Treating the refractory patient

What is a refractory patient?

Whereas up to 70% of children with nocturnal enuresis can be adequately treated with first-line therapies, the remaining need further treatment attempts and more specialized care.

For refractory cases, consider referral to specialized centers.

Further treatment options may include imipramine, anticholinergics, and combination treatments.

The treatment steps for a refractory patient

  • Assess compliance, duration of treatment, and the reasons for treatment failure.
  • Optimize and reintroduce first line treatments if needed.
  • Assess for comorbidities (especially constipation, sleep disordered breathing, ADHD, and other behavioral issues).
  • Discuss combination treatment based on pathophysiology.
  • Home recordings may be helpful, especially during treatment periods.
  • Discuss with the family how far to go.
Bedwetting | 3. Treating nocturnal enuresis
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