Enuresis/Urinary incontinence

Question 1

Definition of enuresis?

Answer 1

Wetting while asleep if > 5 years

Question 2

Difference between primary and secondary nocturnal enuresis?

Answer 2

Primary = never had dry nights for 6 continuous months
Secondary = relapse after at least 6 months of dryness

Question 3

Name 4 causes of secondary NE

Answer 3

Idiopathic
UTI
DM/diabetes insipidus
Epilepsy
Neurogenic bladder
Sexual abuse

Question 4

Difference between monosymptomatic and nonmonosymptomatic (what stupid terms) NE? What’s the importance of this differentiation?

Answer 4

MNE = night wetting without daytime symptoms
NMNE = night wetting + daytime symptoms (any LUTS)

NMNE suggests an organic cause of nocturnal enuresis

Question 5

Name the 3 pathophysiological processes that lead to NE

Answer 5

High nocturnal urine production
Small functional bladder capacity
Poor arousal from sleep with full bladder

Question 6

Name 3 reasons for a high nocturnal urine production

Answer 6

Reduced ADH secretion (can be genetic)
Western diet/obesity/overeating before bed
Abnormal kidney function (Na+ handling, GFR, sympathetic tone)

Question 7

What is the main cause of a small functional bladder capacity?

Answer 7

Overactive bladder/detrusor instability - can’t distend fully before needing to void

Question 8

At what age are interventions for NE usually begun?

Answer 8

At 7 years

Question 9

Name 3 aspects of management to NE

Answer 9

1. Console patient (explain not their fault, that it can be inherited and that it’s common)
2. Bedwetting alarms (usually for 2-3 months)
3. If unsuccessful, trial desmopressin if polyuric and monosymptomatic, or anticholinergics if reduced bladder capacity (overactive bladder)

Question 10

At what age should you investigate day wetting? Name 4 Ix.

Answer 10

After 4 years.

Ix:
Voiding diary (distinguish bladder spasm from voiding postponement)
Urinanlysis (UTI)
Renal and bladder U/S (post-void U/S to see residual volume)
Urodynamic investigations (uroflow - look at velocity of urine)

Question 11

What are the 3 main types of voiding dysfunction?

Answer 11

Overactive bladder (filling problem)
Dysfunctional voiding (emptying problem)
Residual volume (emptying problem)

Question 12

For what condition are anticholinergics useful for?

Answer 12

Overactive bladder - PSNS = pee, so anticholinergics reduce contraction of detrusor muscle