Paeds: Enuresis Flashcards

1
Q

Nocturnal enuresis

Epi

A
  • Quite common 6% of 5-years-olds and 3% of 10-year-olds are not dry at night.
  • 2:1 boys:girls
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2
Q

Nocturnal enuresis

Organic causes

A

• Urinary tract infections
• Faecal retention severe enough to reduce bladder volume and cause bladder neck dysfunction
Polyuria from osmotic diuresis e.g. DM or renal concentrating disorders e.g. chronic renal failure

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3
Q

Nocturnal enuresis Investigation

A

Urine sample for glucose and protein and check for infection

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4
Q

Nocturnal enuresis Management of night-time enuresis

A

• Straight forward management painstaking to succeed.
• After the age of 4 years, enuresis resolves spontaneously in only 5%of affected children each year
In practice treatment is rarely undertaken before 6 years of age.

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5
Q

Nocturnal enuresis Explanation of management

A
  1. Explain to both child and parent that the problem is common and beyond conscious control.
  2. Parents should stop punitive procedures as these are counterproductive
  3. Star chart:
    - praise and a star each morning if the bed is dry
    - wet beds are treated in a matter-of-fact way and the child is not blamed for them.
  4. Enuresis alarm – if star chart is not helpful: wakes child who passes urine and helps to change the bed (only 1 alarm per night)
  5. Desmopressin
    Self-help groups
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6
Q

Nocturnal enuresis

Enuresis alarm

A

Takes several weeks to achieve dryness but is effective in most cases so long as the child is motivated and the procedure is followed fully.
1/3 relapse after a few months, in which case repeat treatment with the alarm usually produces lasting dryness.

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7
Q

Nocturnal enuresis Desmopressin

A

Short-term relief from bedwetting e.g. for holidays or sleepovers can be achieved by the use of synthetic analogue of antidiuretic hormone.

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8
Q

Daytime enuresis: Definition

A

A lack of bladder control during the day in a child old enough to be continent (over the age 3-5 years).

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9
Q

Daytime enuresis:

Causes

A
  • Lack of attention to bladder sensation: a manifestation of a development or psychogenic problem, although can happen in a normal distracted child.
  • Detrusor instability (sudden, urgent urge to void induced by sudden bladder contractions).
  • Bladder neck weakness
  • A neuropathic bladder (bladder is enlarged and fails to empty properly, irregular thick wall and is associated with spina bifida and other neurological conditions)
  • A UTI (rare in absence of other symptoms)
  • Constipation
    An ectopic ureter, causes constant dribbling and child is always damp.
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10
Q

Daytime enuresis:

Examination

A
  • May reveal evidence of a neuropathic bladder i.e. the bladder may be distended, there may be abnormal perineal sensation and anal tone or abnormal leg reflexes and gait.
  • Sensory loss in the distribution of the S2,3 and 4 dermatomes should be sought.
  • Microscopy, culture and sensitivity
  • US
  • Urodynamic studies
  • X-ray of spinal anomaly
  • MRI scan (non-bony defect)
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11
Q

Daytime enuresis: Girls that are dry at night but wet in the am

A

likely to have pooling of urine from an ectopic ureter opening into the vagina

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12
Q

Daytime enuresis:

Management

A
  • Affect children in whom neurological cause has been excluded may benefit from star charts, bladder training and pelvic floor excercises
  • Constipation should be treated
  • Enuresis alarm
    Anticholinergic drugs e.g. oxybutynin, to damp down bladder contractions
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13
Q

Secondary (onset) enuresis:

Due to:

A
  1. Emotional upset, the commonest cause
  2. UTI
  3. Polyuria from an osmotic diuresis in DM or a renal concentrating disorder e.g. CRF or sickle cell disease
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14
Q

Secondary (onset) enuresis:

Investigations:

A
  • Urine testing infection, glycosuria and proteinuria
  • Assessment of urine concentrating ability by measuring osmolality of an early morning urine sample
  • US of renal tract
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