Transition in enuresis patients: Identifying the gaps and opportunities for the future

Sevasti Karamaria; Reiner Mauel; Mauro Van den Ende; Ase Oosterlinck; Alice Verheye; Elke De Bruyne; Eva Degrauewe; Karlien Dhondt; Lien Dossche; Ann Raes; Catherine Renson; Bieke Samijn; Anne-Francoise Spinoit; Karel Everaert; Johan Vande Walle

doi:10.1002/nau.25460

Transition in enuresis patients: Identifying the gaps and opportunities for the future

Neurourol Urodyn. 2024 Apr 8. doi: 10.1002/nau.25460. Online ahead of print.

Authors

Sevasti Karamaria¹, Reiner Mauel², Mauro Van den Ende³, Ase Oosterlinck¹, Alice Verheye¹, Elke De Bruyne⁴, Eva Degrauewe¹, Karlien Dhondt⁵, Lien Dossche^{1

4}, Ann Raes⁴, Catherine Renson³, Bieke Samijn^{3

6}, Anne-Francoise Spinoit³, Karel Everaert³, Johan Vande Walle¹

Affiliations

¹ Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
² Department of Pediatric Intensive Care, Brussels University Hospital, Brussels, Belgium.
³ Department of Urology, eUROGEN Accredited Center, Ghent University Hospital, Ghent, Belgium.
⁴ Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium.
⁵ Department of Child & Adolescent Psychiatry, Pediatric Sleep Center, Ghent University Hospital, Ghent, Belgium.
⁶ Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.

PMID: 38587243
DOI: 10.1002/nau.25460

Abstract

Background: Nocturnal enuresis is generally considered a children's condition, yet it may persist 1%-2% in adolescence and early adulthood. Refractory patients often demand follow-up by multidisciplinary teams, which is only restricted to some of the expert tertiary centers. However, there are no standardized transition programs/guidelines when follow-up must be passed from pediatric to adult healthcare providers.

Aim, materials & methods: To investigate this issue, we conducted a literature search on enuresis transition, which resulted in no articles. We, therefore, proceeded in a rescue search strategy: we explored papers on transition programs of conditions that may be related and/or complicated by enuresis, nocturia, or other urinary symptoms (chronic diseases, CKD, bladder dysfunction, kidney transplant, neurogenic bladder).

Results: These programs emphasize the need for a multidisciplinary approach, a transition coordinator, and the importance of patient and parent participation, practices that could be adopted in enuresis. The lack of continuity in enuresis follow-up was highlighted when we investigated who was conducting research and publishing on enuresis and nocturia. Pediatric disciplines (50%) are mostly involved in children's studies, and urologists in the adult ones (37%).

Discussion: We propose a stepwise approach for the transition of children with enuresis from pediatric to adult care, depending on the clinical subtype: from refractory patients who demand more complex, multidisciplinary care and would benefit from a transition coordinator up to children/young adults cured of enuresis but who persist in having or present lower urinary tract symptoms (LUTS)/nocturia later on. In any case, the transition process should be initiated early at the age of 12-14 years, with adequate information to the patient and parents regarding relapses or LUTS/nocturia occurrence and of the future treating general practitioner on the enuresis characteristics and comorbidities of the patient.

Keywords: LUTS; adolescence; enuresis; multidisciplinary team; nocturia; transition.

Publication types

Review