Enuresis

Question 1

Classical history of enuresis

Answer 1

• day/ night time accidents
• 6% 5 year olds
• 35 10 year olds
• M:F 2:1
• Rule out: UTI, faecal retention large enough to cause bladder neck dysfunction, polyuria (DM, CRF)

Question 2

Investigations and examinations in enuresis

Answer 2

• urine sample- glucose, protein, infection
• most patients are physiologically normal O/E
• daytime enuresis:
  
  • _​_bladder distention
  • abnormal perineal sensation
  • sensory loss S2-4
  • spinal lesion present
• secondary eneuresis:
  
  • _​_urine dip- glucose, protein, infection
  • osmolarity of early morning urine (urinary concentrating ability)
  • USS renal tract
• USS
• Urodynamic studies
• Spinal XR
• MRI

Question 3

Management

Answer 3

• Nocturnal enuresis
  
  • _​_explanation to parent and child
  • star chart
  • enuresis alarm
    
    • when child does not respond to star chart
    • takes several weeks to achieve dryness
    • 1/3 relapse in several months
  • desmopressin
    
    • short term relief
    • synthetic analogue of ADH
  • self-help groups

Daytime enuresis

• no neuro cause- star charts, bladder training and pelvic floor
• small portable alarm
• oxybutinin (anti-cholinergics)

Question 4

Causes of datime enuresis

Answer 4

• lac of attention to bladder sensation: developmental, psychogenic or physiological (distracted by playing etc)
• detrusor instability- sudden bladder contractions
• bladder wall weakness
• neuropathic bladder
  
  • bladder enlarged
  • fails to empty properly
  • irregular thick wall
  • association with spina bifida
• UTI
• constipation
• ectopic ureter- constant dribbling

Question 5

Causes of onset/ secondary eneuresis

Answer 5

• emotional upset
• UTI
• polyuria (DM, CRF)