Differential Diagnosis for Enuresis in a 6-year-old Boy
- Single most likely diagnosis:
- C) Maturational delay: This is the most likely explanation for the patient's enuresis. The boy was toilet trained at the age of 4 but has never remained dry through the night, which suggests a delay in the maturation of his bladder control. The absence of other urinary symptoms, such as pain, urgency, or dribbling, and the normal urinalysis results support this diagnosis.
- Other Likely diagnoses:
- B) Detrusor muscle overactivity: This condition can cause enuresis, especially if the boy has an overactive bladder that contracts involuntarily during the night. However, the lack of daytime urinary symptoms makes this diagnosis less likely.
- A) Adjustment disorder: The boy's recent start in first grade and difficulty making friends could contribute to stress, which might exacerbate enuresis. However, this would not be the primary cause of his enuresis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- E) Urinary tract infection: Although the urinalysis results are negative, a urinary tract infection (UTI) could cause enuresis. It is essential to consider this diagnosis, especially if the boy develops new symptoms, such as dysuria or fever.
- D) Primary sleep disorder: While the boy is described as a "heavy sleeper," a primary sleep disorder, such as sleep apnea, could contribute to enuresis. However, the absence of snoring and other sleep-related symptoms makes this diagnosis less likely.
- Rare diagnoses:
- Neurological disorders: Conditions such as spina bifida, spinal cord injuries, or neurogenic bladder can cause enuresis. However, these diagnoses are rare and would typically be associated with other symptoms, such as bowel or motor dysfunction.
- Hormonal imbalances: Certain hormonal imbalances, such as diabetes insipidus, can cause enuresis. However, these conditions are rare and would typically be associated with other symptoms, such as polyuria or polydipsia.