Efficacy of an enuresis alarm, desmopressin, and combination therapy in the treatment of saudi children with primary monosymptomatic nocturnal enuresis

Abstract

Purpose: We evaluated and compared the effectiveness of an enuresis alarm, desmopressin medication, and their combination in the treatment of Saudi children with primary monosymptomatic nocturnal enuresis (PMNE).

Materials and methods: A total of 136 children with PMNE were randomly assigned to receive an enuresis alarm alone (EA group, n=45), desmopressin alone (D group, n=46), or a combination of both (EA/D group, n=45). Patients were followed weekly during treatment and for 12 weeks after treatment withdrawal.

Results: During treatment, wetting frequencies were significantly reduced in all groups and remained significantly lower than pretreatment values until the end of follow-up. In the D and EA/D groups, an immediate reduction in wetting frequencies was observed, whereas a longer time was required to reach a significant reduction in the EA group. The full and partial response rates were 13.3% and 37.8% in the EA group, 26.1% and 43.5% in the D group, and 40.0% and 33.3% in the EA/D group. A significant difference was observed only between the EA and EA/D groups (p=0.025). Relapse rates were higher in the D group (66.6%) than in the EA (16.6%) and EA/D (33.3%) groups. A significant difference was observed between the D and EA groups only (p=0.019).

Conclusions: Desmopressin, an enuresis alarm, and combined therapy are effective in the treatment of Saudi children with PMNE. Desmopressin produced an immediate effect but relapses were common. The enuresis alarm provided gradual effects that persisted posttreatment. The combined therapy was superior to the alarm in achieving an immediate response; however, its effect was not better than that of the alarm long term.

Keywords: Combined modality therapy; Nocturnal enuresis; Treatment efficacy.

FIG. 1

The flow diagram.

FIG. 2

Box-and-whisker plot. Wetting frequencies, within-group, at different time points were compared with pretreatment values by using paired t-tests. A significant reduction in wet nights was observed between baseline, end of treatment, and end of follow-up in the 3 groups; p<0.0001 in all groups except between end of treatment and end of follow-up in group 2 (p=0.047).

FIG. 3

Wetting frequencies were analyzed week by week in the 3 groups by using paired and independent t-tests. Baseline (week 1); treatment period (weeks 2-13); follow-up period (weeks 14-25). (Δ), time of significant reduction of wet nights in group 1 (p=0.0001); (Ω), time of significant reduction in wet nights in group 2 (p=0.0001); (†), time of significant reduction of wet nights in group 3 (p<0.0001); (Φ), time of significant rebound in group 1 (p=0.0074); (I), time of significant rebound in group 2 (p=0.0009); (O), time of significant rebound in group 3 (p=0.0047); (*), p<0.05, intergroup comparison of group 1 vs. 2; (‡), p<0.05, intergroup comparison of group 1 vs. 3; (#), p <0.05, intergroup comparison of group 2 vs. 3.