Primary nocturnal enuresis: Current

Primary nocturnal enuresis sometimes presents significant psychosocial prob lems for children and their parents. Causative factors may include maturati onal delay, genetic influence, difficulties in waking and decreased nightti me secretion of antidiuretic hormone. Anatomic abnormalities are usually no t found, and psychologic causes are unlikely. Evaluation of enuresis usuall y requires no more than a complete history, a focused physical examination, and urine specific gravity and lipstick tests. Nonpharmacologic treatments include motivational therapy, behavioral conditioning and bladder-training exercises. Pharmacologic therapy includes imipramine, anticholinergic medi cation and desmopressin, These drugs have been used with varying degrees of success.