11 terms

167 Pediatric Nocturnal Enuresis (L10)


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Boys : girls
2:1 (more boys suffer from enuresis)
Risk factors for Pediatric Nocturnal Enuresis:
- positive family history
- institutionalization or low socioeconomic status
- reduced functional bladder capacity (small bladder)
- delayed or lax toilet training
- constipation
- psychological factors or developmental delay
- circadian rhythm abnormality
Monitoring bedwetting symptoms:
- # of nights/week
- # of times/night
- amt of urine
- waking up after bedwetting
1st step tx:
- education and counseling
- adequate fluid intake
- appropriate diet
- toileting patterns
- reward for following above
2nd step tx:
Enuresis alarm
- wakes child at first sign of wetness
How soon should enuresis alarm therapy be assessed?
by 4 weeks
3rd step tx:
Desmopressin +/- enuresis alarm
How soon is complete dryness usually seen after initiating desmopressin +/- enuresis alarm? and how long should therapy last?
1-2 weeks
continue therapy for 3-6 months, then stop, assess, and repeat 3 month course if needed
4th step tx:
Desmopressin + anticholinergic agent (oxybutynin)
x 3 months --> reassess
5th step tx:
Imipramine (TCA) x 3 months, then reassess
desmopressin drug class:
antidiuretic hormone analog