Clinical practice guideline: monosymptomatic primary enuresis in Primary Care

Objective: to elaborate a clinical guide that analyze the evidences and help in the decision making process of prevention, risk factors, diagnosis and treatment of primary monosymptomatic nocturnal enuresis (PMNE). Costs and medical burden was not taken into consideration. Materials and methods: Evidences: a systemathic review answer the key clinical questions about each PMNE point of view. The best evidence described for each of the analysis was discussed, and degrees of recommendation were stated. Measurements: OR for risk factors and RR for treatment results. We only considered the treatment results of: initial success (14 dry nights), complete dryness (100% dry nights), complete response (< 90% wet nights reduction) and cure (initial success or complete response without relapsing). Results: Prevention: we don?t find evidence. Risk factors: chronic headache, attentiondeficit hyperactivity disorder (ADHD), constipation/encopresis and sleep apnoea are associated with an increase frequency of nocturnal enuresis. PMNE has not been associated with either urinary tract infection or psychological problems, although persistence of enuresis drives to low self-steem. Diagnosis: clinical presentation, a normal physical exam and a micturitional diary are the basis of diagnosis. Urinary culture or urine strip lack any utility. Treatment: simple and complex conductual treatment, alarm and treatment with desmopresin were analyzed, as well as the way of weaning the treatment. Prognostic factors of success or treatment failure were analyzed and taken into account when recommending different treatments. Diurnal maximum voided volume, attitude of the child and family to collaboration and their stress, number of wet nights and ADHD.