Clinical Presentation and Diagnosis Pediatric Enuresis

Proper assessment of the child or adolescent with enuresis should explore every aspect of UI, especially the genitourinary and nervous systems. The minimum assessment should include34,35:

• Interview of child and parent(s), being sensitive to the emotional consequences of the enuresis

• Direct physical examination, looking for enlarged adenoids/tonsils, bladder disten-tion, fecal impaction, abnormal genitalia, spinal cord anomalies, and abnormal neurologic signs (look for an organic cause amenable to surgery or drugs; see Table 53-5)

• Obtain a urinalysis (consider a urine culture at the same time)

• A 2-week diary of wet and dry nights prior to intervention is useful in that it can be used to monitor the response to treatment. A first-morning urine specific gravity may help to predict response to DDAVP therapy. Polysymptomatic presentation may require a more elaborate workup, including voiding cystourethrogram, renal and/or bladder ultrasound, urodynamics, and sleep studies.

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