Differential Diagnosis for Nighttime Bed Wetting in a 7-year-old Boy
- Single most likely diagnosis:
- Primary Nocturnal Enuresis: This condition is the most likely diagnosis given the patient's history of nighttime bed wetting despite being daytime toilet trained, absence of urinary urgency or dribbling, and normal urinalysis and urine culture. The family history of delayed nighttime dryness (father achieved nighttime dryness at age 9) also supports this diagnosis.
- Other Likely diagnoses:
- Neurogenic Bladder: Although less likely, neurogenic bladder could be a consideration due to the patient's history of premature birth and attention deficit hyperactivity disorder (ADHD). However, the absence of urinary urgency, dribbling, or other urinary symptoms makes this less likely.
- Polyuria: The patient's frequent urination during the day (5 or 6 times) could suggest polyuria, but this would typically be associated with other symptoms such as excessive thirst, which are not mentioned.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Diabetes Insipidus: Although rare, diabetes insipidus can cause nocturnal enuresis, polyuria, and polydipsia. It is essential to consider this diagnosis due to its potential severity and the need for prompt treatment.
- Urinary Tract Infection (UTI): Despite the normal urinalysis and urine culture, a UTI could still be present, especially if the patient has a functional or anatomical abnormality. UTIs can cause nocturnal enuresis, and missing this diagnosis could lead to complications.
- Rare diagnoses:
- Spinal Cord Anomalies: Conditions such as spina bifida or tethered cord syndrome can cause neurogenic bladder and nocturnal enuresis. However, these conditions are rare and typically associated with other symptoms such as back pain, weakness, or sensory changes.
- Sleep Disorders: Certain sleep disorders, such as sleep apnea, can increase the risk of nocturnal enuresis. However, these conditions are less likely to be the primary cause of bed wetting in this patient.