Urology - Enuresis Flashcards

1
Q

What is enuresis?

A

Involuntary urination

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2
Q

What age do most children get control of daytime urination?

A

2 years

Night time by 3-4 years old

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3
Q

What is primary nocturnal enuresis?

A

Child never managed to be consistently dry at night

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4
Q

What is the most common cause of primary nocturnal enuresis?

A

Nothing abnormal, just a variation on normal development particularly if under 5

Patients will often have a family history of delayed dry nights

Reassurance is key

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5
Q

What are some causes of primary nocturnal enuresis?

A

Overactive bladder - frequent small urination prevents development of bladder capacity

Fluid intake before bed

Failure to wake - underdeveloped bladder signals in deep sleep

Psychological distress - low self esteem, pressure or stress at home

Secondary causes - chronic constipation, UTI, learning disability or cerebral palsy

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6
Q

What is the initial step in primary nocturnal enuresis management?

A

Establish underlying cause

Keep a 2 week diary of toileting, fluid intake and bedwetting episodes

Exclude underlying physical or psychological causes

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7
Q

How is primary nocturnal enuresis managed?

A
  • Reassure parents of kids under 5
  • Lifestyle changes, reduced fluid in evenings, pass urine before bed
  • Encouragement and positive reinforcement
  • Avoid blame or shame
  • Avoid punishment
  • Treat underlying causes
  • Enuresis alarms
  • Pharmacological treatment
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8
Q

What is secondary nocturnal enuresis?

A

Child begins wetting the bed after being dry for at least 6 months

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9
Q

What are some causes of secondary nocturnal enuresis?

A
  • UTI
  • Constipation
  • T1DM
  • Psychosocial problems
  • Maltreatment

Always consider abuse and safeguarding with deliberate bedwetting, punishment for bedwetting or unexplained secondary nocturnal enuresis

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10
Q

How is secondary nocturnal enuresis managed?

A

Treat underlying cause

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11
Q

What is diurnal enuresis?

A

Daytime incontinence

Dry at night but incontinence during the day

More common in girls

Urge or stress incontinence

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12
Q

What can cause diurnal enuresis?

A

Recurrent UTIs
Psychosocial problems
Constipation

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13
Q

What is an enuresis alarm?

A

Makes a noise at first sign of bed wetting

Requires high level of training and commitment

Needs to be used for a prolonged period of time

Can be very helpful but can also be found to be a burden and frustrating

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14
Q

What pharmacological treatment is available for enuresis?

A

Desmopressin
ADH analogue, reduces urine volume, taken at night

Oxybutynin
Anticholinergic, reduces contractility of the bladder, useful for overactive bladder

Imipramine
TCA, helps reduce bladder and lighten sleep

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