MNE infers that the nighttime incontinence occurs in the absence of any other lower urinary tract symptoms. Although the article is focused on children, it is also useful in dealing with adults with MNE. The authors review the primary evaluation including a careful history to assess for daytime voiding or bowel dysfunction. If either of these is present, it needs to be treated before embarking on Inhibitors,research,lifescience,medical therapies for MNE. It is also important to determine whether the child is bothered by nighttime wetting because this will influence motivation to become dry. If the physical examination is unremarkable and the urinalysis shows no glucosuria, proteinuria, or infection, therapeutic

alternatives should be discussed with parents of children age 6 years and older. Although the authors do not recommend routine ultrasound of the kidneys, studies have suggested screening for boys older than age 6 because, on occasion, boys with

posterior urethral valves have a late presentation manifested Inhibitors,research,lifescience,medical by only MNE.6 The authors stress Inhibitors,research,lifescience,medical the importance of keeping a calendar of wet and dry Wee1 inhibitor nights. They also note the importance of voiding first thing in the morning, before retiring, and regularly during the day. Evening fluid and solute intake should be minimized but liberalized during the day, especially in the morning and early afternoon. The authors discuss the conditioning Inhibitors,research,lifescience,medical alarm therapy. If the alarm has been successful, they recommend that the child drink a modest amount of extra water 1 hour before bed. If, after 1 month, they remain continent at night, the alarm is discontinued. Desmopressin has a low curative potential with only about 30% of children responding completely.

Not only does it have an antidiuretic effect but, in addition, there may be a central nervous system antienuretic effect. Desmopressin is most efficient in children with nocturnal polyuria, which is nocturnal urine Inhibitors,research,lifescience,medical production > 130% of expected bladder capacity for age and normal bladder reservoir function (maximum voided volume > 70% of expected bladder capacity for age). Other children placed on desmopressin may have failed alarm therapy or are not candidates Tolmetin for the conditioning alarm. Desmopressin is very safe except when children drink liquids excessively prior to bedtime. This can lead to water intoxication, hyponatremia, and seizures. In December 2007, the US Food and Drug Administration (FDA) issued a formal warning on the potential for intoxication which I review carefully with parents each time I prescribe desmopressin. I advise that the child drink only with dinner. The authors recommend that the desmopressin be taken at least 1 hour before going to sleep with a small amount of water-and restricting fluids for an additional 8 hours.