Experts from China, Denmark and Japan Convene in Shanghai to Explore New Pathways in Childhood Nocturnal Enuresis Care

On 17 October 2026, the Physician Academic Salon on Primary Nocturnal Enuresis (PNE) in Children, hosted by the Chinese Childhood Enuresis Disease Management Collaborative Group of the Nephrology Subgroup, Pediatrics Branch of the Chinese Medical Doctor Association, together with the Beijing Chronic Disease Prevention and Health Education Research Association, was held in Shanghai. Combining an in-person forum with online livestreaming and Chinese–English simultaneous interpretation, the meeting brought together multidisciplinary experts in pediatric nephrology, urology, traditional Chinese medicine and nursing from China, Denmark and Japan to discuss care pathways, guideline translation and specialty system development for primary nocturnal enuresis.

Group photo of on-site attendees

| Opening Remarks 

| Speaker: Professor Xu Hong, Children's Hospital of Fudan University, Conference Chair

A Decade of Accumulation: From 2014 to 2025

Professor Xu Hong , Children's Hospital of Fudan University

Professor Xu Hong of the Children's Hospital of Fudan University, Chair of the conference, recalled in her opening remarks that the Chinese Childhood Enuresis Expert Collaborative Group was founded in 2013 with pediatric nephrologists at its core, bringing together multidisciplinary expertise spanning urology, traditional Chinese medicine (TCM) and psychology. In 2014, China issued its first expert consensus on childhood nocturnal enuresis and established a multi-tier enuresis collaborative network across provinces and cities. After more than a decade of clinical accumulation and specialty development, the consensus was successfully updated and revised in 2025. She recalled in particular that during the revision, Professor Rittig, who was attending a conference in the United States at the time, joined the discussion online in the early hours of his local time. Today, as we meet in person at last, this sustained academic connection across time zones has become the very embodiment of the spirit of this salon: joining hands to advance children's kidney and urinary health.

| Three thematic sessions were set for today's salon:

1. Healthcare delivery system and the patient care pathway

2. Translation of clinical guidelines into practice

3. From clinical practice to specialty system development

| Session I: Healthcare Delivery System and Patient Care Pathway 

| Chair: Professor Shen Tong, Women's and Children's Hospital of Xiamen University

Professor Shen Tong , Women's and Children's Hospital of Xiamen University

Moving the Checkpoint Forward: Primary Care Pathways in Denmark and Japan

Professor Rittig of Aarhus University Hospital, Denmark, used the care trajectory of a six-year-old boy to illustrate a tiered system of 'school nurse screening — first contact with the family doctor — referral to a specialist center'. When a child starts school, the school nurse routinely asks about nocturnal enuresis, advises on keeping a bladder diary, initiates alarm therapy, or refers the child onward. For monosymptomatic cases without warning signs, neither routine physical examination nor urinalysis is required before starting treatment, whereas children with recurrent urinary tract infections, secondary enuresis, combined day-and-night symptoms, or comorbidities such as constipation and ADHD should be referred promptly. Denmark is now building a national digital platform to share bladder-diary data among school nurses, family doctors and hospitals.

Professor Søren Rittig , Aarhus University Hospital, Denmark

Professor Ohtomo of Juntendo University Nerima Hospital, Japan, explained that Japan has carried out health check-ups for children aged three and a half years through 469 public health centers nationwide, and has recently added a check-up at five years of age that screens for voiding and defecation problems as well as ADHD and ASD. Since desmopressin was approved in 2012, first-line treatment has shifted from tricyclic antidepressants to desmopressin, with anticholinergics as second-line therapy. The society maintains separate websites for families and for physicians, with around 28,000 searches each month for nearby clinics.

Professor Yoshiyuki Ohtomo , Juntendo University Nerima Hospital, Japan

Experience from a Single Centre: Changes Over Seven Years

Professor Gao Xia of Guangzhou Women and Children's Medical Center, Guangzhou Medical University, shared her center's data from 2017 to 2025: around 4,000 visits for nocturnal enuresis each year, yet each patient averages only 2.2 to 2.5 visits, indicating a low follow-up rate. The specialty from which patients sought care shifted from predominantly nephrology (down from over 90% to 77%) toward TCM (up from 8% to 16%), urology and neurosurgery. In a cohort of more than 26,000 patients, males accounted for 65% and the median age at first visit approached seven years; desmopressin use rose from under 20% in 2014 to 45% in 2025. Over seven years, 157 cases of neurogenic bladder and more than 220 cases of tethered cord were detected, while only 72 cases of psychological problems were identified, pointing to diagnoses missed within limited consultation time. The center has therefore explored three pathways: an integrated TCM–Western medicine ward, a nurse-led clinic and an MDT clinic. The nursing team completed 784 uroflowmetry examinations in six months and identified 305 abnormal flow curves, and has developed patents including a wearable smart nocturnal urine monitoring system; the MDT clinic saw 125 children and completed 238 visits in one year across 12 departments, with 39.2% of them having comorbidities.

Professor Gao Xia , Guangzhou Women and Children's Medical Center, Guangzhou Medical University

| Roundtable I: Finding the Children — Awareness, Stigma and Breaking Through at the Grassroots

Panelists: Professor Bao Ying (Xi'an Children's Hospital), Professor Wang Mo (Children's Hospital of Chongqing Medical University)

On the three topics of barriers to care, causes of delayed or missed diagnosis, and possible solutions, Professor Bao Ying of Xi'an Children's Hospital noted that traditional views hold that enuresis 'can resolve on its own', so families rarely take it seriously, while outreach by physicians remains concentrated in major cities; a 2017 epidemiological survey showed that adolescents aged 17 to 18 still wet the bed. Professor Wang Mo of the Children's Hospital of Chongqing Medical University added three dimensions: the family (low awareness, stigma and an excessively high expectation of spontaneous resolution), society (the absence of a supportive environment and of public education), and hospitals (non-specialists' insufficient understanding of comorbidities). He proposed three measures: conducting regional surveys of enuresis, building county- or community-level referral and specialty management systems, and using artificial intelligence for early screening and timely referral. Professor Rittig observed that systematic screening through the school system is an experience shared by Denmark and Japan.

| Session II: Translation of Clinical Guidelines into Practice

| Chair: Professor Jiang Xiaoyun, The First Affiliated Hospital, Sun Yat-sen University

Professor Jiang Xiaoyun , The First Affiliated Hospital, Sun Yat-sen University

Implementing the Guidelines: Using the Bladder Diary to Guide Individualized Treatment

Interpreting the ICCS guidelines, Professor Rittig restated the definitions of treatment response: a complete response means dry nights; a reduction of at least 50% in wet nights is a partial response; and below that it is a poor response. About one third of children do not respond adequately to first-line treatment. He stressed that desmopressin targets nocturnal polyuria whereas the enuresis alarm targets reduced bladder capacity and impaired arousal — the two act on different mechanisms rather than competing with each other. Selecting first-line treatment on the basis of the bladder diary can raise response rates by around 50%, and the prediction formula developed by his team has a positive predictive value of about 80%. For completely refractory patients, multimodal combination therapy in a study of 60 patients achieved complete dryness in 61% of them.

Professor Shen Qian of the Children's Hospital of Fudan University systematically interpreted the 2025 Chinese Expert Consensus on the Management of Nocturnal Enuresis in Children. Eighteen recommendations were formed using the Delphi method, each with over 90% agreement. The diagnostic threshold was broadened to 'at least one episode of involuntary night-time voiding per month on average, lasting more than three months'; the definitions of daytime lower urinary tract symptoms and of constipation were clarified; and the bladder diary was adjusted to require two daytime days, which need not be consecutive, plus seven consecutive nights. Desmopressin is started at 0.2 mg, with a maximum of 0.6 mg, for a three-month course, and once dry nights are achieved the dose may be tapered gradually before discontinuation to reduce relapse. The English version of the consensus has been published in an international pediatrics journal, and ten face-to-face dissemination sessions have been completed.

Professor Shen Qian , Children's Hospital of Fudan University

Roundtable II: The Last Mile of Guideline Implementation — Assessment, Adherence and Discontinuation

Panelists: Professor Liu Quan'e (People's Hospital of Xiangxi Tujia and Miao Autonomous Prefecture), Professor Li Yuhong (Guiyang Maternal and Child Health Care Hospital)

On the three topics of gaps in care, improving adherence, and the timing of desmopressin discontinuation, Professor Liu Quan'e of the People's Hospital of Xiangxi Tujia and Miao Autonomous Prefecture held that the priority is to strengthen physicians' knowledge and standardized diagnostic capability; clinicians themselves must no longer cling to the belief that 'it can wait and resolve on its own'. Her center's follow-up rate is just over 30%, with 13.6% of patients lost to follow-up. Professor Li Yuhong of Guiyang Maternal and Child Health Care Hospital outlined three weak links: insufficient assessment (failure to distinguish monosymptomatic from non-monosymptomatic cases using the bladder diary, and neglect of comorbidities such as constipation and ADHD); poor adherence (no reassessment around four weeks after starting medication); and non-standard discontinuation and follow-up (stopping as soon as dryness is achieved, or continuing beyond three months, both of which can cause relapse). Both emphasized explaining the value of the bladder diary to parents and providing standard templates and other tools to lower the burden of recording.

| Session III: From Clinical Practice to Specialty System Development

| Chair: Professor Wen Jianguo, The First Affiliated Hospital of Zhengzhou University

Professor Wen Jianguo , The First Affiliated Hospital of Zhengzhou University

Toward a Specialty: Refractory PNE and System Development

Drawing on more than 20 years of experience since Beijing Children's Hospital opened its enuresis clinic in 2004, Professor Liu Xiaomei of Beijing Children's Hospital, Capital Medical University, analysed refractory nocturnal enuresis: for children who still respond poorly to standardized first-line treatment, the cause should be sought first — assessing adherence, then whether the condition and the regimen match, then overall health, including secondary factors, comorbidities, constitution and sleep quality. She stressed that it is '30% treatment, 70% management'; the goal is not to stop bedwetting today, but to improve quality of life, promote functional development and improve constitution. She also quoted the saying that 'time is not the answer, but the answer often lies in time', noting that enuresis is essentially a developmental issue: give it time, but emphasize management.

Professor Liu Xiaomei , Beijing Children's Hospital, Capital Medical University

Professor Ohtomo returned to the podium to share Japan's experience with second-line medicines and Kampo formulations for the next edition of the Japanese guideline. He also noted that 22% to 32% of ADHD patients have enuresis and that 30% to 40% of children with enuresis have comorbid ADHD, and that atomoxetine and clonidine can play a role in refractory children with comorbid ADHD.

Roundtable III: Specialty Development, Talent Cultivation and Research Directions

Panelists: Professor Liu Ying (Children's Hospital of Fudan University), Professor Zhao Lijun (Shanxi Provincial Children's Hospital)

On specialty center development, talent cultivation and data gaps, Professor Zhao Lijun of Shanxi Provincial Children's Hospital proposed that center building should look beyond the department itself to regional promotion, and suggested that enuresis be included in undergraduate pediatrics textbooks so that awareness begins at the source of medical education. Professor Liu Ying of the Children's Hospital of Fudan University suggested moving the screening checkpoint forward by establishing stable links with pediatrics and child health care, and pushing mature diagnostic standards down to the grassroots in a tiered manner so that primary care doctors can perform standardized initial diagnosis and long-term follow-up. On talent cultivation, young doctors should not be assigned a direction too early; standardized enuresis treatment should be a fixed module within routine training, first building an overview and a sense of achievement, then moving into data summarisation and follow-up.

| Six Institutions Receive Specialty Clinic Accreditation

The conferment ceremony for pediatric nocturnal enuresis specialty clinics was held during the meeting, with Professor Xu Hong, Professor Rittig and Professor Ohtomo presenting plaques to six institutions. The People's Hospital of Guangxi Zhuang Autonomous Region, the Yibin Hospital of the Children's Hospital of Chongqing Medical University, the People's Hospital of Wenshan Zhuang and Miao Autonomous Prefecture, Yunnan, Liuzhou Hospital of Traditional Chinese Medicine, Liuzhou People's Hospital and Chengdu Children's Specialist Hospital received accreditation. The criteria cover six dimensions: clinic stability, personnel qualifications, diagnostic capability, patient volume and facilities, specialist nurse staffing, and advanced examination capability. To date, the programme has organized seven conferment ceremonies covering more than 50 institutions nationwide.

Conferment ceremony for pediatric nocturnal enuresis specialty clinics

| Closing Remarks

In her closing remarks, Professor Xu Hong described the salon as an exchange that combined professional depth with human warmth. Looking ahead, standardized enuresis care will be incorporated into pediatric continuing education and physician residency training, while artificial intelligence will be actively explored for early risk identification, smart screening and tiered assessment — 'the road to preventing and treating nocturnal enuresis is long, but perseverance will bring us there'. The meeting drew more than 350 online attendees through its Chinese-language livestream and was simultaneously broadcast in English on the website of the Asian Society of Pediatric Nephrology (AsPNA), drawing over 430 colleagues from China and abroad. From the first expert consensus in 2014 to the updated 2025 edition, from single-department care to a multidisciplinary collaborative network, the diagnosis and treatment of childhood nocturnal enuresis in China is moving toward standardization and refinement. The China–international dialogue platform built by this salon has forged fresh consensus on standardizing care pathways, translating guidelines into clinical practice, and completing the specialty care system.