Journal of Clinical Pediatrics >
Chinese expert consensus on management of nocturnal enuresis in children
Nocturnal enuresis is a common disease in childhood, which can be harmful to the children’s physical and psychological well-being. Standardized diagnosis and therapeutic approaches are very important for the efficacy and prognosis of enuresis. In recent years, with the accumulation of domestic and foreign clinical research evidence and the application of new diagnostic and therapeutic concepts, it is of great clinical significance to update and improve the consensus on the diagnosis and treatment of enuresis. Therefore, Chinese Cooperative Group for the Management of Pediatric Enuresis Affiliated to Pediatric Nephrology Committee of Chinese Medical Doctor Association has revised and updated the 2014 version of the "Expert Consensus on the Management of Monosymptomatic Nocturnal Enuresis in Chinese Children" based on the latest domestic and international evidence-based rationales and combined with clinical experience. The definition has been revised in accordance with international authoritative guidelines, and the diagnosis process and standardized terminology has been enhanced. The content of medical history collection has been updated to emphasize the differentiation of other diseases and comorbidities, and the recording method of the voiding diary has been revised to improve compliance. For monosymptomatic enuresis, the dosage adjustment and discontinuation plan of desmopressin have been added, and the specific dosage recommendations for second-line drug treatment have been refined. Additionally, a new section on non-monosymptomatic enuresis has been introduced, including treatment strategies and pharmacologic interventions. This consensus recommendations in a problem-oriented manner, delivering more comprehensive and structured guidance for the management of nocturnal enuresis.
Key words： nocturnal enuresis; delphi method; monosymptomatic; non-monosymptomatic; child
Chinese Cooperative Group for the Management of Pediatric Enuresis Affiliated to Pediatric Nephrology Committee of Chinese Medical Doctor Association . Chinese expert consensus on management of nocturnal enuresis in children[J]. Journal of Clinical Pediatrics, 2025 , 43(7) : 483 -499 . DOI: 10.12372/jcp.2025.25e0564
| [1] | 沈茜, 刘小梅, 姚勇, 等. 中国儿童单症状性夜遗尿疾病管理专家共识[J]. 临床儿科杂志, 2014, (10): 970-975. |
| Shen Q, Liu XM, Yao Y, et al. Expert Consensus on the Management of Monosymptomatic Nocturnal Enuresis in Chinese Children[J]. Linchuang Erke Zazhi, 2014, (10): 970-975. | |
| [2] | Wang TM, Yang SS, Tsai JD, et al. Management of nocturnal enuresis in Taiwan: Consensus statements of the Taiwan enuresis expert committee[J]. J Formos Med Assoc. 2019, 118(6):965-972. |
| [3] | 中华医学会小儿外科学分会小儿尿动力和盆底学组和泌尿外科学组. 儿童遗尿症诊断和治疗中国专家共识[J]. 中华医学杂志, 2019, 99 (21): 1615-1620. |
| The Pediatric Urodynamics and Pelvic Floor Group and the Urology Group of the Pediatric Surgery Branch of the Chinese Medical Association. Chinese Expert Consensus on Diagnosis and Treatment of Enuresis in Children[J]. Zhonghua Yixue Zazhi, 2019, 99 (21): 1615-1620. | |
| [4] | Austin PF, Bauer SB, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the international children's continence society[J]. J Urol, 2014, 191(6): 1863-1865. |
| [5] | Austin PF, Bauer SB, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the International Children's Continence Society[J]. Neurourol Urodyn, 2016, 35(4): 471-481. |
| [6] | Nevéus T, Fonseca E, Franco I, et al. Management and treatment of nocturnal enuresis—an updated standardization document from the international children's continence society[J]. J Pediatr Urol, 2020, 16(1): 10-19. |
| [7] | Bastos JM Netto, Rondon AV, Lima GRMD, et al. Brazilian consensus in enuresis- recomendations for clinical practice[J]. Int Braz J Urol, 2019, 45: 889-900. |
| [8] | Bogaert G, Stein R, Undre S, et al. Practical recommen-dations of the eau‐espu guidelines committee for monosymptomatic enuresis—bedwetting[J]. Neurourol Urodyn, 2020, 39(2): 489-497. |
| [9] | The Japanese Society of Nocturnal Enuresis. Nocturnal Enuresis Clinical Practice Guidelines[M]. Tokyo: Diagnosis and Treatment Press, 2021. |
| [10] | Harris J, Lipson A, Dos Santos J. Evaluation and manage-ment of enuresis in the general paediatric setting[J]. Paediatr Child Health, 2023, 28(6): 362-376. |
| [11] | 陶洋旭, 李建军. 医疗共识制订方法:德尔菲法和名义小组法[J]. 国际眼科纵览, 2021, 45(5): 369-373. |
| Tao YX, Li JJ. Methods for developing medical consensus: Delphi method and nominal group technique[J]. Guoji Yanke Zonglan, 2021, 45(5): 369-373. | |
| [12] | Karni?nik K, Koren A, Kos N, et al. Prevalence and quality of life of slovenian children with primary nocturnal enuresis[J]. Int J Nephrol, 2012: 509012. |
| [13] | Rangel RA, Seabra CR, Ferrarez CEPF, et al. Quality of life in enuretic children[J]. Int Braz J Urol, 2021, 47(3): 535-541. |
| [14] | 中国医师协会儿科医师分会肾脏疾病学组中国儿童遗尿疾病管理协作组. 中国5-18岁人群遗尿症患病率的横断面调查[J]. 中国循证儿科杂志, 2020, 15(02): 81-86. |
| Chinese Cooperative Group for the Management of Pediatric Enuresis Affiliated to Pediatric Nephrology Committee of Chinese Medical Doctor Association. Prevalence of nocturnal enuresis in children and adolescents aged 5 to 18 years in China[J]. Zhongguo Xunzheng Erke Zazhi, 2020, 15(2): 81-86. | |
| [15] | Zhong S, Lin X, Wang M, et al. Periaqueductal gray subregions connectivity and its association with micturition desire-awakening function[J]. Eur Child Adolesc Psychiatry, 2025, 34(4): 1435-1444. |
| [16] | Hyams JS, Di Lorenzo C, Saps M, et al. Childhood Functional Gastrointestinal Disorders: Child/Adolescent[J]. Gastroenterology, 2016, 15: S0016- 5085(16)00181-5. |
| [17] | Vande Walle J, Rittig S, Tekgül S, et al. Enuresis: practical guidelines for primary care[J]. Br J Gen Pract, 2017, 67(660): 328-329. |
| [18] | Haid B, Tekgül S. Primary and secondary enuresis: pathophysiology, diagnosis, and treatment[J]. Eur Urol Focus, 2017, 3(2-3): 198-206. |
| [19] | Koff SA. Estimating bladder capacity in children[J]. Urology, 1983, 21(3): 248. |
| [20] | Wang JJ, Wang DJ, Fu HD, et al. Evaluation of a new frequency-volume chart for children with primary monosymptomatic nocturnal enuresis: a prospective, comparative study[J]. World J Pediatr, 2021, 17(6): 643-652 |
| [21] | Iscan B, Ozkay?n N. Evaluation of health-related quality of life and affecting factors in child with enuresis[J]. J Pediatr Urol, 2020, 16(2): 195.e1-195.e7. |
| [22] | Hu HJ, Zhang ZW, Liang Y, et al. Prevalence, risk factors, and psychological effects of primary nocturnal enuresis in Chinese young adults[J]. Int Neurourol J, 2021, 25(1): 84-92. |
| [23] | National Clinical Guideline Centre (UK). Nocturnal Enuresis: The Management of Bedwetting in Children and Young People[M]. London: Royal College of Physicians (UK); 2010. |
| [24] | Experience with the long-term use of desmopressin for nocturnal enuresis in children and adolescents[J]. BJU Int, 2002, 89(4): 420-425. |
| [25] | Purnomo AF, Daryanto B, Nurhadi P. Monosymptomatic nocturnal enuresis treatment using alarm-therapy and desmopressin: a meta-analysis approach[J]. Med Arch, 2021, 75(6): 431-435. |
| [26] | Kamperis K, Hagstroem S, Rittig S, et al. Combination of the enuresis alarm and desmopressin: second line treatment for nocturnal enuresis[J]. J Urol, 2008, 179(3): 1128-1131. |
| [27] | Tsuji S, Kaneko K. Management of treatment-resistant nocturnal enuresis[J]. Pediatr Int, 2023, 65(1): e15573. |
| [28] | Liu J, Ni J, Miao Q, et al. Exploration of the optimal desmopressin treatment in children with monosymptomatic nocturnal enuresis: evidence from a Chinese cohort[J]. Front Pediatr. 2021, 8: 626083. |
| [29] | 初梅, 曹力, 陈朝英, 等. 醋酸去氨加压素中长程疗法治疗儿童原发性单症状夜遗尿症疗效研究[J]. 中国实用儿科杂志, 2017, 32(11): 861-865. |
| Chu M, Cao L, Chen ZY, et al. Efficacy of Long-term desmopressin acetate therapy for primary monosymptomatic nocturnal enuresis in children[J]. Zhongguo Shiyong Erke Zazhi, 2017, 32(11): 861-865. | |
| [30] | Chua ME, Silangcruz JM, Chang SJ, et al. Desmopressin withdrawal strategy for pediatric enuresis: a meta-analysis[J]. Pediatrics, 2016, 138(1): e20160495. |
| [31] | Marschall-Kehrel D, Harms TW. Structured desmopressin withdrawal improves response and treatment outcome for monosymptomatic enuretic children[J]. J Urol, 2009, 182(4 Suppl): 2022-2026. |
| [32] | Ohtomo Y, Umino D, Takada M, et al. Gradual tapering of desmopressin leads to better outcome in nocturnal enuresis[J]. Pediatr Int, 2015, 57(4): 656-658. |
| [33] | Kamperis K, Van Herzeele C, Rittig S, et al. Opti-mizing response to desmopressin in patients with monosymptomatic noc turnal enuresis[J]. Pediatr Nephrol, 2017, 32(2): 217-226. |
| [34] | Dalrymple RA, Wacogne ID. Gradual withdrawal of desmopressin in patients with enuresis leads to fewer relapses than an abrupt withdrawal[J]. Arch Dis Child Educ Pract Ed, 2017, 102: 335. |
| [35] | VandeWalle J, Stockner M, Raes A, et al. Desmopressin 30 years in clinical use: a safety review[J]. Curr Drug Saf, 2007, 2(3): 232-238. |
| [36] | Wolfish NM, Barkin J, Gorodzinsky F, et al. The Canadian enuresis study and evaluation--short- and long-term safety and efficacy of an oral desmopressin preparation[J]. Scand J Urol Nephrol, 2003, 37(1): 22-27 |
| [37] | Everaert K, Hervé F, Bosch R, et al. International continence society consensus on the diagnosis and treatment of nocturia[J]. Neurourol Urodyn, 2019, 38(2): 478-498. |
| [38] | Lucchini B, Simonetti GD, Ceschi A, et al. Severe signs of hyponatremia secondary to desmopressin treatment for enuresis: a systematic review[J]. J Pediatr Urol, 2013, 9 (6 Pt B): 1049-1053. |
| [39] | Schulman SL, Stokes A, Salzman PM. The efficacy and safety of oral desmopressin in children with primary nocturnal enuresis[J]. J Urol, 2001, 166(6): 2427-2431. |
| [40] | Watanabe T, Ikeda H, Ono T, et al. Comparison of wireless and wired alarm devices for nocturnal enuresis treatment[J]. Pediatr Int, 2022, 64(1): e15328. |
| [41] | Song P, Huang C, Wang Y, et al. Comparison of desmopressin, alarm, desmopressin plus alarm, and desmopressin plus anticholinergic agents in the management of paediatric monosymptomatic nocturnal enuresis: a network meta-analysis[J]. BJU Int, 2019, 123(3): 388-400. |
| [42] | Caldwell PH, Codarini M, Stewart F, et al. Alarm interventions for nocturnal enuresis in children [DB/J]. Cochrane Database Syst Rev, 2020, 5(5): CD002911. |
| [43] | Austin PF, Ferguson G, Yan Y, et al. Combination therapy with desmopressin and an anticholinergic medication for nonresponders to desmopressin for monosymptomatic nocturnal enuresis: a randomized, double-blind, placebo-controlled trial[J]. Pediatrics, 2008, 122(5): 1027-1032. |
| [44] | Hodges SJ, Atala A. A randomized, double-blind, placebo-controlled trial of anticholinergic medication for nonresponders to desmopressin for monosymptomatic nocturnal enuresis[J]. Curr Urol Rep, 2011, 12(1): 1-2. |
| [45] | Yu J, Yan Z, Zhou S, et al. Desmopressin plus anti-cholinergic agent in the treatment of nocturnal enuresis: a meta-analysis[J]. Exp Ther Med, 2017, 14(4): 2875-2884. |
| [46] | Cai T, Yao Y, Sun W, et al. Desmopressin in combination with anticholinergic agents in the treatment of nocturnal enuresis: a systematic review and meta-analysis[J]. Front Pediatr, 2023, 11: 1242777. |
| [47] | Ghanavati PM, Khazaeli D, Amjadzadeh M. A comparison of the efficacy and tolerability of treating primary nocturnal enuresis with solifenacin plus desmopressin, tolterodine plus desmopressin, and desmopressin alone: a randomized controlled clinical trial[J]. Int Braz J Urol, 2021, 47(1): 73-81. |
| [48] | Park SJ, Park JM, Pai KS, et al. Desmopressin alone versus desmopressin and an anticholinergic in the first-line treatment of primary monosymptomatic nocturnal enuresis: a multicenter study[J]. Pediatr Nephrol, 2014, 29(7): 1195-1200. |
| [49] | 徐虹, 丁洁, 易著文. 儿童肾脏病学[M]. 北京: 人民卫生出版社, 2018. |
| Xu H, Ding J, Yi ZW. Pediatric Nephrology[M]. Beijing: People's Medical Publishing House. 2018. | |
| [50] | Ramsay S, Lapointe é, Bolduc S. Comprehensive overview of the available pharmacotherapy for the treatment of non-neurogenic overactive bladder in children[J]. Expert Opin Pharmacother, 2022, 23(8): 991-1002. |
| [51] | Van Arendonk KJ, Austin JC, Boyt MA, et al. Frequency of wetting is predictive of response to anticholinergic treatment in children with overactive bladder[J]. Urology, 2006, 67(5): 1049e54. |
| [52] | Gish P, Mosholder AD, Truffa M, et al. Spectrum of central anticholinergic adverse effects associated with oxybutynin: comparison of pediatric and adult cases[J]. J Pediatr, 2009, 155(3): 432e4. |
| [53] | Rakowska-Silska M, Jobs K, Paturej A, et al. Voiding disorders in pediatrician’s practice[J]. Clin Med Insights Pediatr, 2020, 14: 1179556520975035. |
| [54] | Afshar K, Dos Santos J, Blais AS, et al. Canadian Urological Association guideline for the treatment of bladder dysfunction in children.[J] Can Urol Assoc J, 2021, 15(2): 13-18. |
| [55] | Krhut J, Skugarevská B, Míka D, et al. Clinical utility of β3-adrenoreceptor agonists for the treatment of overactive bladder: a review of the evidence and current recommendations[J]. Res Rep Urol, 2022, 14: 167-175. |
| [56] | Blais AS, Nadeau G, Moore K, et al. Prospective pilot study of mirabegron in pediatric patients with overactive bladder[J]. Eur Urol, 2016, 70(1): 9-13. |
| [57] | Fujinaga S, Watanabe Y, Nakagawa M. Efficacy of the novel selective b3-adrenoreceptor agonist vibegron for treatment-resistant monosymptomatic nocturnal enuresis in children[J]. Int J Urol, 2020, 27(8): 693-694. |
| [58] | Pillai RR, Sara B. Effectiveness of bladder retraining programme on bedwetting frequency and relapse rate of children with nocturnal enuresis[J]. J Pediatr Urol, 2024, 20(4): 602.e1-602.e12. |
| [59] | Garcia-Fernandez A, Petros PE. A four month squatting-based pelvic exercise regime cures day/night enuresis and bowel dysfunction in children aged 7-11 years[J]. Cent European J Urol, 2020, 73(3): 307-314. |
| [60] | Ebiloglu T, Ergin G, Irkilata HC, et al. The Biofeedback Treatment for Non-Monosymptomatic Enuresis Nocturna[J]. Neurourol Urodyn, 2016, 35(1): 58-61. |
| [61] | Lindstr?m S, Fall M, Carlsson CA, et al. The neurophysiological basis of bladder inhibition in response to intravaginal electrical stimulation[J]. J Urol, 1983, 129: 405-410. |
| [62] | Dutra MF, de Bessa J Júnior, et al. The effectiveness of parasacral transcutaneous electrical nerve stimulation in the treatment of monosymptomatic enuresis in children and adolescents: a systematic review[J]. Int Braz J Urol, 2024, 50(2): 136-151. |
| [63] | Mcgrath KH, Caldwell PH, Jones MP. The frequency of constipation in children with nocturnal enuresis: a comparison with parental reporting[J]. J Paediatr Child Health, 2008, 44(1-2): 19-27. |
| [64] | Hodges SJ, Anthony EY. Occult megarectum-a commonly unrecognized cause of enuresis[J]. Urology, 2012, 79(2): 421-424. |
| [65] | Kim JH, Lee JH, Jung AY, Lee JW. The prevalence and therapeutic effect of constipation in pediatric overactive bladder[J]. Int Neurourol J, 2011, 15(4): 206-210. |
| [66] | Borch L, Hagstroem S, Bower WF, et al. Bladder and bowel dysfunction and the resolution of urinary incontinence with successful management of bowel symptoms in children[J]. Acta Paediatr, 2013, 102(5): e215-e220. |
| [67] | Dal Pra A, Cury FL, Souhami L. Radiation therapy and androgen deprivation in the management of high risk prostate cancer[J]. Int Braz J Urol, 2011, 37(2):161-175. |
| [68] | Baeyens D, Roeyers H, D'Haese L, et al. The prevalence of ADHD in children with enuresis: comparison between a tertiary and non-tertiary care sample[J]. Acta Paediatr. 2006, 95: 347-352. |
| [69] | Ding H, Wang M, Hu K, et al. Adenotonsillectomy can decrease enuresis and sympathetic nervous activity in children with obstructive sleep apnea syndrome[J]. J Pediatr Urol, 2017, 13(1): 41.e1-41.e8. |
| [70] | Tong C, He Q, Ho M, et al. Tuina for enuresis in children: a systematic review and meta-analysis of randomized controlled trials[J]. Front Public Health, 2022, 10: 821781. |
| [71] | Ton G, Lin C, Ho W, et al. The effects of laser acupuncture therapy on nocturnal enuresis: a systematic review and meta-analysis[J]. Med Acupunct, 2022, 34(4): 228-239. |
| [72] | 王仲易, 杜可, 李晨, 等. 中医儿科临床诊疗指南·小儿遗尿症(修订)[J]. 中医儿科杂志, 2018, 14(1): 4-8. |
| Wang ZY, Du K, Li C, et al. Clinical practice guidelines for pediatrics in traditional chinese medicine - enuresis in children (revised)[J]. Zhongyi Erke Zazhi, 2018, 14(1): 4-8. | |
| [73] | Sharifiaghdas F, Narouie B, Ahmadzade M, et al. Urodynamic findings in children with primary refractory nocturnal enuresis: 10 years' experience of a tertiary center[J]. Health Sci Rep, 2023, 6(10): e1626. |
/
| 〈 |
|
〉 |
