Lowest recurrence in nocturnal enuresis is seen with-

Ans. is 'a' i.e., Bed alarms Enuresis Enuresis is defined as the voluntary or involuntary repeated discharge of urine into clothes or bed after a developmental age when bladder control should be established (mostly mental age of 5 years). o Diagosis of enuresis requires voiding of urine twice a week for 3 consecutive months or clinically significant distress in child's life as a result of wetting. o Most common cause of diurnal enuresis is micturition deferral (waiting until the last minute to void). Treatment o First line treatment for enuresis is behavioral therapy. It consists of rewarding the child for being dry at night, child should void before retiring and the use of conditioning devices (e.g. bed alarm that rings when the child wets a special sheet). o Consistent dry bed training with positive reinforcement has a success rate of 85% and bed and pad alarm systems have a success rate of approximately 75% with relapse rate that are lower than those with pharmacotherapy. o Pharmacotherapy is second line treatment and should be reserved for those patients who have failed behavioural therapy. Imipramine and desmopressin are two impoant drugs useful for enuresis. o Fast action of desmopressin (orally or intranasaly) suggests a role for special occass ons when rapid control of enuresis is required. However, recurrence rate is very high. o Imipramine is associated with cardiac conduction disturbances and is deadly in overdose.