Modern management of pediatric nocturnal enuresis: Evidence-based treatment and practical guidance.

Abstract

Nocturnal enuresis (NE) is a common and multifactorial pediatric condition characterized by abnormalities in bladder storage, renal water regulation, and central arousal mechanisms. According to the International Children's Continence Society, NE is defined as intermittent urinary incontinence that occurs during sleep in children aged 5 years or older, in the absence of congenital or acquired neurologic or urologic disease. Although often self-limiting, NE imposes a substantial psychosocial burden, causing embarrassment, low self-esteem, sleep disruption, and family stress. Advances in neurophysiology and renal chronobiology have clarified that NE represents a developmental delay involving three major pathophysiological domains: nocturnal polyuria, reduced functional bladder capacity or detrusor overactivity, and impaired arousal responses to bladder filling. Contemporary management emphasizes individualized, mechanism-based strategies tailored to the predominant abnormality. This review summarizes current evidence on the pathophysiology, clinical evaluation, and evidence-based treatment of pediatric NE and highlights the importance of early identification, structured behavioral interventions, and family-centered multidisciplinary support to improve long-term outcomes and quality of life.