Combination therapy for nocturnal enuresis

Nocturnal enuresis (NE) is a multifactorial condition of childhood affectin g both children and their parents. NE may result from a vasopressin deficie ncy, bladder instability or lack of arousal from sleep to bladder sensation s. The development of the three-systems model offers increased understandin g of the multifactorial aetiology of NE and may aid the development of a ta ilored treatment regimen for the individual child. For decades, treatment o f NE has focused on pharmacological, behavioural and combination therapies, and many studies provide supporting evidence for each of these treatment a pproaches. However, many of these studies were performed on unselected pati ent populations, without assessment of the cause of the patients' enuresis, and therefore both the methodologies and results of these studies are ques tionable. This paper reviews the efficacy of combined treatment interventio ns and assesses when such interventions may be of most benefit to the patie nt.