A new expert consensus on childhood bedwetting, or nocturnal enuresis (NE), aims to transform care by offering a practical framework for diagnosis and treatment. Published in the World Journal of Pediatrics, the guidance updates the 2014 Chinese consensus and aligns with international standards, addressing challenges such as underdiagnosis and inconsistent practice.
The consensus lowers the diagnostic threshold for NE: children aged five years or older who experience at least one involuntary nighttime void per month for three months now qualify for diagnosis, a shift from the previous weekly standard. This change enables earlier intervention, potentially reducing the psychosocial impact of persistent bedwetting, which can affect self-esteem, sleep, and family life.
The framework emphasizes classifying NE into two types: monosymptomatic NE (MNE), without daytime urinary symptoms, and non-monosymptomatic NE (NMNE), where daytime symptoms like urgency or incontinence are present. This classification drives treatment decisions. A cornerstone of the approach is the voiding diary, requiring at least two daytime charts and seven consecutive nights of fluid intake and voids. This allows clinicians to phenotype children as having nocturnal polyuria, reduced bladder capacity, or both, guiding first-line therapy: desmopressin for nocturnal polyuria, enuresis alarm for reduced bladder capacity, and combination therapy for mixed types.
For NMNE, the consensus prioritizes managing 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 can manage MNE, but non-responders or suspected NMNE require specialist evaluation with urodynamics and lumbosacral MRI. For refractory cases—less than 50% improvement after three months—the consensus advises systematic re-evaluation of adherence, diary findings, and underlying causes before escalating treatment.
The authors stress that NE should not be treated as a uniform disorder. They encourage clinicians to 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 before adding stronger therapy.
In practice, these recommendations could help pediatricians and primary-care clinicians identify children who can be managed locally versus those needing specialist care. Clearer use of voiding diaries and symptom-based classification may reduce trial-and-error treatment, while earlier attention to constipation, sleep-disordered breathing, ADHD, and daytime urinary symptoms could improve response rates. The framework also encourages timely referral, supporting better coordination across care levels.
The authors acknowledge that some recommendations reflect Chinese practice patterns and that evidence is limited for areas such as desmopressin withdrawal strategies. Future trials and multidisciplinary care models could further refine individualized treatment. The consensus, published with DOI:10.1007/s12519-026-01051-4, is available at https://doi.org/10.1007/s12519-026-01051-4.
