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 www.TRYforDRY.com

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

The Guide to Help Your Child Overcome Bedwetting

Patient History and Current Status INTAKE INFORMATION Patient History and Current Status

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

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

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

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

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

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

PREDICTING NORMAL BLADDER CAPACITY

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

PREDICTING NORMAL BLADDER CAPACITY INFREQ VOID WETTING

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

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.

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.

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

PEDIATRIC ENUROLOGY VOIDING DIARIES - habitual water drinker

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)

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

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

Rx Constipation & Toileting

ULTRASOUND “I don’t have to pee!”

6yo girl VOIDED 800ml

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

DRINK - PEE- THEN DRINK AGAIN

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