Abstract

*Mehriban Elkhan Guliyeva, Sevinj Zakir Gojayeva

ABSTRACT

Background: Monosymptomatic nocturnal enuresis (MNE) is a common developmental disorder characterized by intermittent urinary incontinence during sleep in children aged five years or older in the absence of clinically relevant daytime lower urinary tract symptoms. Although spontaneous remission occurs in a proportion of affected children, persistent enuresis may adversely influence emotional well-being, self-esteem, family functioning, and social participation. The heterogeneous pathophysiology of MNE explains why a uniform therapeutic strategy frequently produces suboptimal results. Objective: To evaluate contemporary approaches to the diagnosis and management of monosymptomatic nocturnal enuresis and to formulate a differentiated diagnostic and therapeutic algorithm based on the predominant pathophysiological phenotype, clinical characteristics, and treatment response. Materials and Methods: A structured narrative review of contemporary scientific literature and international recommendations concerning MNE in children was performed. Particular attention was paid to publications addressing nocturnal polyuria, functional bladder capacity, arousal mechanisms, voiding diaries, enuresis alarms, desmopressin therapy, combination treatment, treatment resistance, and clinically relevant comorbidities. Current recommendations of the International Children’s Continence Society (ICCS), European Association of Urology/European Society for Paediatric Urology (EAU/ESPU), and recent evidence-based reviews were incorporated. Results: Current evidence supports differentiation of children with MNE according to the predominant mechanism: nocturnal polyuria, reduced nocturnal or functional bladder capacity, impaired arousal from sleep, or a mixed phenotype. Desmopressin is particularly appropriate when nocturnal polyuria predominates, whereas alarm therapy provides an etiologically rational option in children with adequate family motivation and may offer superior sustained response after treatment discontinuation. Children with mixed phenotypes or incomplete response to monotherapy may benefit from combination therapy. Constipation, sleep-disordered breathing, psychological difficulties, poor adherence, and previously unrecognized daytime lower urinary tract symptoms should be actively investigated in treatment-resistant cases. Conclusion: MNE should not be regarded as a homogeneous clinical condition. Phenotype-oriented assessment based on careful history, voiding diaries, nocturnal urine production, functional bladder capacity, comorbidity screening, and previous therapeutic response can facilitate individualized treatment selection. A differentiated strategy may improve therapeutic efficacy, reduce unnecessary pharmacological exposure, and enhance long-term adherence.