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InstructorInstructorMax Maizels, MDMax Maizels, MDDivision of UrologyDivision of UrologyChildren’s Memorial Hospital – ChicagoChildren’s Memorial Hospital – Chicago

Professor of UrologyProfessor of UrologyNorthwestern Medical SchoolNorthwestern Medical School

Managing Enuresis – Lesson 2Managing Enuresis – Lesson 2

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ATTAIN DAY CONTINENCE - ACCEPTED

NEWBORN CONTROL AT SPINAL LEVELVOID REFLEXIVELY q 2h AT CAPACITY ABOUT 2oz.

INFANT•BEGINS TO SENSE FULLNESS WHILE AWAKE• CAN “WILLFULLY” “HOLD BACK” VOIDING BY CENTRAL INHIBITION OF DETRUSOR REFLEX• VOLITIONALLY CONTRACTS EXTERNAL SPHINCTER AND PELVIC FLOOR MUSCLES

TODDLER INCREASED WILLFULLNESS IMPROVES CONTINENCE FURTHER, GRADUALLY INCREASES BLADDER CAPACITY

VOIDS BY CONTRACT DETRUSSOR & INHIBIT SPHINCTERCONTINENT- INHIBIT DETRUSSOR & CONTRACT SPHINCTERYOUTH

PEDIATRIC ENUROLOGY

ATTAIN NIGHT CONTINENCE - UNKNOWN

SENSE THEN:• INHIBIT DETRUSOR CONTRACTION• CONTRACT PELVIC FLOOR MUSCLES

NOCTURNAL OLIGURIA

• INCREASED NOCTURNAL PRODUCTION OF VASOPRESSIN

PEDIATRIC ENUROLOGY

DELAYS IN ATTAINING NIGHT DRYNESS

• FAMILY HISTORY INVOLVING 1st ORDER RELATIVES• DELAY DEVELOPMENT @ 1 & 3 y.o. MILESTONES• PROLONGED SLEEP IN INFANCY• DAY TRAINING NOT STARTED UNTIL AFTER 18 mo old• MALE GENDER

PEDIATRIC ENUROLOGY

% S

TIL

L T

O A

TT

AIN

BL

AD

DE

R C

ON

TR

OL

AGE OF CHILD

PEDIATRIC ENUROLOGY

NOT RELATED TO DELAY IN ATTAINING NIGHT DRYNESS

• FAMILY SOCIAL BACKGROUND• STRESSFUL LIFE EVENTS• CHANGES IN PARENT FIGURES• CHANGES IN RESIDENCE

PEDIATRIC ENUROLOGY

“HEAVY SLEEP” The children don’t even realize they wet the bed.

The deluge from Springfield’s burst dam floats Ralph Wiggum, in his bed, to Homer’s front door

WHEN TO PURSUE TREATMENT OF ENURESIS?

• AFTER 3 years old?• AFTER 5 years old?• AFTER 7 years old?• AFTER 10 years old?

• ON PARENT’S REQUEST?

PEDIATRIC ENUROLOGY

WHEN TO PURSUE TREATMENT OF ENURESIS?Getting night dryness - B. Schmitt, MD

• 3 yo -self awaken hints limit evening liquids void before sleep praise for dry mornings

• 6 yo -concentrate on self-awakening motivational techniques

• 8 yo -alarm bladder stretch exercise

medications ?

PEDIATRIC ENUROLOGY

DEFINITIONS

PEDIATRIC UROLOGY• SURGICAL PROBLEM

= INCONTINENCE

PEDIATRIC ENUROLOGY•ENUROLOGICAL PROBLEM

= ENURESIS

CHILDHOOD WETTING MAY INVOLVE:

PEDIATRIC ENUROLOGY

3% of

12 Year Olds

Have Never Been Dry at Night

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