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Nocturnal angina — Clinical Guidelines

Overview

Nocturnal enuresis (NE) refers to involuntary urination during sleep beyond the typical age of bladder control, commonly affecting children but also seen in adults. It can be primary (since early childhood) or secondary (developing after a period of dryness). 6 10

Diagnosis

Key Criteria: Involuntary nocturnal urination without daytime symptoms.

Recommended Tests: Urinalysis to rule out infection, renal function tests, and voiding diary to assess frequency and volume.

Grading: Often classified based on frequency (e.g., <1 episode/week is mild, >3 episodes/week is severe). 5

Management

First-Line Treatments:

- Alarm Therapy: Behavioral intervention that wakes the child upon wetting to condition bladder control. 7 8 9 - Desmopressin: Synthetic analogue of vasopressin, typically used at bedtime (dose varies but often 0.2 mg). 4

Adjunctive Treatments:

- Bladder Training: Techniques to increase bladder capacity and control. - Psychological Support: Counseling to address emotional and psychological impacts. 6

Special Populations

Pediatrics: Primary focus with high rates of spontaneous remission; alarm therapy and desmopressin are effective. 4 7 8 9

Secondary NE: Consider underlying causes such as psychological stress, urological issues, or systemic conditions; tailored investigations and management are essential. 10

Key Recommendations

Use alarm therapy as a first-line behavioral intervention for primary nocturnal enuresis (Evidence: Strong 7 8 9).

Consider desmopressin for children unresponsive to alarm therapy or with severe symptoms (Evidence: Moderate 4).

Provide psychological support and counseling to address the emotional impact on children and families (Evidence: Moderate 6).

Investigate secondary nocturnal enuresis thoroughly to identify and address underlying causes (Evidence: Expert opinion 10).

References

1 Press B, Chu E, Aponte V, Barroso U, Kirsch A. Parental Experiences With Nocturnal Enuresis: Treatment Use, Dissatisfaction, and Psychosocial Impact in a Large Metropolitan Pediatric Urology Practice. Neurourology and urodynamics 2026. link 2 Baydilli N, Dönmez MI, Quiroz Madarriaga Y, Banuelos Marco B, Selvi I, Bindi E et al.. International Overview on Diagnosis and Treatment of Nocturnal Enuresis: A Survey Study by EAU YAU Paediatric Urology Working Group. Actas urologicas espanolas 2026. link 3 Fernandes AER, Roveda JRC, Fernandes CR, Silva DF, de Oliveira Guimarães IC, Lima EM et al.. Relationship between nocturnal enuresis and sleep in children and adolescents. Pediatric nephrology (Berlin, Germany) 2023. link 4 Purnomo AF, Daryanto B, Nurhadi P. Monosymptomatic Nocturnal Enuresis Treatment Using Alarm-Therapy and Desmopressin: A Meta-analysis Approach. Medical archives (Sarajevo, Bosnia and Herzegovina) 2021. link 5 Ferrara P, Ianniello F, Romani L, Fabrizio GC, Gatto A, Chiaretti A. Five years of experience in nocturnal enuresis and urinary incontinence in children: where we are and where we are going. Urologia internationalis 2014. link 6 Fleming E. Supporting children with nocturnal enuresis. Nursing times 2012. link 7 Glazener CM, Evans JH, Peto RE. Alarm interventions for nocturnal enuresis in children. The Cochrane database of systematic reviews 2005. link 8 Glazener CM, Evans JH, Peto RE. Alarm interventions for nocturnal enuresis in children. The Cochrane database of systematic reviews 2003. link 9 Glazener CM, Evans JH. Alarm interventions for nocturnal enuresis in children. The Cochrane database of systematic reviews 2001. link 10 Robson WL, Leung AK. Secondary nocturnal enuresis. Clinical pediatrics 2000. link 11 Warwick RT, Whiteside G. Nocturnal enuresis. The Urologic clinics of North America 1979. link

Nocturnal angina