Aims of study: This paper addresses pediatric elimination disorders including nocturnal enuresis from the perspectives of terminology (the Whorf hypothesis), the elimination interview, and the guarding reflex. Methods: The elimination interview and a modern model of normal voiding function, including the guarding reflex, are explained. Results: The language of voiding dysfunction influences our perception of it. Nocturnal enuresis, and all other voiding dysfunctions, should be evaluated by a careful elimination interview. The guarding reflex may fit into an evolving etiologic paradigm for nocturnal enuresis. Conclusions: (1) Words and phrases of eliminology should aim for simplicity, clarity and accuracy. (2) Urologists need to perfect their eliminology skills vis-à-vis the elimination interview. (3) The role of the guarding reflex in nocturnal enuresis and all other voiding dysfunctions should be critically examined.

Keywords:
Enuresis, Toilet training, Elimination, Guarding reflex, Encopresis
1.
Ross PE: On linguistic relativity. Sci Am 1992;266:24.
2.
Bloom DA, Faerber G, Bomalaski MD: Urinary incontinence in girls. Evaluation, treatment, and its place in the standard model of voiding dysfunctions in children. Urol Clin North Am 1995;22:521–538.
3.
Berger RM, Maizels M, Moran GC, et al: Bladder capacity (ounces) equals age (years) plus 2 predicts normal bladder capacity and aids in diagnosis of abnormal voiding patterns. J Urol 1983;129:347–349.
4.
Zerin JM, Chen E, Ritchey ML, et al: Bladder capacity as measured at voiding cystourethrography in children: Relationship to toilet training and frequency of micturition. Radiology 1993;187:803–806.
5.
Steers WD: Physiology of the urinary bladder; in Walsh PC, Retik AB, Stamey TA, et al (eds): Campbell’s Urology, ed 6. Philadelphia, Saunders, 1992, pp 142–176.
6.
Novello A, Novello J: Enuresis. Pediatr Clin North Am 1987;34:719–733.
7.
Fergusson DM, Horwood LJ, Shannon FT: Factors related to the age of attainment of nocturnal bladder control. Pediatrics 1986;78:884.
8.
Bloom DA, Seeley WW, Ritchey ML, et al: Toilet habits and continence in children: An opportunity sampling in search of normal parameters. J Urol 1993;149:1087–1090.
9.
Rittig S, Knudsen UB, Norgaard JP, et al: Abnormal diurnal rhythm of plasma vasopressin and urinary output in patients with enuresis. Am J Physiol 1989;256:F664–F671.
10.
Watanabe H: Treatment system for nocturnal enuresis according to an original classification system. Eur Urol 1994;25:43–50.
11.
Park J, Bloom DA, McGuire EJ: The guarding reflex revisited. Br J Urol 1997;80:940–945.
12.
McGuire EJ, Savastano JA: Urodynamic studies in enuresis and the non-neurogenic neurogenic bladder. J Urol 1984;132:299–302.
13.
Bloom DA, Pohl J, Nørgaard JP: Comment on enuresis, particularly the nocturnal type. Scand J Urol Nephrol Suppl 1994;163:7.
14.
Bloom DA: The American experience with desmopressin. Clin Pediatr Suppl 1993;28–31, special edition.
15.
Koff SA: Enuresis; in Walsh PC, Retik AB, Stamey TA, et al (eds): Campbell’s Urology, ed 6. Philadelphia, Saunders, 1992.
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