Rapid maxillary expansion in children with nocturnal enuresis: A randomized placebo-controlled trial

Area of Science:

• Pediatric Urology
• Orthodontics
• Sleep Medicine

Background:

• Nocturnal enuresis (NE) is a common condition in children, often requiring multidisciplinary treatment approaches.
• Therapy-resistant NE presents a significant challenge, necessitating exploration of novel treatment modalities.
• Rapid maxillary expansion (RME) is an orthodontic procedure with potential, yet unproven, benefits for NE.

Purpose of the Study:

• To evaluate the efficacy of RME as a treatment for therapy-resistant NE in children.
• To determine if any observed treatment effects are attributable to a placebo response.
• To identify prognostic factors associated with a positive response to RME treatment for NE.

Main Methods:

• A randomized controlled trial involving 38 children with therapy-resistant NE.
• Intervention group received RME; placebo group received a sham appliance followed by RME.
• Baseline assessments included medical history, voided volumes, and nocturnal urine production.

Main Results:

• RME treatment resulted in a statistically significant reduction in wet nights (P < .001).
• No significant reduction in wet nights was observed following placebo treatment (P < .40).
• Over 35% of patients experienced a >50% reduction in enuresis frequency; wide maxilla and large voiding volume were positive predictors.

Conclusions:

• RME demonstrates a modest but significant effect in treating children with therapy-resistant NE.
• The positive outcomes are unlikely to be solely due to a placebo effect of the appliance.
• Maxillary width and baseline voiding volume are identified as key predictors for successful RME treatment in NE.