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November 19, 1973

Treatment of Enuresis

JAMA. 1973;226(8):1010-1011. doi:10.1001/jama.1973.03230080146035

To the Editor.—  Dr. John Prutting recently expressed his concern that widely circulated promotional material may lead to inappropriate and indiscriminate use of imipramine hydrochloride in treatment of bed-wetting children (225:315, 1973). I share his concern, but for somewhat different reasons.Experience in our clinic indicates that, contrary to the popular belief, a lower urinary tract organic factor, often an obstructive lesion correctible by minor surgery, is the cause of simple bedwetting in the majority of enuretic children (J Urol 106:951, 1971). Detrusor hypertrophy and hypercontractility and sphincter weakness are basic to the detrusor-sphincter imbalance that is the common cause of juvenile urinary incontinence. Accordingly, lower urinary tract voiding studies are necessary to evaluate adequately the cause of childhood enuresis.Several well-controlled studies have shown anticholinergic drugs to be largely ineffective in eliminating childhood enuresis.1 Several equally valid studies show imipramine to be highly effective in treating daytime urinary