Nocturnal Enuresis Symptom Score

Overview

Monosymptomatic nocturnal enuresis (NE), also known as bedwetting, is also defined as intermittent nocturnal enuresis. Nocturnal enuresis is considered primary when a child has not yet been dry for an extended period of time (six months). The term "secondary NE" is used when a child or adult starts wetting again after being dry for at least 6 months. Non-monosymptomatic NE is used for patients with lower urinary tract-related voiding symptoms (frequent urination, intermittent voiding, incomplete voiding, urinary tract infection, sudden urge to urinate during the daytime, daytime urinary incontinence). It is a relatively common symptom in children, with an incidence of 5-10% at the age of seven and 1-2% in adolescents. The ratio of girls to boys has been reported in the literature as roughly 2 to 1. The annual spontaneous resolution rate is 15% (at any age) and it is considered a relatively benign condition. Enuresis nocturne has important secondary stressful, emotional and social consequences for children. Caregivers (caregivers, parents, etc.) of these patients have reported a lower quality of life compared to control groups in studies. Since children under 5 years of age have a very high probability of spontaneous resolution, the European Society of Urology Guidelines recommend treating children over 5 years of age. Seven out of 100 seven-year-old bedwetting children will continue to wet the bed in adulthood. Initially, conservative methods should be recommended, supportive measures including normal and regular eating and drinking habits should be planned, fluid intake should be restricted 3 hours before bedtime and urination should be encouraged by going to the toilet before going to bed at night. In cases where conservative treatment fails to elicit a response, the child is awakened at a planned time at night with alarm therapy and taken to the toilet to urinate. Thus, it is aimed to empty the urine in the bladder and prevent bedwetting, but with this method, the sleep quality of the child and caregiver is shaken and the quality of life is reduced. Another treatment method is sublingual desmopressin administration as a medical treatment. The dose frequently used in children has been reported as 120 mcg/day and found to be safe. In case of dose inadequacy or inadequate response, there are reports showing that 240 mcg desmopressin sublingual treatment is also effective and safe. Despite sequential and combined treatments, inadequate treatment response may occur in 10-15% of patients or bedwetting symptoms may recur in 25-30% of patients after treatment. In these patients, invasive examinations such as urodynamics and cystoscopy may be planned if necessary, depending on the results of the review after a detailed lower urinary tract function questioning. There is no questionnaire for primary monosymptomatic enuresis nocturna in the literature. This makes categorization of patients, differential diagnosis, treatment monitoring and response evaluation difficult. Our aim with this study is that this form will play an active role in categorizing patients and choosing between different treatment modalities at the diagnosis and treatment monitoring stages and will be a helpful tool for clinicians in the future.