Robson identified conditions associated with enuresis that may require a specialist as well as those that may be initially addressed by a primary care provider. The author is from Children's Clinic in Calgary, Alberta, Canada.


When to refer to a specialist:

(1) cystitis with reduced bladder capacity

(2) constipation or encopresis with reduced bladder capacity

(3) other causes of reduced bladder capacity

(4) impaired arousal during sleep

(5) neurogenic bladder

(6) daytime incontinence

(7) abnormal urine stream, including interrupted stream

(8) unexplained urinary urgency

(9) failure to respond to optimum primary care


Conditions that may be initially managed by a primary care provider:

(1) uncomplicated urinary tract infection

(2) simple constipation

(3) nocturnal polyuria associated with diabetes mellitus or diabetes insipidus

(4) nocturnal polyuria associated with fluid intake just prior to bedtime


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