Exploring Clinical and Urinary Factors in Treatment-Resistant vs. Treatment-Responsive Childhood Enuresis: A Comparative Study

Abstract

Background Nocturnal enuresis is a common pediatric condition affecting 7.61–18.7% of school-aged children. While various treatment options exist, resistance to treatment presents a significant clinical challenge. This study aimed to identify factors distinguishing treatment-resistant from treatment-responsive cases of childhood enuresis. Methods A cross-sectional analytical study was conducted in 2017 at Mohammad Kermanshahi Hospital, Iran. The study included 144 children aged 5–8 years with nocturnal enuresis, divided into treatment-controlled (n = 85) and treatment-resistant (n = 59) groups. Participants received Desmopressin nasal spray (DDAVP) at 10 mcg/spray nightly. Demographics, clinical characteristics, sleep patterns, urination habits, and ultrasound findings were analyzed. Results Several factors were significantly associated with treatment resistance, including multiple bedwetting episodes per night (64.4% vs 28.2%, p < 0.001), abnormal residual urine volume (61.0% vs 31.8%, p < 0.001), and large urine volume per episode (86.4% vs 61.2%, p = 0.001). Logistic regression identified five independent predictors of treatment resistance: nightly bedwetting (OR = 4.82), large urine volume per episode (OR = 3.97), abnormal residual urine volume (OR = 3.35), multiple bedwetting episodes per night (OR = 2.89), and urinary urgency (OR = 2.14). Conclusion Treatment-resistant nocturnal enuresis is associated with specific urinary patterns and bladder dysfunction characteristics. These findings may help clinicians identify patients at risk for treatment resistance and develop targeted therapeutic strategies. Further research with extended follow-up periods is recommended to validate these findings.