Enuresis pediatric

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

Klauber, G.T. (1989) Clinical efficacy and safety of desmopressin in the treatment of nocturnal enuresis. / Pediatr 114 719-722. 

Jalkut MW, Lerman SE, Churchill BM. Enuresis. Pediatr Clin North Am 2001 48 1461-1488. 

Explain the pathophysiology of the major types of urinary incontinence (urge, stress, overflow, and functional) and pediatric enuresis. 

List the treatment goals for a patient with urinary incontinence or pediatric enuresis. 

Considering that pharmacotherapy is inferior to select non-pharmacologic treatment modalities in pediatric enuresis, pharmacotherapy will be most valuable in patients who are not candidates for nonpharmacologic therapy due to nonadherence or who do not achieve the desired outcomes on nonpharmacologic therapy alone. 

Desmopressin is the first-line drug choice in pediatric enuresis. 

The American Academy of Child and Adolescent Psychiatrists and the International Children s Continence Society (ICCS) have published practice guidelines for the assessment and treatment of pediatric enuresis.24,25... 

The two primary agents used to treat enuresis are desmopressin and imipramine (Table 50-7). Desmopressin is the drug of choice in pediatric enuresis. Anticholinergics have a limited role (Table 50-7). Other agents have been studied with inconclusive results.28... 

Chap. 50 - Urinary Incontinence and Pediatric Enuresis Universal Program Number ... 

Children Not recommended for patients younger than 12 years of age. Safety and efficacy are not established for amoxapine in children younger than 16 years of age or trazodone or clomipramine in children younger than 10 years of age. The safety and efficacy of imipramine as temporary adjunctive therapy for nocturnal enuresis in pediatric patients younger than 6 years of age have not been established. The safety of the drug for long-term, chronic use as adjunctive therapy for nocturnal enuresis in pediatric patients 6 years of age and older has not been established. Safety and efficacy are not established in the pediatric age group for trimipramine, nortriptyline, protriptyline, and desipramine. 

Lavigne and colleagues (1996), using categorical approaches with a community sample of 3860 preschoolers aged 2-5 years in a primary care pediatric sample, found the five most frequent axis I diagnoses (DSM IITR) to be ODD (17%), ADHD (2%), avoidant disorder (0.7%), overanxious disorder (0.7%), simple phobia (0.6%), and functional enuresis (0.7%). Five percent of children also met criteria for parent-child relational... 

Longstaffe, S., Moffatt, M.E. and Whalen, J.C. (2000) Behavioral and self-concept changes after six months of enuresis treatment a randomized, controlled trial. Pediatrics 105 935-940. 

Norgaard, J.P., Rittig, S., and Djurhuus, J.C. (1989) Nocturnal enuresis an approach to treatment based on pathogenesis./ Pediatr 114 705-710. 

Reiner, W.G. (1995) Enuresis in child psychiatric practice. In Riddle, M.A., ed Child and Adolescent Psychiatric Clinics of North America, Pediatric Psychopharmacology II, Vol. 4. Philidelphia W.B. Saunders, pp. 453 60. 

Natochin YV, Kuznetsova AA. Nocturnal enuresis correction of renal function by desmopressin and diclofenac. Pediatr Nephroi 2000 14 42-47. 

Triantafyllidis A, Charalambous S, Papatsoris AG, Papathanasiou A, Kalaitzis C, Rombis V, Touloupidis S. Management of nocturnal enuresis in Greek children. Pediatr Nephrol 2005 20 1343-5. 

Passi GR, Shad R. Seizures and coma after desmopressin for nocturnal enuresis. Indian Pediatr 2004 41 1276-7. 

Robson WL, Norgaard JP, Leung AK. Hyponatremia in patients with nocturnal enuresis treated with DDAVP. Eur J Pediatr 1996 155(ll) 959-62. 

Brodzikowska-Pytel A, Giembicki J. Hyponatremia as a complication of nocturnal enuresis treatment with desmopressin in a child. Pediatr Pol 1999 74 79-83. 

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. 

Although pediatric psychopharmacology is much neglected, nocturnal enuresis is an area of extensive research. An earlier review catalogued almost 100 publications on the topic (13). The tricyclic antidepressants have been shown to be effective in well-controlled trials, and over 40 publications had appeared before 1970. At that time adverse effects in children appeared to be minimal and comparable to those in adults. Since then considerable concern has developed over cardiotoxic effects and the risks of accidental overdose in children. The earlier reports have been summarized (SEDA-1,10) managing overdose in children has been reviewed (SEDA-2,10) death in a 16-month-old infant has been reported (SEDA-3, 9). 

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