Night after consecutive night of involuntary voiding in the child who bladder controls during the day time.
Typically seen among the age group of 5 years or older.
Enuresis (NE) is a symptom complex, not a disease state; therefore, it can be affected by a number of etiologic factors including:
Maturational delay - The most convincing argument for this is even if left untreated most enuretics eventually develop complete urinary control.
35 - 90% of UDS studies reveal a small capacity bladder for age.
Abnormal circadian rhythms
Relative nocturnal polyuria might contribute to NE.
Sleep disorder- EEG studies have been confusing with the most recent, sophisticated studies showing random enuretic episodes, unrelated to sleep patterns, which do not vary from the normal control. EEG studies do not evaluate the arousal threshold and therefore the possibility of a child’s inability to awaken to the stimulus of a full bladder cannot be excluded.
Psychological factors - a higher proportion of enuretics are maladjusted; they are more immature and less self-reliant.
Referring provider’s initial evaluation and management:
Pre Work Up
Assess familial pattern, heredity
Perform a urine analysis
Note pattern and trend of daytime voiding habits
Note bowel elimination pattern
Urinary Tract Infections
Abnormal Circadian Rhythms (ADH)
When to initiate referral/ consider refer to Urology Clinic:
Recurrent bedwetting that is refractory to the recommended treatment or causing anxiety, self-esteem issues in the child.
What can referring provider send to Urology Clinic?
1. Using Epic
Please complete the external referral order In order to help triage our patients and maximize the visit, the following information would be helpful include with your referral order:
Urgency of the referral
What is the key question you would like answered?
Note: Our office will call to schedule the appointment with the patient.
2. Not using Epic external referral order:
In order to help triage our patients maximize the visit time, please fax the above information to (414) 607-5288. It would also be helpful to include:
Chief complaint, onset, frequency
Recent progress notes
Treatment and Drugs
Reinforce robust hydration throughout the daytime
Reinforce a timed voiding schedule Limit fluids after suppertime
Specialist’s workup will likely include:
After referral to Urology Clinic:
Assessment of overall health and wellbeing, past medical history and medication review/evaluation
In depth assessment of dietary/beverage consumption.
Assessment of daytime voiding patterns and habits
Assessment of bowel habits
Assessment of sleep patterns, snoring
Urine analysis, possible uroflow, bladder scan in clinic setting