4 - Paeds - Community Paeds + Psych - Enuresis

Question 1

define daytime enuresis

Answer 1

lack of bladder control in child old enough to be continent (3-5y)

Question 2

causes of daytime enuresis?

Answer 2

lack of attention to bladder sensation (preoccupied/dev or psychogenic problem)
detrusor instability
bladder neck weakness
neuropathic bladder
UTI
Constipation
Ectopic ureter

Question 3

Ex?

Answer 3

may show neuropathic bladder (distension, loss of sensation, abnormal gait/reflexes

Question 4

Ix?

Answer 4

urine sample - MC+S
USS - show anatomical pathology
XR/MRI maybe

Question 5

MGMT - daytime enuresis

Answer 5

trt constipation
trt underlying pathology
star chart/dryness calendar
bladder training + pelvic floor exercises

Question 6

Nocturnal enuresis - gender prevalence? 2 possible causes? (non-organic)

Answer 6

boys:girls = 2:1

genetic delay in sphincter competence
emotional stress > 2ndary enuresis at night

Question 7

Trt approach? nocturnal

Answer 7

most kids are normal, symptomatic approach

also address underlying stress, emotional or physical disorder

Question 8

Organic causes of nocturnal enuresis

Ix?

Answer 8

UTI, constipation, osmotic diuresis eg DM, chronic renal failure

urine sample for glucose/protein/infection

Question 9

MGMT of enuresis - 5 principles/approaches

Answer 9

explanation
star charts
enuresis alarm
desmopressin
self-help groups

Question 10

explanation ?? star charts??

Answer 10

• problem is common and beyond conscious control - stop punishments
• earns praise and a star each morning if bed dry, dont blame if bed wet

Question 11

enuresis alarm??

Answer 11

sensor in pants/bed - alarms if wet - baby monitor transmission to parents room - wakes child to go toilet and remake bed and go back to sleep

Question 12

Desmopressin?? self help groups??

Answer 12

• short term relief eg holidays/sleepovers - synthetic ADH analogue
• advice and assistance to parents and health professionals