a. Sleep alarms
b. Desmopressin
c. Reassure
d. Behavior training
e. Imipramine
answer: D
Primary Nocturnal Enuresis
• definition: involuntary loss of urine at night, bladder control has
never been attained
• etiology: developmental disorder or maturational lag in
bladder control while asleep
• management
-
time and reassurance if <6years
-
behavior modification (voiding prior to sleep)
-
conditioning: “wet”
alarm wakes child upon voiding {first
line <7years}
-
medications (considered second line therapy,
may be used for sleepovers/camp):
Desmopressin
(1st line >7years} {2nd line <7years or if alarm inappropriate, or rapid
control needed}
imipramine
(rarely used, lethal if overdose, cholinergic side effects) {resistant cases}
Secondary Enuresis
•
definition: involuntary loss of urine at night, develops after child has sustained period of bladder control (>6 mo)
• etiology: inorganic regression due to stress
or anxiety (e.g. birth of sibling, significant loss, family discord), focused
on other activities, secondary to organic disease (UTI, DM, DI, neurogenic
bladder, CP, seizures, pinworms)
• management: treat underlying cause
Diurnal Enuresis
•
definition: daytime
wetting (60-80% also wet at night)
• etiology: micturition deferral (holding urine
until last minute) due to psychosocial stressor (e.g.
shy), structural anomalies (e.g. ectopic ureteral site, neurogenic
bladder), UTI, constipation, CNS disorders, DM
• management: treat underlying cause,
Behavioral
(scheduled toileting, double voiding, good bowel program)
Desmopressin
if >7years
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