Enuresis nocturna

Schwab M, Ruder H. Hyponatraemia and cerebral convulsion due to DDAVP administration in patients with enuresis nocturna or urine concentration testing. Eur J Pediatr 1997 156(8) 668. 

Another causal factor in enuresis nocturna might be rapid bladder Ailing (N0rgaard et al. 1989). In this context the rare anatomic abnormality of a completely duplicated ureteral system in which an ectopic ureter empties directly outside the bladder has to be kept in mind. In this case the upper renal moiety drains through a ureter that empties below the urethral sphincter or at some other ectopic site such as the vagina, uterus or even the perineum. Hence, these children are wet all of the time. This condition occurs exclusively in girls. 

Distinction should be made between monosymptomatic enuresis nocturna and incontinence. Patients with persistent and severe monosymptomatic enuresis nocturna despite treatment should undergo kidney and bladder ultrasound and VCU as well, if there are positive ultrasound findings and/or a history of urinary tract infection. In wetting children (daytime with or without nighttime urinary incontinence) with urinary tract infection with/without urge, kidney and bladder ultrasound and a VCU have to be performed as well. Assessment of potential stool retention has to be part of the imaging studies. 

In primary monosymptomatic enuresis nocturna and in children with minor wetting before treatment and without irritative voiding symptoms and without urinary tract infection, VCU should not be performed. 

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