Enuresis

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Enuresis

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▪ Age: > four years old ▪ Not caused by other condition/substance (except constipation) TREATMENT MEDICATIONS ▪ Daily laxatives (stool softeners: 1g/kg polyethylene glycol per day) OTHER INTERVENTIONS Dietary ▪ Avoid constipating foods ▪ Adequate hydration ▪ Increase ﬁber intake; ﬁber tablets Remove fecal impaction ▪ Polyethylene glycol/mineral oil ▪ Rectal enema PSYCHOTHERAPY ▪ Behavioral therapy ▫ Encourage toilet usage, normalize bowel movements ENURESIS osms.it/enuresis PATHOLOGY & CAUSES DIAGNOSIS ▪ Repeated voluntary/involuntary passage of urine into inappropriate places ▪ Can be nocturnal, diurnal, both ▪ Can involve poor bladder control (physiological developmental reasons)/ exceeding bladder capacity ▪ Repeated voluntary/involuntary passage of urine into inappropriate places ▪ “Clinically signiﬁcant”: occurs > two times per week for > three consecutive months or affects day-to-day life ▪ Age: > ﬁve years old ▪ Not caused by other substance CAUSES ▪ Genetic, environmental; stress-related ▫ Often associated with psychiatric comorbidities ▫ More common in biological males SIGNS & SYMPTOMS ▪ Repeated voluntary/involuntary passage of urine into inappropriate places 706 OSMOSIS.ORG TREATMENT MEDICATIONS ▪ Desmopressin (reduce urine production) PSYCHOTHERAPY ▪ Behavioral therapy (e.g. bedtime alarm therapy), bladder program

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Enuresis

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USMLE® Step 1 style questions USMLE

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A 6-year-old boy is brought to the pediatrician by his parents due to recent bedwetting. He was toilet-trained at the age of 3 and has been able to stay dry during the day. However, he continues to have nighttime “accidents” 3-4 times per week. The patient consumes fluids in the morning and afternoon, but not prior to bed. The family recently moved from their home in the city to a suburban neighborhood, and he has experienced difficulty making new friends at school. Temperature is 37.2°C (99.0°F), blood pressure is 107/68 mmHg, and pulse is 79/min. A complete physical examination is noncontributory. The patient is subsequently trialed on scheduled timed voids overnight and a bedwetting alarm, both of which fail to control his symptoms. The patient is subsequently initiated on a medication that acts as an antidiuretic hormone analog. Which of the following medications was most likely prescribed?

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