Correct Answer – E Urine analysis UA

Explanation:

This patient is suffering from secondary nocturnal enuresis. Nocturnal enuresis is defined as repeated involuntary urination that occurs 2x/weeks for at least 3 months in a child who is at least 5 years old. It is more prevalent in boys. It can be primary (the child did not achieve continence before) or secondary (the child achieved continence before) like the patient described above. The first step in the management of this case would be to take a detailed history from the mother, as most of the patients would be subjected to a stressor that might have triggered the symptoms to start. In the vignette, the arrival of a new baby was the stressor. Other risk factors may include family conflicts, sexual abuse or family history of nocturnal enuresis. The best next step would be to exclude organic causes through urine analysis (choice E) and potentially ultrasound. The first line of treatment would be psychoeducation (choice B) of the mother and the child and behavioral modification. This can be achieved by timed voiding, fluid restriction at night and positive reinforcement when he has dry nights. The next best step is using a urine alarm that wakes the child when he wets the bed (choice A). The pharmacological options for management include Desmopressin (choice C) as a first line and Imipramine (choice D) as a second line, as the latter has more side effects. REF: 1-Gomez Rincon M, Leslie SW, Lotfollahzadeh S. Nocturnal Enuresis. 2021 Feb 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 31424765.