Alarm interventions for nocturnal enuresis in children

Evidence Summaries

Level of Evidence = B
Alarm interventions appear to be an effective treatment for nocturnal enuresis in children and may be more effective than desmopressin by the end of treatment and subsequently.

The quality of evidence is downgraded by study quality (risks of bias and imprecision for many outcomes).

A Cochrane review 1 included 74 studies with a total of 5,983 children.

At treatment completion, alarms appear to reduce the number of wet nights a week compared to control or no treatment (mean difference (MD) −2.68, 95% CI −4.59 to −0.78; 4 trials, 127 children). More children may achieve complete response (14 consecutive dry nights) with alarms compared to control or no treatment (RR 7.23, 95% CI 1.40 to 37.33; 18 trials, 827 children) and more children may remain dry post-treatment (RR 9.67, 95% CI 4.74 to 19.76; 10 trials, 366 children).

At treatment completion, alarms may reduce the number of wet nights a week compared with behavioural interventions (waking, bladder training, dry-bed training, and star chart plus rewards) (MD 0.81, 95% CI 2.01 to 0.38) and may increase the number of children achieving complete response (RR 1.77, 95% CI 0.98 to 3.19) and may slightly increase the number of children remaining dry post-treatment (RR 1.39, 95% CI 0.81 to 2.41).

Alarms probably slightly increase the number of children remaining dry post-treatment compared with desmopressin (RR 1.30, 95% CI 0.92 to 1.84; 5 trials, 565 children).

Alarm plus desmopressin may reduce the number of wet nights a week compared with desmopressin monotherapy (MD −0.88, 95% CI −0.38 to −1.38; 2 trials, 156 children). Alarm plus desmopressin may increase the number of children achieving complete response (RR 1.32, 95% CI 1.08 to 1.62; 5 trials, 359 children) and the number of children remaining dry post-treatment (RR 2.33, 95% CI 1.26 to 4.29; 2 trials, 161 children) compared with desmopressin alone.

Adverse events attributed to alarms included failure to wake the child, ringing without urination, waking others, causing discomfort, frightening the child and being too difficult to use. Adverse events of comparator interventions included nose bleeds, headaches and abdominal pain.

SoF table https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002911.pub3/fu...

References

1. Caldwell PH, Codarini M, Stewart F et al. Alarm interventions for nocturnal enuresis in children. Cochrane Database Syst Rev 2020;(5):CD002911.  [PMID:32364251]


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