Incontinence, urine, pediatric / enuresis

Rationale

Enuresis is the involuntary passage of urine in a child. The majority of children with enuresis have primary nocturnal enuresis. Daytime and secondary enuresis are much less common, but require differentiating between underlying diseases and stress-related conditions.

Causal Conditions

(list not exhaustive)

1. Primary enuresis (e.g., family history)
2. Secondary enuresis (e.g., urinary tract infection, vesicoureteral reflux)

Key Objective

In a child five years of age or older, determine whether a physical abnormality is causing the involuntary passage of urine.

Enabling Objectives

Given a patient with enuresis, the candidate will

1. list and interpret critical clinical findings, including
   1. an appropriate history and physical examination to
      1. determine whether medical reasons underlie the enuresis;
      2. determine whether a stressful event preceded the occurrence of enuresis (e.g., birth of a sibling);
2. list and interpret critical clinical and laboratory findings, including
   1. urinalysis and urine culture;
3. construct an effective management plan, including
   1. counselling, education, and reassurance of the parents of a child with primary nocturnal enuresis, including treatment options;
   2. counselling and reassurance of the child to improve self-esteem;
   3. in the case of secondary enuresis, treatment of the underlying cause;
   4. determining if the patient needs to be referred to a specialist.