Outcome evaluation

• Monitor the patient for symptom relief. Have the desired outcomes jointly developed by the health care team, the patient, and his or her parents/guardians been achieved and to what degree? Evaluate the daily diary completed by the patient or parents/guardians since the last clinic visit and quantitate the clinical response (the number of dry nights versus the total number of nights, and the frequency of nights with greater than or equal to two enuresis episodes). If a diary has not been used, elicit the clinical response, in general terms, since the last visit.

• Elicit adverse events of therapy in a nonleading manner and ask the patient to judge their severity. Ask the patient or parents/guardians what measures if any were used to ameliorate them. Assess adherence (ask patient or parents/guardians about missed doses; do pill counts if the prescription vial is available).

• The balance of clinical response, tolerability, and burden on the family will dictate the approach to management. As most nonpharmacologic approaches are "all or none" and drug dosages after an initial titration period are fixed, the major decision process involves either changing therapy if clinical results are inadequate, or beginning or continuing tapering-off and discontinuation of therapy after success. There is no consensus on which treatment approach to withdraw first, although the ICCS recommends the nonpharmacologic (alarm) therapy first, then pharmacologic (DDAVP) therapy.

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