Night wetting and soiling — OSCE

Objectives

1. Open without blame and stop punitive toileting. [1]
2. Classify primary MNE with retentive encopresis and explain overflow. [2] [11]
3. Offer a stepped plan: bowel clearance/maintenance, alarm for cure, desmopressin for camp with safety. [4] [5] [6] [9]
4. Safety-net red flags and review. [1] [2]

Candidate brief

12-minute station. Parents and child present. Task: assess the problem representation, counsel, and agree a non-punitive management plan including school camp. [1] [4]

Expected actions

• Open with normalisation; explicitly stop punishment and shaming. [1]
• Clarify night-only versus daytime LUTS; primary versus secondary course. [2]
• Identify constipation with overflow as the likely soiling mechanism. [11]
• Screen red flags: polyuria/polydipsia, continuous wetting, neurology, safeguarding. [1] [2]
• Plan bladder/bowel diary and focused exam principles (abdomen, spine, neurology). [2]
• Disimpaction then PEG maintenance concept for months, not days. [9] [12]
• Scheduled toileting after meals with foot support and rewards for sitting/success. [9]
• Offer enuresis alarm for durable dryness when family ready. [5]
• Offer desmopressin for camp short-term dryness with evening fluid restriction and hyponatraemia counselling. [6] [14]
• Agree school plan (toilet access, spare clothes, no public shaming) and review timing. [1] [4]
• Teach-back the difference between cure goal (alarm) and temporary dryness (desmopressin). [4] [5] [6]

Marking

Pass: non-punitive framing; correct phenotype; constipation treated; alarm versus desmopressin goals correct; desmopressin fluid safety stated; clear review/safety-net. [1] [4] [5] [6] [9]
Fail: endorses punishment; treats soiling as deliberate dirtiness without bowel plan; starts desmopressin without fluid rules; promises lasting cure from desmopressin alone; ignores red flags. [1] [6] [11] [14]