Enuresis: modern aspects of etiology, pathogenesis, psycho-, pharmaco-, physical therapy and phytotherapy (part 1)

Abstract

The review (part 1) discusses modern views on the etiology, pathogenesis and clinical course of bedwetting in children. Enuresis is a common condition that causes significant disruption in critical areas of a child's life. Despite the existence of an international standard and clinical guidelines for the treatment of bedwetting, specialists do not have a single approach to the management of patients with enuresis. In order to systematize modern views on these issues, 73 sources were analyzed. The criteria for enuresis according to ICD-10 and DSM-5.0 and various approaches to classifying the types of enuresis are present in the review. The characteristics of simple, neurotic, endocrinopathic, epileptic, neuropathic and dysplastic forms of enuresis are given. The modern concepts of the pathophysiology of enuresis are analyzed. Connection between bedwetting and sleep problems, high levels of arousal in the cerebral cortex, fragmentation, and poor sleep quality are accentuated in the several analyzed studies. The changes in the autonomic nervous system and hemodynamics arising in connection with these disorders contribute to the excessive formation of urine and an increase in the activity of the bladder. Some patients have nocturia associated with circadian fluctuations in the level of vasopressin, which, however, does not always explain the occurrence of bedwetting. A number of analyzed studies have established a relationship between polyuria and changes in salt and water excretion. Other mechanisms of the pathogenesis of enuresis, concerning violations of the reservoir function of the urinary bladder during sleep, are also highlighted. Knowledge of the etiology and pathogenesis of enuresis helps doctors better understand the nature of a particular child's condition and, personalize treatment, based on modern protocols. The patient-centered approach to the treatment of enuresis is discussed in article, as well as sequence of therapeutic measures, including behavioral therapy, alarm-therapy and pharmacotherapy, and if indicated, also physical therapy and herbal medicine, a detailed analysis of which is presented in part 2 of the review.