Zusammenfassung
Enuresis ist als Einnässen im Schlaf in mindestens 2 Nächten im Monat nach dem 5. Lebensjahr definiert. In diesem Alter nässen 15 bis 20% aller Kinder noch ein. Mehr als die Hälfte dieser Kinder zeigt zusätzlich tagsüber Pollakisurie, Drangsymptome und Harninkontinenz (nicht monosymptomatische Enuresis). Der andere Teil der Kinder ist tagsüber unauffällig und nässt nur nachts ein (monosymptomatische Enuresis). Nächtliche Polyurie, Detrusorüberaktivität sowie eine verminderte Erweckbarkeit sind pathogenetisch die Hauptursachen. Psychologisch-psychiatrische Aspekte, genetische Faktoren und Obstipation spielen ätiologisch eine zusätzliche Rolle. Jeder Therapie muss obligat eine Basisdiagnostik vorausgehen. Anamnese, körperliche Untersuchung, Ultraschall des Harntrakts, Harnuntersuchung und Miktionsprotokoll sind Voraussetzung für einen erfolgversprechenden Therapieansatz. Die Eckpfeiler der primären Enuresistherapie sind allgemeine Verhaltensmaßregeln, Pharmakotherapie und Alarmgeräte. Therapieresistente enuretische Kinder bedürfen einer neuerlichen erweiterten Evaluation und meist einer multidisziplinären Therapie. Bei sorgfältiger Evaluierung und kausaler Therapie sind heute mit dem breiten therapeutischen Spektrum Erfolgsraten um 80% zu erzielen.
Abstract
Enuresis is defined as nocturnal bed wetting for at least 2 nights per month in children older than 5 years. At this age the prevalence of enuresis is about 15–20%. More than 50% of these children show day time symptoms, such as frequency, urgency and incontinence (non-monosymptomatic enuresis). The other children are asymptomatic during day time and wet the bed during the night time (monosymptomatic enuresis). The main pathogenetic factors are nycturia, detrusor overactivity and reduced arousability. Psychological and psychiatric aspects, genetics and obstipation play an additional role in the etiology. Basic diagnostic investigations are mandatory before treatment. Clinical history, physical examination, sonography of the urinary tract, urinalysis and bladder diary are prerequisites before any therapeutic steps are taken. The cornerstones of primary enuresis therapy are general lifestyle advice, pharmacotherapy and alarm devices. Therapy-resistant children deserve further evaluation and a multidisciplinary therapy approach. After careful evaluation specific therapy is efficient in approximately 80% of patients.
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Riccabona, M. Evaluierung und Management der Enuresis. Urologe 49, 861–870 (2010). https://doi.org/10.1007/s00120-010-2328-2
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DOI: https://doi.org/10.1007/s00120-010-2328-2