Nocturnal Enuresis

Wet

Step 1: View clinicals

A 7 year old boy is brought in by his mother, because he wets his bed 2 to 3 times each week. He has never achieved complete nighttime dryness, despite being toilet trained at 3 years of age. There is no history of daytime incontinence, frequency, urgency, or dysuria. He does not drink much fluids during the day, with his water intake mainly being in the evening. In addition, he does not void much during the daytime, using the school bathroom at most once each day. His medical and surgical histories are unremarkable and all developmental milestones were age appropriate. His mother has a history of bedwetting upto the age of 6.


Step 2: Order all relevant investigations

Urinalysis + Urine Cultures

Urinalysis: Pus cells: none Glucose: nil Leukocyte Estarase: negative Nitrites: negative Urine cultures show no growth.

Fasting Plasma Glucose

The fasting plasma glucose level is 90 mg/dL (70-100)

Renal Ultrasound

Renal ultrasonography reveals no abnormalities in the kidneys or urinary system.

Voiding Cystourethrogram

The voiding cystourethrogram will be performed in 2 days time.


Step 3: Select appropriate management

Desmopressin
Bedwetting Alarms
Imipramine
Oxybutynin


Score: ★★☆