NC.com

Enuresis

Definitions

• Primary monosymptomatic enuresis: Nocturnal incontinence, in absence of other LUTS, without a prior period of nocturnal dryness
• Secondary monosymptomatic enuresis: Nocturnal incontinence, in absence of other LUTS, with a prior period of noctural dryness (6+ months)
• Non-monosymptomatic enuresis: Noctunral incontinence, with other LUTS present

General Treatment Tips

• The child must be willing/able to participate in treatment otherwise it will not succeed
• Void before bed, avoid fluids before bed
• Do not punish for enuresis (counterproductive)
• Assess family history (may be genetic component)
• May benefit from sleep study if frequent snoring

Enuresis alarm

• Best for motivated families, children with low PVR and without polyuria
• When alarm triggered, the child has to change bedding, reset alarm (active participation)
• Continue until at least 14 consecutive dry nights
• If no improvement after at least 6 weeks, unlikely to improve
• Discontinuation: 30%, skin irritation, bothersome to rest of family, or failure

Desmopressin

• Most effective in nocturnal polyuria (> 130% expected bladder capacity for age) and normal bladder function (max voided volume > 70% expected capacity for age)
• Dosing: 0.2mg 1hr before bedtime, titrate up by 0.2mg to max dose 0.6mg at bedtime
• Reassess within 2 weeks to determine whether improvement present
• Consider using only for certain occasions vs nightly
• Drug holiday for 1 week every 3-6 months to assess whether still warranted

TCAs

• Considered third line therapy
• Dosing: 10-25mg imipramine 1hr before bed, can titrate up by 25mg after 1 week, usual dose 25mg (5-8yo) and 50mg (9+yo), do not exceed 50mg (6-12yo) and 75mg (13+yo)
• Reassess efficacy at 1mo, if no improvement after 3mo then discontinue with taper
• Drug holiday q3-6mo to assess continued need, tapering dose over 2 weeks
• Side effects: less than 5% overall, but can increase suicidal ideations and cardiac complications (risk with overdosing) - obtain personal/family cardiac history