ENURESIS

Ask the following questions:

1. Is the bed-wetting frequent or only occasional? Frequent bed-wetting should signify pathology in the urogenital tract or endocrine system. If the bed-wetting is infrequent, one should consider epilepsy.
2. Are there abnormalities found on the urogenital examination? There are many causes of enuresis that can be found on a simple examination, such as phimosis, balanitis, meatal stricture, vulvitis, or intestinal worms.
3. Are there abnormalities on the urinalysis? Urinalysis alone is usually not adequate, and a urine culture should be done to rule out cystitis and pyelonephritis. The simple examination of the urine sediment for bacteria is also helpful. Sugar in the urine may indicate diabetes mellitus, but it may also indicate Fanconi's syndrome.
4. Is there polyuria? Polyuria might indicate diabetes insipidus, diabetes mellitus, hyperthyroidism, and hypoparathyroidism.
5. Are there abnormalities on the neurologic examination? Here one would be looking for cerebral palsy and congenital anomalies of the spinal cord.

Finally, if the neurologic examination, urogenital examination, and urinalysis are normal, perhaps the patient has a simple neurosis or situational maladjustment.

DIAGNOSTIC WORKUP

Patients who are suspected of having a urologic condition as the cause of their enuresis should have a urinalysis, intravenous pyelogram, and voiding cystogram with a urine culture and colony count. Referral to a urologist for cystometric testing may be required. If there is polyuria, a glucose tolerance test, a thyroid profile, and tests for calcium phosphorus, alkaline phosphatase, and parathyroid hormone level should be done. If epilepsy is suspected, an EEG should be ordered. If the neurologic examination is abnormal, referral to a neurologic specialist would be in order. If all the studies and examinations are within normal limits, a referral to a psychiatrist or psychologist may be in order. However, the child may have simple enuresis, in which case all that is required is to reassure the parents that the child will grow out of it by puberty.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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