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An interprofessional approach to managing children with treatment-resistant enuresis: an educational review

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Abstract

Enuresis (intermittent urinary incontinence during sleep in a child aged ≥ 5 years) is commonly seen in paediatric practice. Despite the availability of effective interventions, treatment resistance is encountered in up to 50% of children. In this educational review we attempt to provide insight into the causes of treatment resistance, and offer practical suggestions for addressing this condition using an interprofessional approach. We explore the pathophysiology of and standard treatments for enuresis and discuss why standard treatments may fail. An interprofessional approach to treatment resistance is proposed which utilises the expertise of professionals from different disciplines to address the problems and barriers to treatment. The two interprofessional approaches include a multidisciplinary approach that involves the patient being sent to experts in different disciplines at different times to address their treatment resistance utilising the skills of the respective experts, and an interdisciplinary approach that involves a patient being managed by members of interdisciplinary team who integrate their separate discipline perspectives into a single treatment plan. Although an interdisciplinary approach is ideal, interdisciplinary teams may not be available in all circumstances. Understanding the roles of other disciplines and engaging clinicians from other disciplines when appropriate can still be helpful when treatment resistance is encountered.

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Authors and Affiliations

  1. The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia

    Patrina H. Y. Caldwell, Melissa Lim & Gail Nankivell

  2. Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia

    Patrina H. Y. Caldwell

Authors
  1. Patrina H. Y. Caldwell
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  2. Melissa Lim
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Correspondence to Patrina H. Y. Caldwell.

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1. c; 2. e; 3. a; 4. c; 5. d

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Caldwell, P.H.Y., Lim, M. & Nankivell, G. An interprofessional approach to managing children with treatment-resistant enuresis: an educational review. Pediatr Nephrol 33, 1663–1670 (2018). https://doi.org/10.1007/s00467-017-3830-1

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