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April 15, 1974

Enuresis: Treatment With Imipramine

Author Affiliations

Morristown, NJ

JAMA. 1974;228(3):289-290. doi:10.1001/jama.1974.03230280017017

To the Editor.—  Dr. Martin postulates (227:327, 1974) that because enuretics have frequent bladder contractions and a "delayed tendency to develop normal bladder capacity," and wet in deep sleep, when their intravesical pressures are higher than in light sleep, they suffer "a fundamental defect... in subcortical centers controlling micturition." He suggests that imipramine, by lightening sleep, compensates for these defects and that the larger bladder and maturing nervous system of increasing age may render imipramine unnecessary.One may not properly use an infant's frequent physiological bladder contractions to attribute immaturity to an enuretic's irritable bladder contractions. The routine cystometric study does not necessarily permit distinction between peripheral and central irritation. We know of no demonstration of an abnormal voiding center or an abnormal neural pathway. Depth of the enuretic's sleep is no warrant to consider the bladder diseased.Clinical experience and animal studies show that urethral or bladder mucosal irritation