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Enuresis Updated 3/2011

Melanie J.S. Malec, MD
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BASICS

  • Description
  • Epidemiology
  • Risk Factors
  • General Prevention
  • Pathophysiology
  • Etiology
  • Associated Conditions

DIAGNOSIS

  • Signs and Symptoms
  • Tests
  • Differential Diagnosis

TREATMENT

  • Medication (Drugs)
  • Additional Treatment
  • Complementary and Alternative Medicine
  • Surgery

Ongoing Care

  • Follow-Up Recommendations
  • Diet
  • Patient Education
  • Prognosis
  • Complications
The following is an excerpt....
BASICS

Description
  • Nocturnal enuresis (NE): Repeated spontaneous voiding of discrete amounts of urine during sleep after the anticipated age of bladder control (age 5)
  • Daytime incontinence: Uncontrollable leakage of urine while awake
  • Classification:
    • Primary NE: 1% of adult population; 80% of all cases; child/adult who has never established urinary continence on consecutive nights for a period of 6 months or more
    • Secondary NE: 20% of cases; resumption of enuresis after at least 6 months of urinary continence
  • Also categorized as:
    • Monosymptomatic NE (uncomplicated): Bed wetting without lower urinary tract symptoms other than nocturia and no history of bladder dysfunction
    • Nonmonosymptomatic NE: Bed wetting with lower urinary tract symptoms such as frequency, urgency, daytime wetting, hesitancy, straining, weak or intermittent ...

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See Also
Images >
Figure 29.4. Surgical therapy for urinary incontinence. (A1–A3) Anterior vaginal wall repair, the Kelly-Kennedy procedure. (A1) Anterior vaginal wall is opened and undermined. (A2) Paraurethral tissue lateral to the urethrovesical (UV) junction is sutured. (A3) This creates a firm bar of tissue that supports the UV junction. (B1–B4) Retropubic suspension procedures, the Marshall-Marchetti-Krantz procedure. (B1) The suture is placed in the periurethral tissue and then into the pubic periosteum so that (B2) the urethra may be advanced upward into an intra-abdominal position. (B3) The Burch procedure, by which the tissue adjacent to the UV angle is sutured to the iliopectineal (Coopers) ligament. (B4) The Richardson paravaginal repair, by which the sutures are placed between the superior sulcus of the vagina and lateral pelvic side wall at the level of the iliopectineal line. (C1–C3) Sling procedures. (C1) The Pereyra procedure, by which a needle is guided transabdominally into the paraurethral tissue and back through (C2) to be tied suprapubically, thus supporting the UV angle. (C3) The Stamey procedure, by which a Dacron support material is used in the paraurethral tissue to buttress the tissue.Credit: Charles RB Beckmann, Frank W, etal. Obstetrics and Gynecology, Fifth Edition. Philadelphia: Lippincott Williams & Wilkins, 2006
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