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Enuresis - Coggle Diagram

- - - - UTI
      - faecal retention severe enough to reduced bladder vol + cause bladder neck dysfunction
      - polyuria
  - - - synthetic ADH
      - for short term relief (e.g. sleepover, on hols)
      - PO or sublingual
- - - - developmental problem
      - psychogenic
      - usually child in normal but preoccupied with what they're doing
    - - bladder enlarged, fails to empty properly, thick walls
      - a/w spina bifida + other neuro conditions
        
        do spine x-ray for vertebral anomaly
        
        may need MRI to look for non-bony defect (e.g. tethering of cord)
      - on exam: distended bladder, abnormal perineal sensation/anal tone (S2,3,4), abnormal LL reflexes + gait, spinal lesion may be present
      - do bladder US
    - - examine urine: M, C+S
    - - constant dribbling, child always damp
      - girls who are dry @ night but wet on getting up likely have pooling of urine from an ectopic ureter opening into vagina
- - - - DM
      - renal concentrating disorder
        
        sickle cell disease
        
        chronic renal failure
  - - - measure osmolality of early morning sample
      - rarely a formal water deprivation test