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Enuresis alarm and desmopressin initially equal, but better long-term success with alarm

Clinical Question:
Are desmopressin and enuresis alarms equally effective in the management of nocturnal enuresis in children aged 6 to 15 years?

Bottom Line:
Desmopressin (DESM) and enuresis alarm treatment are equally effective in the management of nocturnal enuresis in children aged 6 years to 15 years. The relapse rate after 12 weeks is significantly higher in children treated with DESM. Partial responders and nonresponders to initial therapy benefitted from a switch to the alternative treatment. (LOE = 1b-)

Reference:
Kwak KW, Lee YS, Park KH, Baek M. Efficacy of desmopressin and enuresis alarm as first and second line treatment for primary monosymptomatic nocturnal enuresis: Prospective randomized crossover study. J Urology 2010;184(6):2521-2526.  [PMID:20961574]

Study Design:
Cross-over trial (randomized)

Funding:
Foundation

Allocation:
Uncertain

Setting:
Outpatient (specialty)

Synopsis:
These investigators identified 104 children, aged 6 years to 15 years, meeting standard criteria for nocturnal enuresis without daytime lower urinary tract symptoms. Eligible patients randomly received (uncertain allocation concealment) DESM 0.2 mg daily increased to 0.4 mg daily if necessary after 2 weeks, or a standard enuresis alarm (EA) for 12 weeks total. All children were advised to restrict fluid and fruit and empty their bladder before bedtime. Parents aware of group assignments supplied outcome information using daily wetting diaries. Children who were either partial responders or nonresponders to their first-line treatment were switched to the alternative treatment for an additional 12 weeks. Complete follow-up occurred for 96% of patients at 24 weeks. Using intention-to- treat analysis, following first-line treatment, there were no significant differences between the DESM and EA groups in achieving a successful result (reduction in wet nights by at least 50%: 77.8% vs 82.0%, respectively) or full response (37% vs 50%, respectively). Of the children with a full response, significantly more children relapsed in the DESM group than in the EA-treatment group (50% vs 12%). Following second-line crossover treatment, there were no significant differences between the EA-DESM group and DESM-EA group in achieving a successful result (71.4% vs 67.8%, respectively).

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