1 / 37

TRY for DRY Healthcare Training

TRY for DRY Healthcare Training. Managing Enuresis – Lesson 5. Instructor Max Maizels, MD Division of Urology Children’s Memorial Hospital – Chicago Professor of Urology Northwestern Medical School. www.TRYforDRY.com. PEDIATRIC ENUROLOGY. NIGHT DRYNESS IMPEDED BY :. DEEP SLEEP

leane
Download Presentation

TRY for DRY Healthcare Training

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. TRY for DRY Healthcare Training Managing Enuresis – Lesson 5 Instructor Max Maizels, MD Division of Urology Children’s Memorial Hospital – Chicago Professor of Urology Northwestern Medical School www.TRYforDRY.com

  2. PEDIATRIC ENUROLOGY NIGHT DRYNESS IMPEDED BY: • DEEP SLEEP • REDUCED FUNCTIONAL • BLADDERCAPACITY • FOOD SENSITIVITIES • OBLIGATORY POLYURIA • CONSTIPATION • UTI’S • UROLOGICAL BIRTH DEFECTS

  3. PEDIATRIC ENUROLOGY TRY for DRY “Multi-modal” treatment works better than single agent treatment

  4. Multi-modal treatment T = Thumb = Try for Dry Alarm

  5. Multi-modal treatment I =Index finger = Inducements Star chart and moderate encouragement.

  6. Multi-modal treatment M = Middle Finger =Meds Oxybutynin - - - Desmopressin

  7. Multi-modal treatment R = Ring Finger = Right Food Elimination Diet

  8. Multi-modal treatment P = Pinkey = Poo Bowel Management

  9. PEDIATRIC ENUROLOGY STRATEGY OF THE TRY for DRY EVALUATION INTAKE INFORMATION PRE-OFFICE INFO 1st OFFICE VISIT > WORKING Dx >ENURESIS > TFD MULTIMODAL TREATMENT 1 Month Later EVALUATE PROGRESS • 2nd OFFICE VISIT >CONTINUE TFD or PEDIATRIC UROLOGY REFERRAL DRYNESS by 3-6 months OUGHT TO BE ACHIEVED 3rd OFFICE VISIT> IF NOT DRY ….. SPECIALIST REFERRAL

  10. PEDIATRIC ENUROLOGY STRATEGY OF THE TRY for DRY EVALUATION 1o or 2o NOCTURNAL ENURESIS MANAGEMENT 1st OFFICE VISIT TRY for DRY ALARM - Review Instructions Explain Star Chart INDUCEMENTS Review MEDS Rx - Oxybutynin TID \ HS Depends on bladder size - DESMOPRESSIN 10+ years old Review Elimination Diet -RIGHT FOODS - Review Bowel Program if Defecation is Irregular - POO

  11. PEDIATRIC ENUROLOGY STRATEGY OF THE TRY for DRY EVALUATION 1o or 2o NOCTURNAL ENURESIS MANAGEMENT 1st OFFICE VISIT DON’T TREAT ENUROLOGICALLY UNTIL DEFECATION IS REGULAR

  12. PEDIATRIC ENUROLOGY STRATEGY OF THE TRY for DRY EVALUATION 1o or 2o NOCTURNAL ENURESIS MANAGEMENT 1st OFFICE VISIT DDAVP CONSIDERATIONS • BOTH PARENTS WORK • SPECIAL NIGHTS (SLEEP OVERS) • PARENTAL FEAR OF ALARM • ALARM FAILURES • IN CONJUNCTION WITH OXYBUTYNIN

  13. TFD #2 …. TREAT KIT START AFTER 1ST OFFICE VISIT “happy bladder” diet TFD alarm Video alarm instructions Calendar tracks day\night dryness “Panda” taper treatments

  14. bladder

  15. T = Thumb = Try for Dry Alarm DAY WET - Alarm worn on belt line NIGHT WET – Alarm worn on shoulder

  16. As Mono Treatment Effective in About 50% • Delayed Results ( 3-6 months ). • May not be routinely accepted by child. • Time intensive for child, family and physician. • Considered most effective treatment for long term remission of enuresis.

  17. I =Index finger = Inducements Add star chart Rewards used for day or night wetting Reinforce Dryness Star Chart - Treats – Read a Story – Grab Bag

  18. DITROPAN (OXYBUTYNIN) • ANTICHOLINERGIC. • REDUCES UNINHIBITED BLADDER CONTRACTIONS. • HELPS DAY WETTING. • NO BENEFIT WHEN USED ALONE FOR BEDWETTING. M = Middle Finger =Meds SMALL BLADDER CAPACITY Wet by day – RxDitropan (Oxybutynin)

  19. DITROPAN (OXYBUTYNIN) Strategy • AGE • BLADDER CAPACITY • SENSITIVITY to MED. • HOME or SCHOOL SCHEDULE for TIME to ADMINISTER M = Middle Finger =Meds SMALL BLADDER CAPACITY Night Wet – Youth = Ditropan

  20. PEDIATRIC ENUROLOGY DITROPAN DOSEAGES & TITRATION 5-7yo

  21. PEDIATRIC ENUROLOGY DITROPAN DOSEAGES & TITRATION 8-12yo

  22. PEDIATRIC ENUROLOGY DITROPAN DOSEAGES & TITRATION >12yo

  23. PEDIATRIC ENUROLOGY DITROPAN (OXYBUTYNIN) Adverse Effects • FACIAL FLUSHING • CRABBINESS • NOSE BLEED • DRY MOUTH • ERRATIC BEHAVIOR • STOMACH ACHES • NIGHTMARES

  24. M = Middle Finger =Meds DDAVP Reduces Nocturnal Polyuria. Can be used as mono therapy. SMALL BLADDER CAPACITY Night Wet – Teen = Ditropan + DDAVP

  25. R = Ring Finger = Right Food Elimination Diet Avoid: - Milk - Citrus - Sugars - Carbonated Drinks

  26. We have found that certain foods appear to inhibit dryness in approximately 10% of children who wet.

  27. P = Pinkey = Poo Rx ALL PATIENTS Daily AM toileting Patients w/ HARD bowel movements Rx = mineral oil Patients w/ Irregular emptying Rx = stimulant (Senkot)

  28. P = Pinkey = Poo Rx ALL PATIENTS Daily AM toileting Patients w/ HARD bowel movements Rx = mineral oil Patients w/ Irregular emptying Rx = stimulant (Senkot)

  29. PEDIATRIC ENUROLOGY STRATEGY OF THE TRY for DRY EVALUATION 1o or 2o NOCTURNAL ENURESIS MANAGEMENT 2nd OFFICE VISIT Follow-up 1 Month after initial office visit • At second visit,80% of patients show improved dryness • Expect Remission in 3-6 months • (Goal 14 Consecutive Dry Days &Nights) • Relapse Rate 15% ( 2 Wet episodes\ month) • “CURE” = REMISSION FOR 1 YEAR • If wetting has not improved consider urological issues.

  30. PEDIATRIC ENUROLOGY STRATEGY OF THE TRY for DRY EVALUATION 1o or 2o NOCTURNAL ENURESIS MANAGEMENT 2nd OFFICE VISIT Patients with improved dryness • FOLLOW UP VISITS prn WITH PEDIATRICIAN • POSTCARD FROM FAMILY TO CONFIRM: • REMISSION • NO RELAPSE AFTER STOP TFD Rx

  31. PEDIATRIC ENUROLOGY STRATEGY OF THE TRY for DRY EVALUATION 1o or 2o NOCTURNAL ENURESIS MANAGEMENT 2nd OFFICE VISIT Patients with NO improved dryness • USING ALARM CORRECTLY? • ACTUALLY WEARING IT? • PLACEMENT OF SENSOR? • FEAR OF ALARM? • TITRATE DOSE OF DITROPAN.

  32. PEDIATRIC ENUROLOGY STRATEGY OF THE TRY for DRY EVALUATION 1o or 2o NOCTURNAL ENURESIS MANAGEMENT 2nd OFFICE VISIT Patients with NO improved dryness BM’s NOT REALLY DAILY. SNEAKING ON ELIMINATION DIET. NEED PSYCHOLOGICAL REFERRAL? NEED PEDIATRIC UROLOGICAL REFERRAL?

  33. PEDIATRIC ENUROLOGY STRATEGY OF THE TRY for DRY EVALUATION 1o or 2o NOCTURNAL ENURESIS MANAGEMENT PEDIATRIC UROLOGICAL CONSIDERATIONS • UA C\S • ULTRASOUND: • thick detrusor -> void dysfunction, • posterior urethral valves, • hydronephrosis -> ectopic ureter • symmetric renal growth -> VUR • fecal plug • residual urine • BM’s NOT REALLY DAILY • KUB - SPINA BIFIDA OCCULTA • CONSIDER CYSTOSCOPY AND VCUG

  34. PEDIATRIC ENUROLOGY STRATEGY OF THE TRY for DRY EVALUATION 1o or 2o NOCTURNAL ENURESIS MANAGEMENT PEDIATRIC UROLOGICAL CONSIDERATIONS • URODYNAMICS NEUROGENIC BLADDER • VCUG VUR • CYSTOSCOPY POSTERIOR URETHRAL VALVES • MRI TETHERED CORD

  35. PEDIATRIC ENUROLOGY STRATEGY OF THE TRY for DRY EVALUATION 1o or 2o NOCTURNAL ENURESIS MANAGEMENT PEDIATRIC UROLOGICAL CONSIDERATIONS • INCONTINENCE - 3% OF CASES • 60% SPINA BIFIDA OCCULTA • DAY\NIGHT WET & STOOL PROBLEMS • UTI COMMON • 30% POSTERIOR URETHRAL VALVES • SLOW FLOW • HYDRONEPHROSIS \ DILATED BLADDER • 10% ECTOPIC URETER • DAY AND NIGHT WETTING IN A GIRL

  36. E nuresis nfection ncopresis PEDIATRIC ENUROLOGY • Try for Dry commonly applied to other clinical problems • involving wetting

  37. Close ScreenReturn to Lesson

More Related