Nocturnal enuresis in children

Involuntary urination during sleep in a child over 5 years, at least twice weekly for 3 months. Primary form (no prior dry period) affects 15–20% of 5-year-olds. ICCS 2020 and AAP 2023 set desmopressin and alarm therapy as first line.

ICD-10 F98.01 drug

Also known as: Bedwetting, Nighttime wetting

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

DTolterodineNot recommended · Muscarinic receptor antagonist for overactive bladderTolterodine is sometimes prescribed to children with nocturnal enuresis against international guidelines. ICCS 2020 and AAP 2023 place desmopressin and alarm therapy (moisture-triggered alarm) as first line. In children under 12 years, tolterodine is not approved by AEMPS or FDA. Cochrane Review (Sureshkumar 2003, updated 2011) rated the evidence for antimuscarinics in children as low quality: 4 small RCTs with varied methodology and wide effect estimates. In a child, the drug increases the risk of urinary retention and cognitive side effects. If tolterodine was prescribed to a child without a trial of alarm therapy and desmopressin, consider seeking a second opinion.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit