KARACHI, Jan 7: A wet child can cause embarrassment to the parents, besides personally facing a difficult situation at the school due to no fault of his or hers but because of an undersized bladder or inadequate voluntary control.

Dr Imran Mushtaq, Consultant Paediatric Urologist from Great Ormond Street Hospital for Sick Children, London, said this while delivering a lecture at the Sindh Institute of Urology and Transplantation (SIUT), here on Wednesday. He defined Enuresis as the normal voiding of urine at an inappropriate time.

"It could be involuntary, at an unacceptable time and could be during day or night," he said, adding that good history-taking for assessing a wet child and, if required followed by good physical examination, could be helpful in excluding anatomical abnormalities.

According to him, useful investigations include X-ray of the abdomen, uroflow studies and where indicated, cystoscopy. General treatment was said to comprise avoiding caffeine, voluntary voiding every two hours or so, completely emptying of the bladder and treating constipation.

Regarding the importance of good history taking for assessing a wet child, Dr Imran said this involved information on the time of wetting, frequency, place of occurrence, condition of school toilets and presence or otherwise of constipation.

Fluid intake should be noted, especially the type of fluids such as coloured drinks like colas. He said how these colours led to wetting was not yet established but on stopping them relief had been noted. "Again too many chocolates and sweets can cause wetting in a child and certain drugs especially salbutamol used for asthma are an important reason," he said.

The paediatrician said bed-wetting or enuresis was 50 per cent more common in boys and was again mainly due to a low bladder capacity, bladder irritability or difficulty in arousal due to deep sleep. The genetic factor was further cited as a possible reason.

Bed-wetting was treated by reducing fluid intake in the evening, avoiding coloured drinks, voiding before getting into bed and motivation of a child by star charts. Bed alarms were helpful and in selected cases drugs as dermopressin, anticholinergics or imipramine may be used.

Dr Imran Mushtaq also discussed the role of minimally invasive surgery in managing children with chronic renal failure. He said laparoscopic nephrectomy gave a faster recovery with a shorter hospitalization time. - APP