jslum.

com | Medicine
Nocturnal Enuresi s

Definition General Examination

Common Problem Inspection of Genitalia
> 6 – 7 y/o Palpate Bladder
Many cases resolve spontaneously Inspect Back
Most cases are treatable Reflexes of Lower Limbs
Psychological Stress
Etiology Management
Incidence of Bedwetting Bladder Problems (50% )
Small Bladder Immature Small Dyssynergy
Irritable Bladder Present
Anticholinergic Education of
Medications Patient
Bladder Training Urological Kine
Urine Producti on too ↑ (20% )
Circadian Rhythm of ADH Desmopressin
Both Normal (25%)
Desmopressin
Psychological Guidance
Wet Alarm
Physiology Dry Bed Training
Maturation Process Psychiatric (< 0.5%)
• 2 – 5 y/o Psychiatric Care
• Bladder Capacity ↑ 5th Group (5%)
• ADH Circadian Rhythm Distended Bladder Strict Voiding Schedule
• Pretty Girls Intermittent Catheterisation
• Keen on Clean Toilets Education of Patient
• Not PU on school Psychological Guidance
• Causing Overdistended Bladder
Automatic Process • Residual Urine
• Stress Incontinence (often )
Causes • Straining during Micturition
Small Bladder Capacity • Prone to UTI
• Immaturity of Bladder • 2° Incontinence
• Irritable Bladder • Voiding Habits
• Neurogenic Bladder
↑ Nocturnal Urine Production Diagnostic Approach
Bladder Capacity
• Circadian Rhythm of ADH
Drink a lot
• Diabetes Insipidus
Keeping Urine as Long as Possible
• Diabetes Mellitus
Measuring Voided Volume
• Renal Tubular Problems
Normal Bladder Capacity = (Age + 2) x 30 ml
Concentration Pr ofile
Normal Bladder Capacity (Normal Concentration Profile)
Collect Urine 3 hourly during 24h
Late Maturation
Keep Samples in Fridge
Often Familial
Bring Next Day (samples) to Lab
Have Missed the Automatic Learning OSM, CREAT on each sample
Can become Dry (within a few months) (with some help) Micturation Calendar
True Psychogenic (very small group)

Micturation History
Frequency, Dysuria
Diurnal Incontinence
Urgency
Micturition in one time
Good Stream
Strain Investigations
Stress Incontinence Ultrasound of Bladder
Constipation Urine Examination
Encopresis (Soiling of Underwear with Stool in Children) Ultrasound of Kidneys
Deep Sleep X-ray of Spine
School Performan ce Uro-Flow Metry
Psycho Social Stress Urodynamics
Previous UTI
Drinking Habits
Other Health Problems
Kidney Problems
Associated Problems in Family
(eg. Deafness)

Previously Tried Methods

Punishment, Rewards
No Drinking before Sleep
Waking Up
Traditional Methods
Wet-Alarms
Medication