Enuresis and voiding disorders in children

• No routine tests: no blood test, no imaging, no dipstick from the outset.

Urine tests, only in some cases

• Urine dipstick (enuresis that began a few days or weeks ago, daytime symptoms, signs of illness, urinary tract infection or diabetes)if needednon-French guidelineNICE does not do routine urinalysis for enuresis, unless it began a few days or weeks ago, there are daytime symptoms, signs of illness, or features suggesting a urinary tract infection or diabetes ^[2].
• Urine microscopy and culture (if leucocytes or nitrites on the dipstick)if needednon-French guidelineA dipstick positive for leucocytes or nitrites means the urine is sent for culture ^[3].

Urine tests

• Urine dipstick (leucocytes, nitrites, glucose, protein)
• Urine microscopy and culture (if leucocytes or nitrites on the dipstick, or signs of urinary tract infection)if needednon-French guidelineUrine culture if the dipstick shows leucocytes or nitrites, in recurrent urinary tract infection or if the clinical picture and the dipstick are discordant ^[3].

Blood tests, only if there is a warning sign

• Serum creatinine with eGFR (weight loss, growth retardation, nausea, or excessive thirst with need to drink at night)if needednon-French guidelineThe ICCS asks for creatinine for weight loss, growth failure or nausea, and to consider it for excessive thirst with a need to drink at night; blood tests are indicated only in case of glycosuria or signs of polyuric renal failure ^[1].
• Urine osmolality on morning urine (excessive thirst with need to drink at night)if needednon-French guidelineExcessive thirst with a need to drink at night: dipstick glycosuria, list of drinks, and consider creatinine and first-morning urine osmolality ^[1]. See the page “Polyuria-polydipsia”.

• No routine tests before or during treatment.

Only if there is a warning sign or a high-risk combination

• Serum electrolytes (serum sodium): headache, nausea, vomiting, rapid weight gain, confusion, or combination with a drug promoting inappropriate ADH secretionif neededThe desmopressin SmPC says to stop the treatment and do serum electrolytes if there are symptoms suggestive of hyponatraemia, and to start serum sodium monitoring in a child taking a drug that promotes inappropriate antidiuretic hormone secretion (tricyclics, SSRIs, chlorpromazine, carbamazepine, NSAIDs) ^[6].