NOCTURAL ENURESIS

Question 1

what is nocturnal enuresis

Answer 1

involuntary urination during sleep = common children

Question 2

non-drug tx of nocturnal enuresis

Answer 2

• advice on fluid intake
• diet
• toileting behaviour
• use of reward systems

Question 3

which age category does noctural enuresis resolve without intervention

Answer 3

<5yr

Question 4

tx if no reponse to lifestyle advice

> 1 -2 wet beds per week

Answer 4

enuresis alarm

Question 5

which age is enuresis alarm given to and when

Answer 5

• <7yr
• given depending on maturity, motivation, understanding

Question 6

benefit of enuresis alarm

Answer 6

less relaspe than drug tx when discontinued

Question 7

After how many week does enuresis alarm need to be reviewed

Answer 7

4 weeks

Question 8

what is the min duration of enuresis alarms

Answer 8

continue for min 2 weeks of uninterrupted dry nights

Question 9

drug tx if both advice and enuresis alarm is unsuccesful

Answer 9

add in or replace with desmopressin

Question 10

age category for desmopressin

Answer 10

5+

Question 11

when is desmopressin given for noctural enuresis

Answer 11

• when alarms = undesirable
• when needing rapid results (cover holidays)

Question 12

duration and monitoring of desmopressin

Answer 12

• assess 4 weeks after tx and continue for 3 months if response

Question 13

repeated courses of desmopressin withdrawal

Answer 13

withdraw gradually at regular intervals

Question 14

drug tx of noctural enuresis

including specialist

Answer 14

1) desmopressin
2) specialist = desmopressin +/- antimuscarnic (oxyb/tolterdine)
3) no response = imipramine

Question 15

desmopressin potency and s/e

Answer 15

• more potent + longer duration of action than vasopressin
• no vasoconstrictor effect
• s/e = hyponatraemia + nausea