Urology - Enuresis Flashcards
What is enuresis?
Involuntary urination.
What is diurnal enuresis?
Inability to control bladder during the day due to urge or stress incontinence
What is nocturnal enuresis
Bedwetting, with nighttime bladder control usually achieved by 3-4 years
What is primary nocturnal enuresis?
Child has never been consistently dry at night.
What is secondary nocturnal enuresis?
Child starts bedwetting after being dry for at least 6 months.
What conditions are associated with secondary nocturnal enuresis?
UTI
constipation
T1DM
stress
maltreatment.
What bedside investigations are needed for enuresis?
Urine dip (UTI, diabetes), urine MCS, 2-week bladder diary.
When is imaging required for enuresis?
Renal tract USS if secondary enuresis or red flags.
What should be done for primary nocturnal enuresis with daytime symptoms?
Referral to secondary care / enuresis clinic.
How is primary nocturnal enuresis managed in children <5 years old?
Reassurance
toilet access at night
bladder emptying before bed
positive reward system
What is the first-line treatment for primary nocturnal enuresis in children >5 years old?
Enuresis alarm with a positive reward system.
How does an enuresis alarm work?
Detects first sign of bedwetting, makes a noise, and wakes the child.
What is the second-line treatment for primary nocturnal enuresis?
Desmopressin, especially for short-term control (e.g., school trips).
When should a child with enuresis be referred to secondary care?
If they do not respond to two complete courses of enuresis alarm or desmopressin.
What is the first step in managing secondary nocturnal enuresis?
Assess for an underlying cause (UTI, constipation, diabetes, stress, maltreatment).
When should a child with secondary nocturnal enuresis be referred to a specialist?
If the cause cannot be managed in primary care or is unclear.
What specific conditions warrant specialist referral?
Diabetes, recurrent UTIs, psychological problems, family issues, developmental difficulties.
