Enuresis

Question 1

Def

Answer 1

involuntary loss of urine that occurs only at night in a child 5 to 6 years old with at least 2 or more bed wetting episodes per month, and in a child >6 years of age with 1 or more wetting episode per month.

Question 2

Types

Answer 2

According time;
1ry +2ry
According symptoms;
Monosymx
Nonmonosyx

Question 3

Etiology

Answer 3

1) Familial and genetic
2) Anatomical abnormalities (puv, ectopic ureter.
3) psychosocial (sexual abuse)
4) maturational delay
5) nocturnal polyuria and OSA
6) others : chronic constipation
7) Neurological

Question 4

DDx

Answer 4

UTI
Chronic constipation 
ADHD
DM
Renal failure 
OSA
Anxiety
Overactive bladder or dysfunctional voiding.

Question 5

Tx

Answer 5

1) treat the cause
2) Family Education
3) Behavioural therapy (motivational and alarm, bladder diary)
4) pharmacological therapy (Desmopressin, imipramine”TCA”, Anticholinergic.
5) Referral to urologist (recurrent uti, anatomical abnormalities)

Question 6

complicated enuresis,

Answer 6

previous or current UTI, severe voiding dysfunction, or a neurologic finding, are evaluated with a renal sonogram and a voiding cystourethrogram.

Question 7

Urologist referral

Answer 7

If vesicoureteral reflux, hydronephrosis, or posterior urethral valves are found,

Question 8

The most important contraindication of imipramine

Answer 8

is the risk of overdose (associated with fatal cardiac arrhythmia).

Question 9

Relapse rate of desmopressin

Answer 9

90%

Question 10

BRS Etiology

Answer 10

Genetic 
Psychosocial 
Chaotic life
Sleep arousal mechanism (osa)
Urine volume (lack of vasopressin peak)
Bladder capacity 
Organic causes 
Constipation