Alarms for nocturnal enuresis in children

Evidence Summaries

Level of Evidence = A
Alarm interventions are an effective treatment for nocturnal enuresis in children and may be more effective than desmopressin or tricyclics by the end of treatment and subsequently.

A Cochrane review 1 included 56 studies with a total of 3,257 children of whom 2,412 used an alarm. Compared to no treatment, about two thirds of children became dry during alarm use (RR for failure 0.38, 95% CI 0.33 to 0.45). Nearly half who persisted with alarm use remained dry after treatment finished, compared to almost none after no treatment (RR of failure or relapse 45/81 [55%] vs 80/81 [99%], RR 0.56, 95% CI 0.46 to 0.68). There was insufficient evidence to draw conclusions about different types of alarm, or about how alarms compare to other behavioural interventions. Relapse rates were lower when overlearning (giving extra fluids at bedtime after successfully becoming dry using an alarm) was added to alarm treatment (RR 1.92, 95% CI 1.27 to 2.92) or if dry bed training was used as well (RR 2.0, 95% CI 1.25 to 3.20). Penalties for wet beds appeared to be counter-productive. Alarms using electric shocks were unacceptable to children or their parents.

Although desmopressin may have a more immediate effect, alarms appear more effective by the end of a course of treatment (RR 0.85, 95% CI 0.53 to 1.37) but their relative effectiveness after stopping treatment was unclear from two small trials which compared them directly. Evidence about the benefit of supplementing alarm treatment with desmopressin was conflicting. Alarms were better than tricyclics during treatment (RR 0.59, 95% CI 0.32 to 1.09) and afterwards (7/12 [58%] vs 12/12 [100%], RR 0.58, 95% CI 0.36 to 0.94). However, other Cochrane reviews of desmopressin and tricyclics suggest that drug treatment alone, while effective for some children during treatment, is unlikely to be followed by sustained cure as almost all the children relapse.

References

1. Glazener CM, Evans JH, Peto RE. Alarm interventions for nocturnal enuresis in children. Cochrane Database Syst Rev 2005 Apr 18;(2):CD002911 [Assessed as up-to-date: 27 Feb 2007].  [PMID:15846643]


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