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  #1  
Old 03-22-2010
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Question Monosymptomatic Nocturnal Eneuresis Question

7 year old boy with life time history of bed wetting otherwise completely normal . He has no history of trauma or abuse .. Only wet during night not in day time .. No history of incontinence , burning micturation , fever or Increase thirst .. No past history .. Physical exam normal .. What is the most appropiate next step in Mx ...
1. Bladder training
2. enuresis alarm
3. imipramin therapy
4. CT pelvis
5. Renal U/S
6. Urine analysis
7. Urine culture and sensitivity
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Old 03-22-2010
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I'd use the alarm in this case!
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Old 03-22-2010
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Since he has no day time symptoms or incontinace then we should not worry about secondary enuresis
I think we should start imipramine
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Old 03-22-2010
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Some people say don't start therapy until age 8 years.
I pick bladder training as the answer
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Old 03-23-2010
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i think i ask for urine analysis
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Old 03-23-2010
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Quote:
Originally Posted by mosallam View Post
i think i ask for urine analysis
Why you will ask for urine analysis? Please explain
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Old 03-23-2010
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I think imipramine ... is probable answer ... Its relatively late primary enuresis ... I've encounterd similar case which showed " Imipramin" or " other drugs " as answers although the case I saw was alittle bit older " 8 years "
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Old 03-23-2010
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FSUSTC please tell the correct answer if you know it
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Old 03-23-2010
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Thank you All for your answers .......
Correct ans is URINE ANALYSIS ...... before starting any therapy .. U have to find out other abnormality by physical exam for anatomic abn , urine analysis to see UTI ( mostly ) , DI , DKA ....... If all of these are negative then go for behavioural therapy , if don work drug therapy ...... so next best step is Urine analysis ...
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Old 03-23-2010
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Quote:
Originally Posted by FSUSTC View Post
Thank you All for your answers .......
Correct ans is URINE ANALYSIS ...... before starting any therapy .. U have to find out other abnormality by physical exam for anatomic abn , urine analysis to see UTI ( mostly ) , DI , DKA ....... If all of these are negative then go for behavioural therapy , if don work drug therapy ...... so next best step is Urine analysis ...
But the patient has no burning, no thirst, no fever, and exam was normal!
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Old 03-23-2010
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Quote:
Originally Posted by mary View Post
But the patient has no burning, no thirst, no fever, and exam was normal!
U have a point there ... But what they said is always take careful history for family history or any distress then look for anatomic abn by physical exam and do urine analysis ( to exclude UTI or other ds ) if all are negative then start regular therapy of enuresis .....
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Old 03-23-2010
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Quote:
Originally Posted by FSUSTC View Post
U have a point there ... But what they said is always take careful history for family history or any distress then look for anatomic abn by physical exam and do urine analysis ( to exclude UTI or other ds ) if all are negative then start regular therapy of enuresis .....
I think the question is not written perfectly. Because when they say that the patient has no fever, no dysuria, no family history ...etc it means you already asked about these and excluded them and I see no point in doing urinalysis if the patient is perfectly normal.
But I think we should be smarter than the question maker and conclude that he means urinalysis because the next step is behavioral therapy and both bladder training and the alarm are forms of behavioral therapy so when you have two options looking the same they must be both wrong as Rasheed said here Two Similar Options Are Wrong
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The above post was thanked by:
FSUSTC (03-23-2010), yarasara77 (10-27-2012)



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