Clinical Management

Kuwerrtz-Broking and von Gontard (2017) describe 2 types of bedwetting; monosymptomatic (no daytime symptoms) nonmonosymptomatic (daytime urinary symptoms). This article was reviewed for patients with bedwetting only, no daytime symptoms.  They encourage obtaining a complete history, voiding questionnaire, urinalysis (the only mandatory testing for a bedwetting) and you can consider a uroflow with a post void residual.  The first treatment step is explaining how the bladder works, the importance of voiding regularly, not holding their urine, sitting properly, and treating constipation. Step two, is to hydrate liberally during the day.  Step three, tracking wet and dry nights, 15% of kids can become dry with tracking alone. Step three, choosing between desmopressin or the bedwetting alarm. Using desmopressin for sleep overs was suggested.  Thirty percent of kids are complete responders to desmopressin. Imipramine is another medication option, it is a tricyclic antidepressant. It is effective in 40% of kids but it can have side effects of mood changes.  The alarm has to be used every night and works best when the family understands how to use it correctly. Success with the alarm is reported between 50-80% after 10-12 weeks. If the child has failed alarm therapy in the past, trying the alarm again 2 years later is recommended.

Kuwertz-Bröking, E., & Gontard, A. V. (2017). Clinical management of nocturnal enuresis. Pediatric Nephrology,33(7), 1145-1154. doi:10.1007/s00467-017-3778-1

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