"Enuresis diurna" is not a diagnosis--new results on classification, pathogenesis and therapy of functional urinary incontinence in childhood

Newer research results have shown that the previous classification of enuresis into nocturnal, nocturnal and diurnal and diurnal forms is not sufficient. Day wetting constitutes a heterogeneous group of syndromes, which should be considered as functional urinary incontinences and which require differentiated diagnostics and therapies. General aspects of functional urinary incontinence are discussed, including: classification, epidemiology, symptomatology, especially the association with urinary tract infections, vesicoureteral reflux, obstipation and encopresis. The rate of psychiatric problems seems to be increased compared to children with nocturnal enuresis. Methodological problems of previous studies are discussed. General guidelines regarding diagnostics and therapy include the requirement of sonography, uroflowmetry with pelvic-floor-EMG, urinalysis and specific therapy-forms. The three most important syndromes are urge incontinence with urge symptoms, frequent micturition, holding manoeuvres due to a physiological instability of the detrusor and lower, mostly secondary psychiatric symptoms. Voiding postponement is a general refusal syndrome with a psychiatric etiology, characterized by a postponement of micturition and retention of urine. The detrusor-sphincter-dyscoordination has as the main symptom a paradox contraction instead of relaxation of the bladder sphincter during micturition. It is recommended hat the previous classification should be left in favour of more specific diagnoses to ensure specific, causally effective therapies.