Enuresis
Steering Committee of World Bedwetting Day 2017
The first medical appointment for children with enuresis is usually with the GP when the child is aged ≥5 yr. Treatment of enuresis below the age of 5 yr is not recommended.
At this stage, it is essential to screen for patients with bladder dysfunction (eg, overactive bladder [OAB], daytime incontinence).
Treatment of enuresis in primary care is only advisable if monosymptomatic is suspected (ie, no daytime bladder dysfunction is detected).
Nocturnal polyuria can be treated using the vasopressin analogue desmopressin, which reduces the amount of urine during the night. In most countries, the recommended starting dose for children is 120 µg/day (melt) or 200 mg/day (tablet). Desmopressin treatment can be optimized by following appropriate recommendations. If children with nocturnal polyuria are unresponsive to desmopressin despite good adherence, referral is advised. Increasing the dose is not recommended in primary care.
Small maximum voided volumes and arousal problems in children with MNE are treated using a bedwetting alarm.
Patients should drink sufficiently during the day (∼1000 mL/day for child of 10 kg; 1500 mL/day for child of 20 kg), and achieve urinary output ∼30–40 mL/kg, with fluid restriction before sleep. A trial of this advice can be recommended before the start of alarm/desmopressin.
Reference
Walle JV, Rittig S, Tekgul S, et al. Enuresis: practical guidelines for primary care. Br J Gen Pract. 2017 May 22. http://bjgp.org/content/early/2017/05/22/bjgp17X691337.long
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Cite this: Key Pediatric Clinical Practice Guidelines in 2017 - Medscape - Jan 10, 2018.
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