An updated expert consensus on childhood nocturnal enuresis (NE) offers a new roadmap for clinicians, aiming to standardize care and improve outcomes. The guidance, published in the World Journal of Pediatrics, includes 18 recommendations covering diagnosis, classification, evaluation, first-line therapy, comorbidity management, and referral. It lowers the diagnostic threshold to at least one involuntary nighttime void per month for three months in children aged five years or older, enabling earlier intervention.
The consensus distinguishes between monosymptomatic NE (MNE), without daytime lower urinary tract symptoms, and non-monosymptomatic NE (NMNE), where daytime symptoms like urgency or incontinence are present. This classification drives treatment decisions. The voiding diary becomes a cornerstone of diagnosis, requiring at least two daytime charts and seven consecutive nights of recording fluid intake and voids. This allows clinicians to phenotype children as having nocturnal polyuria, reduced bladder capacity, or both.
For MNE, treatment is phenotype-driven: desmopressin for nocturnal polyuria, enuresis alarm for reduced bladder capacity, and combination therapy for mixed types. For NMNE, management prioritizes daytime lower urinary tract symptoms and comorbidities, especially constipation, which affects 36–80% of these children, before addressing nighttime wetting. The framework also outlines referral criteria: primary care may manage MNE, but non-responders or suspected NMNE require specialist evaluation with urodynamics and lumbosacral magnetic resonance imaging (MRI). Refractory cases, defined as less than 50% improvement after three months, should prompt systematic re-evaluation of adherence, diary findings, and underlying causes before escalating treatment.
The authors emphasize that NE should not be managed as a single disorder. Instead, clinicians should identify the child's specific pattern, look for daytime symptoms and comorbidities, and match treatment to the likely underlying mechanism while keeping the family involved. Apparent treatment failure should trigger a careful review—of adherence, voiding records, and possible missed conditions—before adding stronger therapy.
These recommendations could help pediatricians and primary-care clinicians identify children who can be managed locally and those needing specialist assessment. Clearer use of voiding diaries and symptom-based classification may reduce trial-and-error treatment. Earlier attention to constipation, sleep-disordered breathing, attention-deficit/hyperactivity disorder (ADHD), and daytime urinary symptoms could improve response rates. The framework also encourages timely referral when first-line therapy fails or NMNE is suspected, supporting better coordination across levels of care.
The authors acknowledge that some recommendations reflect Chinese practice patterns and that evidence remains limited for areas such as desmopressin withdrawal strategies. Future trials and multidisciplinary care models could further refine individualized treatment. The study is published with DOI 10.1007/s12519-026-01051-4.
