Evaluation of the enuretic child

Clinical perspectives in primary nocturnal enuresis

Primary nocturnal enuresis (PNE) is prevalent among the pediatric population, but not all professionals are aware of the current research regarding the etiology and treatment of this disorder. This paper presents a broad overview of PNE, including etiology and evaluation, with a specific emphasis on treatment issues. The most current treatments (imipramine, desmopressin acetate arginine vasopressin, enuresis alarms) are discussed, including recent research on their effectiveness. In considering the recent data on long-term efficacy, overall cost, and safety, the treatment of choice appears to be the enuresis alarm for those families who are capable of following protocols. Desmopressin acetate arginine vasopressin is a safe alternative that has the advantage of quick response and ease of administration.

Evaluation and management of primary nocturnal enuresis

Enuresis can be a source of family crisis, and can contribute to a lack of self-esteem in the affected child. It must be stressed to both parent and child that improvement is gradual and largely a function of maturation in cases where no organic problem is identified. Research shows that many enuretic children seem to have small bladder capacities (Long, 1991), and that the majority have a polyuric factor such as a decreased level of AVP that is amenable to replacement therapy with desmopressin (Bloom, 1993; Hamburger, 1993; Hjälmås & Bengtsson, 1993; Nørgaard & Djurhuus, 1993). Utilizing pharmacologic treatment can accelerate spontaneous cure or act as a substitute until time provides nocturnal continence (Nørgaard & Djurhuus, 1993). Nurse practitioners can use multiple modalities in a holistic approach to reframe this problem and to involve children in solving their own problem. The child who is given a basic understanding of the physiology involved in the healing process will be able to identify inner healing resources and utilize external resources available to him or her. This approach begins with children's imaging the desired outcome of urinary control and ends with achieving increased self-esreem and the sense of competence they deserve.