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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
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.
To evaluate the effectiveness of a 3-month enuresis alarm (EA) treatment and repeat EA treatment among pediatric patients with nocturnal enuresis, and to compare patient characteristics among "responders" and "nonresponders" to treatment.
Materials And Methods:
Clinical outcomes were retrospectively evaluated for 137 children (94 boys and 43 girls, mean age, 10.1 years). Effectiveness was evaluated after an initial 3-month treatment, using the International Children's Continence Society criteria. Among children in the no-response group at 3 months, those who continued the EA treatment for ≥4 months were subclassified into group 1, whereas children who repeated the EA treatment at an interval ≥6 months were subclassified into group 2.
Among our 137 cases, 19 achieved complete response and 47 achieved partial response at 3 months, for an overall treatment effectiveness rate of 48%. Among the no-response group, treatment was extended in 17 cases (group 1), with 3 (18%) achieving a successful outcome. Treatment was repeated in 18 cases (group 2). In group 2, 8 (44%) achieved successful outcome at 3-month time point. Daytime urinary incontinence did not modify treatment effectiveness.
EA treatment should be given for a short period of time and should not be continued without a definite purpose or clear response. Suspending and then repeating this treatment after an appropriate interval is effective for patients who do not respond to the initial course of treatment.