Nocturnal enuresis

Question 1

How do you treat nocturnal enuresis in children under 5?

Answer 1

Should resolve without intervention

Question 2

Whats first line to treat nocturnal enuresis in children over 5?

Answer 2

1st advice on fluid intake - no fluids four hours before bed, diet, toileting behaviour and use of reward systems.
if that doesnt work try enuresis alarm.

Question 3

What are the key points with enuresis alarm?

Answer 3

Alarms in patients less than 7 years depends on maturity, motivation and understanding.
Alarms have less relapse than drug treatment
Review alarm after 4 weeks
Continue until a minimum of two weeks of uninterrupted dry nights.
If complete dryness has not been achieved within 3 months but its’s improving and there is still motivation then it can be continued.

Question 4

What drug treatment can you use in children over 5?

Answer 4

Desmopressin

Question 5

when should you reassess Desmopressin treatment?

Answer 5

after 4 weeks and continue for three months if patient responding

Question 6

How should repeated courses me withdrawn?

Answer 6

Withdrawn gradually at regular intervals.- for one week every 3 months

Question 7

What can be given in patients for nocturnal enuresis be given if desmopressin not working or they experience day time symptoms?

Answer 7

Desmopressin +/- antimuscarinic (oxybutynin or tolterodine) for 3 months
or Imipramine (TCA) if no response to others but relapse is likely and must be made aware of dangers of overdose.

Question 8

Key points of desmopressin:

Answer 8

More potent and longer duration of action than vasopressin
No vasoconstrictor effect
Side effects:
- Hyponatraemia if given too rapidly which can lead convulsions
- Nausea