1. TRY for DRY Healthcare Training
Managing Enuresis – Lesson 4
Instructor
Max Maizels, MD
Division of Urology
Children’s Memorial Hospital – Chicago
Professor of Urology
Northwestern Medical School

2. Non Surgical Issues Related to Wetting
TRY for DRY
Non Surgical Issues Related to Wetting
ENURESIS

3. The Guide to Help Your Child Overcome Bedwetting

4. Patient History and Current Status
INTAKE INFORMATION
Patient History and Current Status

5. PEDIATRIC ENUROLOGY STRATEGY OF THE TRY for DRY EVALUATION
INTAKE INFORMATION
PRE-OFFICE INFO
OFFICE VISIT
WORKING Dx -> ENURESIS -> TFD MULTIMODAL TREATMENT
1mo LATER EVALUATE PROGRESS
CONTINUE TRY for DRY or
PEDIATRIC UROLOGY REFERRAL
OUGHT TO BE DRY by 3-6 mo
IF NOT DRY … REFER to SPECIALIST

6. TFD-001 Pre-Treatment Kit
PEDIATRIC ENUROLOGY
TFD-001 Pre-Treatment Kit
Measure bladder capacity
Intake questionnaires
COMPLETE BEFORE 1ST OFFICE VISIT

7. TFD-001 Pre-Treatment Kit
PEDIATRIC ENUROLOGY
TFD-001 Pre-Treatment Kit
Measure Urine Output
Measure bladder capacity
Intake questionnaires
COMPLETE BEFORE 1ST OFFICE VISIT

8. TFD-001 Pre-Treatment Kit
PEDIATRIC ENUROLOGY
TFD-001 Pre-Treatment Kit
Measure Urine Output
Measure bladder capacity
Intake questionnaires
HOME DIARY OF:
BLADDER CAPACITY
FOOD \ FLUIDS
STOOL PATTERN
COMPLETE BEFORE 1ST OFFICE VISIT

9. TFD-001 Pre-Treatment Kit
PEDIATRIC ENUROLOGY
TFD-001 Pre-Treatment Kit
Measure bladder capacity
INVENTORY OF
DEMOGRAPHICS:
PARENT EDUCATION
WHO ELSE WETS
TREATMENTS TRIED
BEHAVIOR CHECKLIST
MARITAL SATISFACTION
Intake questionnaires
HOME DIARY OF:
BLADDER CAPACITY
FOOD \ FLUIDS
STOOL PATTERN
COMPLETE BEFORE 1ST OFFICE VISIT

10. PEDIATRIC ENUROLOGY INVENTORY OF DEMOGRAPHICS: PARENT EDUCATION
WHO ELSE WETS
TREATMENTS TRIED
BEHAVIOR CHECKLIST
MARITAL SATISFACTION
COMPLETE BEFORE 1ST OFFICE VISIT

11. PREDICTING NORMAL BLADDER CAPACITY

12. PEDIATRIC ENUROLOGY PREDICTING NORMAL BLADDER CAPACITY
BLADDER CAPACITY (ml) = 32 x AGE(yrs) + 73
BLADDER CAPACITY (oz) = AGE(yrs) + 2
(+ 2oz SD)
Berger, Maizels: J. Urol. 129:349, 1983

13. PREDICTING NORMAL BLADDER CAPACITY
INFREQ VOID
WETTING

14. FUNCTIONAL BLADDER CAPACITY
PEDIATRIC ENUROLOGY
VOIDING DIARY ANALYSIS
CONTINENT Yes or No
FREQUENCY \ URGENCY
INFREQUENT VOIDING
GIGGLE \ STRESS WETTING
WET ALWAYS OR ONLY POST VOID
ABDOMINAL PAIN
SQUATTING
FUNCTIONAL BLADDER CAPACITY

15. Primary Nocturnal Enuresis
PEDIATRIC ENUROLOGY
VOIDING DIARIES
Primary Nocturnal Enuresis
We expect to see a smaller than average functional bladder capacity.
7 Year Old +2 = 9 oz. AVG.

16. PEDIATRIC ENUROLOGY VOIDING DIARIES
Compare to this second patient who wets by day and by night.
Shows frequency and very small void quantity.
8 yo + 2 = 10 oz AVG.

17. PEDIATRIC ENUROLOGY VOIDING DIARIES Lazy Bladder. Note both
Day & Night Wet.
plus UTI
and erratic void pattern with both large and small void amount..

18. PEDIATRIC ENUROLOGY
VOIDING DIARIES - habitual water drinker

19. 1st OFFICE VISIT IS TO DIAGNOSE: ENURESIS vs. INCONTINENCE
PEDIATRIC ENUROLOGY
1st OFFICE VISIT IS TO DIAGNOSE:
ENURESIS vs. INCONTINENCE
HISTORY
PHYSICAL EXAM
UA (CULTURE OPTIONAL)
FLOW RATE ASSESSED (VISUALLY)
ULTRASOUND
(OPTIONAL ON 1st VISIT)

20. ULTRASOUND thick detrusor -> void dysfunction,
posterior urethral valves
hydronephrosis -> ectopic ureter
symmetric renal growth -> VUR
fecal plug
residual urine

21. ULTRASOUND
“I poo when I need to..
I don’t need to now!”

22. Rx Constipation & Toileting

23. ULTRASOUND
“I don’t have to pee!”

24. 6yo girl VOIDED 800ml

25. AGE 7 + 2 = 9 oz 7 Year Old Girl PREDICTED NORMAL BLADDER CAPACTIY

26. DRINK - PEE- THEN DRINK AGAIN

27. Close Screen Return to Lesson