Published online November 1, 2004
PEDIATRICS Vol. 114 No. 5 November 2004, pp. 1483-1487 (doi:10.1542/peds.2004-1721Q)
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Right arrow Office Practice

SUPPLEMENT ARTICLE

An Opportunity for Office-Based Research*

Key Words: office research • primary care research • enuresis

The first 300 words of the full text of this article appear below.


   CASE
 
Robert, a nearly 12-year-old boy, traveled an hour to see a new pediatrician. Robert’s mom told the pediatrician that Robert had not been seen by a doctor for several years because "no one seems to be able to help him with his problem." Robert had been wetting the bed "ever since he was toilet-trained" at age 2 years.

Robert wets the bed approximately 5 out of 7 nights. He never has daytime accidents. He did not have a history of urinary tract infection, dysuria, urgency, or increased frequency of urination. He has daily bowel movements and denied soiling or accidents. Robert’s mom said he had "toilet-trained himself" at age 2 years. Both Robert’s mom and maternal grandfather had nocturnal enuresis "into their teenage years."

The pediatrician was surprised to learn that another physician had treated Robert with imipramine at age 5 years. The medication worked intermittently, and Robert continued to take it for approximately 1 year. At age 6 years, Robert’s parents saw an advertisement for a bed-wetting alarm. They purchased the alarm but found that Robert never woke up when the alarm sounded. At age 7 years, Robert saw a urologist who told him he would "outgrow the problem." A year later, the urologist prescribed desmopressin acetate (DDAVP) nasal spray, which Robert took on occasion during the next 2 years. Every time he stopped the DDAVP, he resumed wetting the bed. His parents never punished him for his accidents, but they did try restricting fluids after dinner and also woke Robert in the middle of the night and encouraged him to go to the bathroom. Neither of these strategies was successful. Robert said he was "frustrated" and wondered if "I would still be wetting the bed as a grown-up."

The pediatrician explained the nature of enuresis to Robert and . . . [Full Text of this Article]

Martin T. Stein, MD

Professor of Pediatrics
University of California
San Diego, California

William Barbaresi, MD

Director of Developmental-Behavioral Pediatrics
Mayo Clinic
Rochester, Minnesota

Irwin Benuck, MD

Associate Professor of Clinical Pediatrics
Northwestern University Medical School
Chicago, Illinois