FUNCTIONAL-ASPECTS OF ENURESIS IN CHILDHOOD - CONSEQUENCES FOR DIAGNOSTIC AND THERAPY

Increasing knowledge of normal and disturbed development of bladder control has led to a more functional point of view of enuresis in childhood. Dysregulated circadian rhythm of ADH-secretion and/or an abnormally high threshold for the perception or urge are currently under discussion as being underlying disorders in isolated nocturnal enuresis. In contrast, diurnal enuresis is often associated with bladder dysfunctions like detrusor-instability or detrusor-sphincter-dyscoordination. In these cases enuresis is frequently only one symptom beside others, such as recurrent urinary tract infections. The diagnostic classification of the underlying bladder dysfunction is important to determine the risk of renal parenchymal damage. Often a careful history and urological examination uncover the type of bladder dysfunction without using invasive urodynamic procedures and will allow a well-directed therapy. Enuretics without provable urodynamic abnormalities require psychological evaluation and therapy.