O

In females, estrogen therapy is used to treat urge and mixed UI and OAB symptomatology, particularly in postmenopausal women. Estrogens, which are used both systemically or topically, restore the functional integrity of the urethral mucosa, increasing resistance to outflow. Newer drugs approved for UI and OAB are the anticholinergic, trospium chloride and duloxetine.

6.23.2.5 Nocturnal Enuresis

Nocturnal enuresis or bedwetting affects some 8-9 million children in the USA. This disorder exists in two types: primary when a child has never developed complete night-time bladder control, and secondary when a child has accidental wetting having had bladder control for 6 or more months. Causes include consuming fluids before bedtime; a deep sleep pattern; and laziness, e.g., not getting out of bed to void. Secondary nocturnal enuresis may involve neurogenic bladder and associated spinal cord abnormalities, urinary tract infections, etc. Treatments include enuresis alarms, that are triggered by moisture; used for 3-5 months these are effective in 70% of children. However, in 10-15% of children bedwetting returns. Drug treatments for nocturnal enuresis, while short-term solutions, work more rapidly than alarms and include tricyclic antidepressants and the synthetic analog of arginine vasopressin (antidiuretic hormone) desmopressin (DDAVP) given as an nasal spray or orally.

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