PE5.4 | Enuresis — Summary & Reflection

KEY TAKEAWAYS

Enuresis is involuntary urinary incontinence diagnosed from age 5 years. Primary enuresis (never dry >6 months) accounts for 80–85% of cases; secondary enuresis (dry ≥6 months then relapsed) always has a precipitant — most commonly psychosocial stress, UTI, or diabetes mellitus — and must be investigated. Monosymptomatic nocturnal enuresis (MNE) is the commonest form and involves three mechanisms: reduced nocturnal ADH secretion (nocturnal polyuria), high arousal threshold, and reduced functional bladder capacity. Management of MNE: general measures (fluid restriction, regular voiding, motivational charts) first; enuresis alarm (12–16 week trial, ~65–75% cure) for long-term treatment; desmopressin (fluid restriction mandatory, relapse ~70% on stopping) for short-term/situational use; imipramine as third-line only due to cardiac risk. Always exclude organic causes with urine dipstick and blood glucose in all enuretic children.

REFLECT

A 7-year-old boy is seen in your clinic — the third paediatrician he has seen in two years. He has been prescribed antibiotics three times for 'recurrent UTIs' that were never culture-confirmed, and his mother has been told he will 'grow out of it.' His bedwetting has continued and he is now refusing to go to school because a classmate found out. How does this case illustrate the real cost of misdiagnosis and delayed appropriate treatment? Kolb's reflective observation asks you to consider: what knowledge gap in the previous clinicians led to this outcome, and how does your understanding of the three mechanisms and evidence-based treatment options change the trajectory for this child today?