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
Mahony DT. Treatment of Enuresis. JAMA. 1973;226(8):1010–1011. doi:10.1001/jama.1973.03230080146035
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