Nocturnal Enuresis Flashcards
What does coexisting day time wetting indicate?
Possible underlying overactive bladder
What history is typical of bed wetting?
Large volume of urine in the first few hours of the night. Whereas a variable urine, often more than once a night, is typical of bed wetting and daytime symptoms with possible underlying overactive bladder.
When alarm treatment is started, when do you reassess?
4 weeks.
When do u stop alarm treatment?
2 weeks uninterrupted dry nights achieved or no response at 3 months
If no response to alarm treatment by 3 months, what do you do?
Either stop alarm and start desmopressin or use both
When to reassess when desmopressin is started?
4 weeks. If there is response continue for 3 months and if response is sustained, stop treatment.
If no response by 4 weeks, increase dose to 400 meg for Desmotabs or 240 mag for Desmomelt.
If no response, advise to take desmopressin 1-2 hrs before bedtime.
If partial response, continue for 6 months and reassess and stop.
What advice goes with starting desmopressin?
That many may relapse if treatment is stopped.
Should be taken at bedtime
Fluid restrict from 1 HR before until 8 hrs after taking desmopressin
What are the factors associated with enuresis?
Sleep disordered arousal Nocturnal polyuria Bladder dysfunction Genetic Poor SE status
How frequent is bladder dysfunction in enuresis?
Seen in 1/3 to 2/3rd of children with enuresis
What are different types of bladder dysfunction seen?
Constitutionally small normal bladder which is full by the early hours of the morning
Idiopathic overactive bladder with a small bladder capacity- associated with detrusor overactive contractions. These are small capacity but completely emptying bladders.
A normal or large capacity bladder with a significant PVR. This could be due to dysfunctional voiding, an underactive detrusor or significant VUR.
What is the Expected Bladder Capacity, EBC?
In ages 4-12:
(Age in years+1) x 30 mls
>12 yrs- 400-600 mls
What is normal PVR?
4-6 yrs: abnormal if repetitive PVR > 20 mls or 10% of bladder capacity
7-12 yrs: abnormal if repetitive PVR > 10 mls or 6% of bladder capacity
What baseline charting is useful in evaluating enuresis?
7 night record of bed wetting
72 HR drink void charts
7 day bowel diary charts
7 night recording of nocturnal urinary volumes
When is desmopressin and oxybutinin used in combination?
In children with small bladder capacity and overactive bladder.
What are the side effects of anti-cholinergics?
Dry mouth, nightmares
