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Nocturnal enuresis

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					   Nocturnal Enuresis
         Kirsty Torson

ITP post in Community
    Paediatrics
                 Definitions
   Enuresis
       Involuntary voiding of urine when old
        enough to be continent (>5yr)
 Nocturnal - wetting the bed at night
 Primary enuresis
       Never achieved continence
   Secondary enuresis
       At least 6 month dry period
                          UTI
Diuretics                                Constipation




                      CAUSES




Organic                                       Genetic



            Behavioural         Stress
The 3 System Hypothesis


  Lack of          Lack of
  arousability     ADH



           Bladder
           instability
                   History
•No. of voids/day
•No. of wettings –
size of patch            •Psychosocial
•Urgency                 •Stress
•Bowel habit / UTI       •Beliefs/Attitudes
•Fluids (type, volume,       •Family support
timing)                  •Self esteem
•?Primary/secondary      •Specific issues
•Arousal                 e.g. teasing / bullying
•Family Hx
•Sleeping arrangement
•Toilet arrangement
Examination & Investigation
     Height/weight centile
     Abdo exam
     Genitalia
     Spine
     Lower limbs – tone/reflexes
     BP
     Urinalysis/MC&S
     Bladder capacity diary
Referral pathway
Bromley PCT guidelines
ALARMS
                                           OXYBUTYNIN
•Child to learn to stop
                                           •Theory: relaxant
urinating when alarm
                                           effect on urinary
goes off                  Reward systems   smooth muscle 
•Used 3-5 months
                                           increased bladder
•Discontinue after 14
                                           capacity
consecutive dry nights
                                           •Avoid in <7yr
•Motivated child
                                           •Used in OAB in
                                           adults
                          Management
DESMOPRESSIN                               TRICYCLICS

•Analogue of ADH -                         •Main = imipramine
reduces urine volume                       (less sedating)
•Stop for 1 week & re-                     •Similar efficacy
assess every 3 months        Support       to desmopressin
•Monitor for ↓Na and                       •More adverse
fluid overload                             effects
•Stop in D&V                               •3 months then re-
                                           assess
Any Questions?

				
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posted:12/24/2011
language:English
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