Paeds Cases · nephrology-urology-fluids-and-electrolytes
Nocturnal enuresis — structured clinical encounter
Structured encounter testing the approach to a 7-year-old with monosymptomatic nocturnal enuresis: the definition and classification, the voiding diary and urinalysis, the choice between the enuresis alarm and desmopressin first-line, the desmopressin dose and fluid-restriction safety rule, and the red flags that reclassify the problem.
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Station brief (candidate)
You are the paediatric registrar in a general clinic. A 7-year-old boy is referred because he wets the bed on five or six nights a week. He is dry by day, growing normally and otherwise well, and his father wet the bed until age 11. A voiding diary shows a large overnight urine volume with normal daytime voids, and urinalysis is normal. The family is motivated and able to wake with the child, but they would also like the option of quick control for an upcoming school camp. The team asks you to establish the definition and classification, outline the assessment and investigations, choose and justify the first-line therapy, and counsel on the desmopressin safety measures. You have 12 minutes with the team and 5 minutes for examiner discussion. [1]
References6ShowHide
- [1]Nevéus T; Fonseca E; Franco I; et al Management and treatment of nocturnal enuresis-an updated standardization document from the International Children's Continence Society. J Pediatr Urol, 2020.PMID 32278657
- [3]Kuwertz-Bröking E; von Gontard A Clinical management of nocturnal enuresis. Pediatr Nephrol, 2018.PMID 28828529
- [4]Hahn D; Stewart F; Raman G Desmopressin for nocturnal enuresis in children. Cochrane Database Syst Rev, 2025.PMID 40728007
- [5]Glazener CM; Evans JH; Peto RE Alarm interventions for nocturnal enuresis in children. Cochrane Database Syst Rev, 2005.PMID 15846643
- [8]Skoog SJ; Stokes A; Turner KL Oral desmopressin: a randomized double-blind placebo controlled study of effectiveness in children with primary nocturnal enuresis. J Urol, 1997.PMID 9258137
- [11]Chen X; Zeng F; Tian N; et al Efficacy and safety of first-line therapies and first-line-based combination therapies for monosymptomatic nocturnal enuresis in children: a network meta-analysis. Pediatr Nephrol, 2026.PMID 41902910