Pediatric urinary incontinence.

A clear understanding of the current concepts, pathophysiology, and typical symptoms of voiding dysfunction and pure nocturnal enuresis usually allows the clinician to distinguish these troublesome but benign problems from true underlying pathological conditions of the urinary tract. If a careful history confirms that wetting is the only symptom, and the pattern of wetting is consistent with uninhibited bladder contractions, or if the wetting occurs only during sleep, initial empiric treatment rather than invasive investigation is our preference. On the other hand, if the wetting is associated with infection or persistent dysuria, or if the history or pattern of wetting is suggestive of anatomic or neurogenic causes, a complete investigation of the urinary tract is necessary prior to initiating therapy.