1. ENURESIS (Bed wetting)

2. ENURESIS (Bed wetting) Def : Involuntary voiding of urine into cloths or bed after developmental age when bladder control should be established. this should be twice a week for at least three consecutive month, or clinically significant distress in child life.

3. Prevalence FemaleMale Total percent. Age/ yr 3%7%10%5 2%3%5%10 -1% 18

4. 60% ==> boys 50% ==> F / H 44% ==> one parent 77% ==> both parent 15 – 20 % of patient yearly will spontaneously improve with out treatment.

5. Classification 1) Primary or persistent 90%. 2) Secondary or regressive 10% due to stressful environmental events. Distinction is important as the pathogenesis of the tow patterns is different.

6. Further classification : Nocturnal only En. Diurnal only En. Nocturnal / diurnal En.

7. Pathogenesis : Delayed maturation of the cortical mechanism that allow voluntary of the micturition reflex. Sleep disorder most of them are described as deep sleeper. Decrease ADH at night this will increase U.O.P. Genetic factor. Psychologic factor mainly in secondary En. Sleep apnea (snoring) secondary to enlarged adenoid.

8. Management I. General suggestion - Reasurance & avoid punishment. - restrict fluid intake after 7 pm. - void before retiring. - waking the child few hour, after sleep for voiding. - reword the child for dry night. - secondary En. As a result of environmental stressors. - refer al to ENT especially if the child snoring. II. Condition therapy : a device alarm that rings when the child wet, a special sheet … success rate 60%.

9. III. Pharmacologic therapy : * Desmopressin : synthetic analog of vasopressin. 0.2 – 0.6 mg at night 0.10 µg Effectiveness 40 – 60 % * Imipramine tah. mild anticholinergic mild alfa – adrenergic Effectiveness 30 – 60 % * Oxybutinin anticholinergic, antispasmodic limited studies available. Effectiveness 17 % * Active treatment a voided before seven years.