Successful management of daytime enuresis using alarm procedures: a randomly controlled trial.

Abstract

SUMMARY Forty four children with daytime wetting were included in a randomly controlled trial of two alarm devices, a contingent one that sounded when wetting occurred and a non-contingent one that went off from time to time unrelated to wetting events. A quota allocation system ensured comparability between treatment groups. Two thirds responded to an alarm by becoming dry. The non-contingent alarm produced as good a response as the contingent one and is recommended for routine use in children with diurnal enuresis. Twenty three per cent of those who responded to treatment relapsed up to two years after completion of the trial. This study was set up to evaluate a contingent alarm system for the treatment of diurnal enuresis using a randomly controlled trial. Children who did not receive the device being tested were managed with what seemed to be an identical alarm but which in fact merely emitted a similar loud tone about every two hours, whether wetting had occurred or not. Patients and methodsChildren aged 5 to 15 attending a children's enuresis clinic were selected for inclusion in the trial.Daytime wetting had to be sufficiently common and severe to make it the main problem complained about by the mother. For most of the children the pants became so wet each day that urine soaked through to trousers or skirt; it was rare, however, for there to be a puddle on the chair seat or floor.About two thirds of the children were referred by consultant colleagues (tertiary referral) and the other third by general practitioners or clinical medical officers. Any children identified as having severe urinary tract abnormality were excluded; urinary tract infections were treated before the child was included in the study. Children with very severe social or psychological problems that made them unsuitable for routine management in a paediatric outpatient clinic were also excluded. Nevertheless, the sample of cases included in the study was virtually a consecutive series of children presenting with troublesome daytime wetting; only two were excluded because of being too disturbed for paediatric management.Fifty cases were collected, but in one instance the family refused to participate, in another the child developed diabetes mellitus, and for four others treatment was not thought to be necessary as there was a period of at least seven days without wetting during the baseline period. Therefore, 44 children were included in the trial and allocated to one of the two treatment groups. The mean (SD) age of those included was 8-5

Clinical behavioral problems in day- and night-wetting children

“…The attainment of dryness after the age of 10 years increased the risk for behavioral problems -independently of the primary or secondary status [9]. Equally, the group of day-wetting children as a whole were more psychiatrically disturbed than controls [10] and than nocturnal enuretics [4,5] in parental and teacher questionnaires, as well as by psychiatric assessment.…”

Psychologisch-psychiatrische Aspekte der Enuresis nocturna und der funktionellen Harninkontinenz

“…In einer frühen Studie, die nicht den jetzigen kinderpsychiatrischen Standards entspricht, zeigten 30% der tags einnäs-senden Kinder eine Verhaltensaufällig-keit [13], in einer anderen Studie zeigten 25% der Kinder eindeutige und weitere 14% mögliche emotionale Störungen [21]. In der eigenen Studie erfüllten 53% aller tags einnässenden Kinder die Kriterien In einer neueren pädiatrischen Studie von 418 Kinder im Alter von 5-17 Jahren wurden die tags einnässenden Kinder als sturer, oppositoneller und verheimlichender beschrieben als die nächt-lichen Enuretiker [24].…”

Efficacy of alarm intervention in primary monosymptomatic nocturnal enuresis in children

“…12 In majority of studies the intervention was given for 12 weeks. 18,19 The accepted treatment period for nocturnal enuresis was reported by Forsythe to be 12-16 weeks. 20 In the present study it was found that reduction in mean number of wet night started from 8 weeks of intervention and best results were seen after 20 weeks.…”