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Expert consensus on the management of nocturnal enuresis in children

World J Pediatr · 2026 · China

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Authors
Qian Shen, Hong Xu, The Cooperative Group Member
Title
Expert consensus on the management of nocturnal enuresis in children
Journal
World Journal of Pediatrics, 2026
DOI
10.1007/s12519-026-01051-4
Licence
CC BY 4.0
Changes
Verbatim excerpts; formatting adapted

Full text retrieved 2026-10-27 from Europe PMC · PMC13578046

Licence statement of the original publication

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This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.

Open the original publication →Full text on Europe PMC

Recommendations

Verbatim, with grade of recommendation or strength of consensus where given.

Definition and classification

  • Recommendation 1The definition of pediatric NE is updated to children aged five years or above with at least one involuntary urination during sleep per month on average, lasting for three months or morefully agreed: 97.5%
  • Recommendation 2After confirming a diagnosis of NE, classify it as MNE or NMNE based on the presence or absence of daytime LUTSfully agreed: 97.5%

History taking

  • Recommendation 3Diagnosing NE requires a detailed history, covering overall health status, voiding and bowel habits, sleep and behavioral issues, and past diagnostic and treatment history, while taking care to distinguish other diseases and comorbid conditionsfully agreed: 100%

Physical examination

  • Recommendation 4The diagnostic workup for NE requires a routine physical examination, assessing overall health and checking for any genitourinary anomalies, spinal developmental abnormalities, or neurological signs in the lower limbs.fully agreed: 97.5%

Ancillary investigations

  • Recommendation 5Ancillary investigations are important for NE diagnosis and evaluation. It is recommended that newly diagnosed children undergo urinalysis and ultrasound of the urinary system. For those with significant daytime LUTS and/or abnormal bowel habits, consider urodynamic studies and lumbosacral MRIfully agreed: 100%

Voiding diary

  • Recommendation 6Children with NE keep a voiding diary to guide clinical diagnosis and to evaluate treatment efficacyfully agreed: 95%

Age to initiate treatment

  • Recommendation 7The age to initiate treatment for childhood enuresis should be individually assessed; generally, treatment is recommended for children over five years old. Children with NMNE often require more aggressive evaluation and multidisciplinary managementfully agreed: 100%

Keep a voiding diary

  • Recommendation 8For younger children or those whose enuresis has a minimal impact on daily life, basic treatment can be attempted first; basic treatment measures should be maintained throughout the entire course of enuresis managementfully agreed: 97.5%

First-line treatments

  • Recommendation 9Desmopressin and enuresis alarms are first-line treatments for MNE. Desmopressin is preferred for children with nocturnal polyuria, whereas the enuresis alarm is recommended for those with small bladder capacity. Combined therapy is advised for children with both conditions. The final treatment plan should be individualized based on the clinical profile and the preferences of the parents and childfully agreed: 100%
  • Recommendation 10The recommended initial dosage of desmopressin is 0.2 mg once nightly, which may be titrated up to a maximum of 0.6 mg once nightly based on response. Although hyponatremia and water intoxication are potential adverse effects, the risk is extremely low with correct adherence to fluid restriction, and the drug is generally well tolerated. A treatment course of three months is typical before attempting discontinuation in responders, which can be abrupt or via a graded taperfully agreed: 100%

Second-line treatment

  • Recommendation 11For children with MNE who do not respond to the first-line therapy (correct use of an enuresis alarm or adequate dosing of desmopressin), other treatment methods or combination therapies should be selected, such as combining desmopressin with an anticholinergicfully agreed: 100%

Treatment principles

  • Recommendation 12The initial management of NMNE should prioritize the treatment of daytime symptoms, with a focus on treating LUTS and comorbid conditions. Nocturnal enuresis symptoms that persist after the resolution of daytime symptoms should be managed according to the principles for MNEfully agreed: 100%

Pharmacological management for daytime symptoms

  • Recommendation 13Anticholinergic medications and β3-adrenergic receptor agonists are therapeutic options for patients with NMNEfully agreed: 100%

Non-pharmacological management

  • Recommendation 14Pelvic floor muscle training and biofeedback therapy can be considered for children with daytime LUTS (e.g., urgency, urge incontinence, voiding difficulty). Transcutaneous electrical nerve stimulation may be an option for patients with refractory NMNE, particularly when associated with OAB and constipationfully agreed: 100%

Treatment of comorbidities

  • Recommendation 15Children with enuresis who have comorbid conditions (e.g., constipation, ADHD, OSAS) often have a lower response to basic therapy. Concurrent management for these comorbidities is essentialfully agreed: 97.5%

Role of primary health care institutions

  • Recommendation 16Primary health-care institutions may initiate management of MNE. Referral to a specialized center for further diagnosis and treatment is recommended if there is no response to first-line treatment or if NMNE is diagnosed or suspectedfully agreed: 100%

Traditional Chinese medicine approaches

  • Recommendation 17Comprehensive TCM therapies, including herbal medicine and external therapies (e.g., acupuncture, massage, medicinal patches), may improve enuresis-related symptoms based on syndrome differentiation. They may be integrated with Western medicine in the treatment of enuresisfully agreed: 100%

Refractory enuresis

  • Recommendation 18Children with refractory enuresis should undergo a comprehensive re-evaluation. This includes assessing treatment adherence, reviewing the voiding diary, and performing appropriate investigations to identify underlying causes and guide treatment adjustmentfully agreed: 97.5%

Abstract

Background: Nocturnal enuresis (NE) is a common condition in childhood that can adversely affect children’s physical and psychological health. Since the publication of the “Expert Consensus on the Management of Monosymptomatic Nocturnal Enuresis in Chinese Children” in 2014, substantial clinical experience has been accumulated and international guidelines have been updated, necessitating a revision to standardize and improve clinical management.

Methods: This consensus was developed by the Chinese Cooperative Group for the Management of Pediatric Nocturnal Enuresis, the Pediatric Nephrology Committee of the Chinese Medical Doctor Association using the Delphi method. A core writing group of nine experts drafted statements based on a synthesis of current evidence. These were subjected to iterative voting by 42 multidisciplinary panelists to achieve consensus, defined as ≥ 90% agreement.

Results: The consensus provides 18 key recommendations. It updates the diagnostic criteria for children aged ≥ 5 years with at least one involuntary void per month for three months. It emphasizes classification into monosymptomatic (MNE) or nonmonosymptomatic (NMNE) NE based on daytime lower urinary tract symptoms. Recommendations cover comprehensive evaluation (history, physical exam, voiding diary), basic management (education, lifestyle), and first-line treatment (desmopressin for nocturnal polyuria, alarm therapy for reduced bladder capacity). Strategies for treatment-resistant cases, management of NMNE (prioritizing daytime symptoms), and the role of primary care and traditional Chinese medicine are outlined.

Conclusions: This expert consensus provides an updated, evidence-based, and practical framework for the diagnosis and management of childhood NE. It aims to harmonize clinical practice, promote individualized care, and improve patient outcomes through standardized recommendations.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s12519-026-01051-4.

Contents of the original publication

The section headings of the original.

  • Introduction
  • Methods
  • Expert panel
  • Consensus development process
  • Recommendations and discussion
  • Diagnosis of nocturnal enuresis
  • Management of nocturnal enuresis
  • Limitations and future directions
  • Conclusions
  • Contributor Information

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