Therapeutic target
- Decrease in enuresis
Therapy recommendations
- Treatment of comorbid disorders must precede or parallel initiation of urinary incontinence treatment.
- Standard durotherapy (basic therapy of nonorganic enuresis) [first therapeutic measure]-see “Further therapy” for details.
- Apparent behavioral therapy (AVT) with a wake-up device; alternatively, in case of high nocturnal urine volume: desmopressin (ADH analogue/antidiuretic hormone); in case of non-MEN and small bladder capacity, if there is evidence of nocturnal polyuria, the combination treatment of an anticholinergic and AVT or desmopressin may be effective.Switch to the respective other form of treatment in case of treatment failure of AVT or desmopression; a combination of both forms of therapy does not bring any advantage.
- In non-MEN (non-monosymptomatic enuresis nocturna), treat daytime symptoms (bladder dysfunction) first; in non-MEN and small bladder capacity, combination treatment of an anticholinergic and AVT may be effective if there is evidence of nocturnal polyuria
- For overactive bladder (OAB; small bladder capacity) and urge incontinence when urotherapy is not sufficient: propiverine (anticholinergic).
- In urinary incontinence with micturition postponement, attention must be paid to psychological comorbidities (concomitant diseases).
- In dyscoordinated micturition should be parallel to urotherapy biofeedback treatment; in therapy refractory dyscoordinated micturition and neurogenic bladder (detrusor-sphincter dyssynergy): alpha-blocker.
Further note
- Urinary tract infections must be treated consistently; if necessary, antibacterial prophylaxis.
- In very rare cases, botulinum toxin (for therapy failure with small bladder capacity) is used.
