What is the best next step in managing a child with nocturnal enuresis who has tried conservative measures?

In the management of nocturnal enuresis, especially when conservative measures have been attempted without success, the next appropriate step is often the prescription of desmopressin. Desmopressin is an effective treatment for nocturnal enuresis as it acts as an antidiuretic, reducing urine production during the night. It is particularly useful in cases where the child may produce an excess of urine at night, leading to bedwetting.

Desmopressin is generally well-tolerated and can lead to significant improvements in enuresis in many children. It allows for a non-invasive approach to management and can be part of a comprehensive treatment strategy that might also include behavioral modifications and support for the child and family.

While observing for spontaneous resolution could be relevant for younger children or those with a milder form of enuresis, it would not be appropriate for a child who has already undergone conservative measures without success. Prescribing imipramine, an older tricyclic antidepressant, is not the first-line approach due to potential side effects and safety concerns. Referral to urology may be necessary if there are anatomical abnormalities or more severe underlying issues, but it is not typically the next step in standard management unless indicated by