Erectil Disfuntion

NOCTURNAL ENURESIS
Assessment
Areas to cover in the history:
* Pattern of bedwetting, daytime symptoms and toileting patterns:
1. Consider use of diary to keep a record.
2. Is therepain on passing urine, daytime frequency, urgency, straining or abdominal pain?
3. Does the child pass urine regularly through the day and do symptoms occur only in certain situations? (do they avoidusing toilets at school?)
* What is the appropriate daily fluid intake?
1. Children 4-8 years old 1l/day
2. Teenage girls 2.5l/day, boys 3.2l/day
* Ask about possible triggers if morethan 6 months of dry nights previously (secondary enuresis: UTI, constipation, DM, physical or emotional triggers).
Investigations
Urinalysis if onset bedwetting within the last few days or weeks,if daytime symptoms or any signs of ill health or if suspected UTI or DM
Consider further assessment and/or referral if:
* Children with behavioural or emotional problems or learning disability.* Recurrent UTIs, known or suspected physical, neurological or developmental problems or if the child or family is vulnerable.
* Suspected maltreatment.
Treatment
General measures and rewardsystems:
1. Give information and advice about bed protection, washable/disposable products
2. Advise on fluid intake, regular toileting (4-7 times a day and before sleep)
3. Rewardsshould be given for agreed behaviour rather than dry nights (use patient.co.uk)
Lifting and waking
Should only be used as a short term measure, neither of them promote long term dryness.

Enuresisalarm
First line treatment for children in whom bedwetting has not responded to initial treatments/advice. Effort and commitment are required to achieve long term success so it might not be appropriatefor all families.
Initial response may take several weeks, you can combine alarm with desmopressin treatment
Drug treatment- Desmopressin
Is indicated when rapid-onset and/or short-term dryness is...