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Paediatric Surgery
Nocturnal Enuresis
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
10 sections · 71 slides
Overview
- What this deck will teach you
What Bedwetting Actually Is
Getting the definitions right first
- Defining enuresis
- What is NOT called enuresis
- Subdividing by history: primary vs secondary
- Subdividing by frequency and by daytime symptoms
- Daytime symptoms that make enuresis nonmonosymptomatic
How Common Is It?
Epidemiology and natural history
- Enuresis by the numbers
- Reading those prevalence figures
- Natural history: some, but not all, grow out of it
- Why not just wait and see?
Why Children Wet the Bed
Three body mechanisms, not a psychological flaw
- A complete change of thinking
- Genetics: it runs in families
- Mechanism 1 - Nocturnal polyuria
- Three caveats about the polyuria story
- Mechanism 2 - Detrusor overactivity
- Mechanism 3 - High arousal thresholds
- A paradox in how these children sleep
- A shared root in the brainstem
- The three pathogenic pillars at a glance
- When enuresis has another underlying cause
What Else Travels With Bedwetting
Comorbid conditions that change management
- Psychology and psychiatry: cause or consequence?
- The ADHD overlap
- Bladder dysfunction and urinary tract infections
- Vesico-ureteral reflux (VUR): keep it in perspective
- Bladder and bowel dysfunction: the constipation link
- Sleep and arousal problems
Evaluating the Bedwetting Child
Simple by design - the history does the work
- The guiding principle: keep it simple
- Warning signs that call for extra evaluation
- History taking: the cornerstone
- Voiding charts: turning story into data
- Sample bladder and bowel diary (page 1)
- Sample bladder and bowel diary (page 2)
- Formula for expected bladder capacity (EBC)
- Physical examination: selective, not routine
- Urine and blood tests: minimal
- Other investigations: reserved for red flags
First-Line Treatment
The alarm and desmopressin
- Who should we actively treat?
- The role of basic bladder advice
- Choosing which first-line therapy to try
- The enuresis alarm: how it works
- Rules that make the alarm succeed
- Alarm - strengths and weaknesses
- Desmopressin: how it works
- Desmopressin: how to give it
- Desmopressin: the one real safety rule
- Combination therapy
The Therapy-Resistant Child
Re-evaluation and second-line drugs
- Re-evaluating therapy-resistant enuresis
- What we can assume about these children
- Second-line: anticholinergics
- Anticholinergics: three side effects to manage
- Second-line: tricyclic antidepressants (imipramine)
- Imipramine: safety is everything
- Possible future and salvage therapies
Enuresis in Special Situations
When the usual rules bend
- Obstructed breathing and polyuric kidney disease
- Neuropsychiatric problems and intellectual disability
Bringing It Together
The key messages
- Key takeaways
- References (1/4)
- References (2/4)
- References (3/4)
- References (4/4)
- Pediatric Surgery and Pediatric Urology