Question

A 5 year old boy presents with bedwetting. His mother states that for the past two months, he has been wetting the bed several times a week. The child is embarrassed about this new incontinence, and has had no problems in the daytime. The patient's mother insists that the child has otherwise been healthy; she denies fevers and increased appetite or fluid intake. The patient's past medical history is remarkable only for a hospitalization at age 1 for bronchiolitis. The boy lives with his mother, father, and a younger sister who was adopted from Russia several months ago. Everyone at home has been well. On physical exam, the patient is a talkative, interactive male. Speech, motor, and physical development are all normal. What is the most appropriate initial step in the management of this patient?

A. Urine culture
B. Voiding cystourethrogram
C. Recommend an enuresis alarm
D. Desmopressin
E. Urinalysis

Answer 1

The most appropriate initial step in the management of a 5-year-old boy presenting with bedwetting, with no other urinary symptoms or significant medical history, is to recommend an enuresis alarm option (c).

Step-by-step explanation:

In the case of a 5-year-old boy with a new onset of bedwetting (enuresis), it is important to begin with the least invasive and most appropriate initial steps to manage the condition.

Since the patient does not have any daytime symptoms, fevers, increased appetite, or increased fluid intake, and his physical exam is normal, the most appropriate initial step would be to recommend a non-invasive behavioral intervention.

Therefore, C. Recommend an enuresis alarm would be the appropriate initial intervention. Enuresis alarms are a form of conditioning therapy, which helps the child to recognize and respond to the sensation of a full bladder during sleep.

If behavioral interventions such as the enuresis alarm do not lead to improvement, or if there are signs of other underlying conditions, further investigation with tests like urinalysis or urine culture may be warranted. However, in a typically developing child without any other symptoms, these tests are not the first line of approach.