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Importance of neuropsychiatric evaluation in children with primary monosymptomatic enuresis

Mariangela Gulisano, Carla Domini, Mara Capelli, Alessandra Pellico, Renata Rizzo

Journal of Pediatric Urology, Available online 25 November 2016, http://dx.doi.org/10.1016/j.jpurol.2016.10.019

Commentary by Guy Bogaert

This study has focused on the neuropsychiatric evaluation of children with primary monosymptomatic enuresis.  200 children with bedwetting problems were recruted for this study from the neuropsychiatric unit of the university hospital of Catania (Sicily) and I allow to say that there is already a significant bias as where the children are coming from.  The control population were coming from a local school.  The authors have found a higher score in the Child Behavior Check List, in the Conners’ Multidimensional Anxiety Scale for Children, in the Child Depression Inventory, in the Yale global Tic Severity Score and in the Child Yale-Brown Obsessive Compulsive Scale score in the group of bedwetting children 1.  In addition, the quality of life score were lower in the group of bedwetting children.  We know from other studies that indeed, the quality of life of children who wet their bed, and their mothers are impaired and improve when the child becomes dry, so this is a normal finding.  However to be able to generalize the “high incidence” of neuropsychiatric disorders in children with nocturnal enuresis and that on the basis of this study “all bedwetting” children have to undergo this evaluation, I am not convinced at all.  The authors weaken their statement in a conclusion where “clinicians should not underestimate the effects on psychosocial development”: who said we did?

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Consensus Guidelines

Practical consensus guidelines for the management of enuresis. 
Evaluation and management of enuresis, a common condition, is not a priority in training programs for medical doctors (MDs), despite being a common condition. 

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Diagnosis and Treatment of Nocturnal Enuresis developed by the Working Group of Nocturnal Enuresis Belgium.