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Discussion Starter · #1 ·
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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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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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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Discussion Starter · #9 ·
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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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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Discussion Starter · #11 ·
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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Yes you are right ....

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 http://www.usmle-forums.com/usmle-articles/1928-two-similar-options-wrong.html
 
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