Enuresis evaluation

Assess the patient s symptoms to determine if patient-directed therapy is appropriate or whether the patient should be evaluated by a physician. Assessment includes the types and severities of symptoms and the presence or absence of exacerbating factors. Does the patient have any enuresis-related complications ... 

Behrle, R.C. (1956) Evaluation of a conditioning device in the treatment of nocturnal enuresis. Pediatrics 17 849. 

Tietjen DN, Husmann DA. Nocturnal enuresis a guide to evaluation and treatment. Mayo Clin Proc 1996 71 857-862. 

Rushton HG. Nocturnal enuresis Epidemiology, evaluation and currently available treatment options. J Pediatr 1998 114 691-696. 

Nervous system The safety of desmopressin in children with primary monosjmiptomatic nocturnal enuresis has been reviewed [86 ]. After 61 cases of seizures, including two deaths, the FDA asked that the prescribing information be changed in 2007 to state that desmopressin spray is no longer indicated for monosymptomatic nocturnal enuresis or in patients at risk of hyponatremia. The authors of the review concluded that hyponatremia often resulted from inappropriately high doses of desmopressin and usually occurs in the elderly people they supported continuing the use of desmopressin to treat monosymptomatic nocturnal enuresis imder appropriate medical supervision. Hyponatremia has been reported more commonly with the spray than with the oral formulation this may reflect differences in pharmacokinetics or more extensive evaluation of the spray. 

It is accepted that evaluation of the child with wetting with a history of infection is indicated because some 30%-50% of children who present with UTI will have VUR demonstrated on voiding cystourethrography (VCU). However, no clear guidelines have been established for the evaluation of wetting children with sterile urine demonstrated at the time of admission or without a history of UTI. In a study on children with enuresis, Sujka et al. (1991) demonstrated that no one symptom or combination of symptoms segregated these patients likely to have VUR 16% of their 83 patients with sterile urine and no history of infection had VUR out of those, 16 showed reflux nephropathy as well. They concluded that one of six children who present with enuresis and sterile urine will have VUR. 

Sujka SK, Piedmonte MR, Greenfield SP (1991) Enuresis and the voiding cystourethrogram a re-evaluation. Pediat Urol 38 139-142... 

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