 14.
    Neveus T, Bader G, Kruse S et al (2002) Enuresis, sleep and desmopressin treatment. Acta Paediatr 91(10):1121–1125PubMedCrossRefGoogle Scholar
  15. 15.
    Neveus T, Gontard A von, Hoebeke P et al (2006) 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 176(1):314–324PubMedCrossRefGoogle Scholar
  16. 16.
    Norgaard JP, Hansen JH, Nielsen JB et al (1985) Simultaneous registration of sleep-stages and bladder activity in enuresis. Urology 26(3):316–319PubMedCrossRefGoogle Scholar
  17. 17.
    Radmayr C, Schlager A, Studen M et al (2001) Prospective randomized trial using laser acupuncture versus desmopressin in the treatment of nocturnal enuresis. Eur Urol 40(2):201–205PubMedCrossRefGoogle Scholar
  18. 18.
    Rittig S, Knudsen UB, Nørgaard JP et al (1989) Abnormal diurnal rhythm of plasma vasopressin and urinary output in patients with enuresis. Am J Physiol 256(4 Pt 2):664–671Google Scholar
  19. 19.
    Robson WL, Leung AK, Norgaard JP et al (2007) The comparative safety of oral versus intranasal desmopressin for the treatment of children with nocturnal enuresis. J Urol 178(1):24–30PubMedCrossRefGoogle Scholar
  20. 20.
    Rushton HG, Belman AB, Zaontz MR et al (1996) The influence of small functional bladder capacity and other predictors on the response to desmopressin in the management of monosymptomatic nocturnal enuresis. J Urol 156(2 Pt 2):651–655PubMedCrossRefGoogle Scholar
  21. 21.
    Snajderova M, Lehotska V, Kernova T et al (2001) Desmopressin in a long-term treatment of children with primary nocturnal enuresis—a symptomatic therapy? Eur J Pediatr 160(3):197–198PubMedCrossRefGoogle Scholar
  22. 22.
    Snajderova M, Lehotska V, Kocnarova N (1999) Long-term treatment with desmopressin in children with primary nocturnal enuresis. An international multicenter study. Cas Lek Cesk 138(14):429–435PubMedGoogle Scholar
  23. 23.
    Thumfart J, Roehr CC, Kapelari K et al (2005) Desmopressin associated symptomatic hyponatremic hypervolemia in children. Are there predictive factors? J Urol 174(1):294–298 PubMedCrossRefGoogle Scholar
  24. 24.
    Tekgül S, Riedmiller H, Gerharz E et al (2009) „Monosymptomatic enuresis“ guidelines on paediatric urology. European Association of Urology, European Society for Paediatric Urology, Arnhem, pp 29–31Google Scholar
  25. 25.
    Uluocak N, Erdemir F, Parlaktas BS et al (2007) Bladder wall thickness in healthy school-aged children. Urology 69(4):763–766PubMedCrossRefGoogle Scholar
  26. 26.
    Vande Walle J, Rittig S, Bauer S et al (2012) Practical consensus guidelines for the management of enuresis. Eur J Pediatr 171(6):971–983CrossRefGoogle Scholar
  27. 27.
    Yeung CK, Diao M, Sreedhar B (2008) Cortical arousal in children with severe enuresis. N Engl J Med 358(22):2414–2415PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • J. Seibold
    • 1
    Email author
  • S. Alloussi
    • 2
  • T. Todenhöfer
    • 3
  • A. Stenzl
    • 3
  • C. Schwentner
    • 3
  1. 1.Urologische PraxisStuttgartDeutschland
  2. 2.Abteilung für UrologieStädtisches Klinikum NeunkirchenNeunkirchenDeutschland
  3. 3.Universitätsklinik für Urologie TübingenTübingenDeutschland

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