2/24/2024 0 Comments Secondary enuresis![]() ![]() Pharmacological treatment: reserved for children ≥ 7 years of age if nonpharmacological options are unsuccessful or if more rapid improvement is desired.More likely to achieve long-term success than pharmacological options.Trains the child to become aware of urination and use the toilet instead.A moisture sensor embedded in the child's underwear or in a sleeping pad triggers an alarm and/or vibration, alerting the child and/or parent when involuntary urination begins.Training with an enuresis alarm: first-line therapy in patients Advanced treatment: if initial approaches are unsuccessful.Parent management training (focused on positive reinforcement of proper voiding ).Psychoeducation and behavioral training.Initial approach: nonpharmacological measures.In patients with secondary enuresis, start with treatment of the primary condition (e.g., laxatives for constipation).Organic causes (e.g., urinary tract infections, urinary tract abnormalities, renal disorders) must be excluded before any treatment is started.Treatment may become indicated when enuresis causes distress or impairs social function.Treatment is typically not recommended in children under 5 years of age and if enuresis is not distressing.Occurs at least twice per week for ≥ 3 months or causes clinical distress.Dysfunctional voiding and urinary tract malformations: daytime lower urinary tract symptoms.Chronic kidney disease and diabetes mellitus: polydipsia, polyuria, weight loss, failure to thrive, hypertension (see “ Diagnostics for chronic kidney disease” and “ Diagnostic criteria for diabetes mellitus”).Obstructive sleep apnea: excessive daytime sleepiness, adenotonsillar hypertrophy (see “ Diagnostics” in “ Obstructive sleep apnea” for more information).Features that suggest an underlying disease:.Psychiatric disorders (e.g., conduct disorder, generalized anxiety disorder ) and neurodevelopmental disorders (e.g., ADHD, autism spectrum disorder ).Psychosocial stress factors (e.g., problems at school).Primary enuresis: positive family history, can occur as a response to stress (e.g., recent move, sexual abuse, family conflicts).Primary (patient never achieved nocturnal continence) or secondary (onset of symptoms after patient had achieved nocturnal continence).Definition: repeated involuntary elimination of urine that is inappropriate for developmental age (e.g., bed-wetting ).
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