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Evaluation of the Effectiveness of a Short-term Treatment and Repeat Treatment of Nocturnal Enuresis Using an Enuresis Alarm

Taiju Hyuga, Shigeru Nakamura, Shina Kawai

Urology, Volume 105, July 2017, Pages 153-156

Commentary by Guy Bogaert

The wetting alarm is a well-recognized and accepted treatment for nocturnal enuresis, however the practical implementation seems to be very heterogeneous.  There is a large variety in alarm material but also in duration and follow-up of those children.  In the present retrospective study of Hyuga et al., the authors have looked on the effectiveness of a so-called short-term treatment period of 3 months using an alarm and repeat treatment.  The authors have noticed a 19/137 complete dryness after 3 months, meaning 14%.  This is extremely low and I have not found a detailed description on how the authors are following up on those children and their families between beginning of treatment and the 3-months period: have they seen those patients every week, every 2-weeks, or maybe not at all?  From a view from a child and their family, keeping up with their motivation to wake up when the alarm is sounding at night is extremely difficult.  I can agree with the authors that “continuing” beyond a 3-month period will not improve for a successful outcome.  Besides the fact that this is a retrospective study, the group of patients is very heterogeneous as some of the patients, not further detailed, have received anticholinergic treatment, desmopressine, alpha blockers and even some tricyclic antidepressants at the same time of the alarm treatment.  A wise conclusion seems also that interrupting a unsuccessful alarm treatment and then repeating after “an appropriate interval” seems to be effective.  I like to comment, that an appropriate interval could be, “when the child and his family is motivated” for the treatment and can be coached closely.

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Consensus Guidelines

Practical consensus guidelines for the management of enuresis. 
Evaluation and management of enuresis, a common condition, is not a priority in training programs for medical doctors (MDs), despite being a common condition. 

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Diagnosis and Treatment of Nocturnal Enuresis developed by the Working Group of Nocturnal Enuresis Belgium.