Daytime urotherapy in nocturnal enuresis: a randomised, controlled trial
Malin Borgström1,2, Amadeus Bergsten2, Maria Tunebjer2
1Center for Clinical Research Dalarna, Falun, Sweden.
Objective:
According to international guidelines, children with enuresis are recommended urotherapy, or basic bladder advice, before treatment with evidence-based alternatives such as the enuresis alarm is given. The efficacy of this strategy has, however, not been supported by controlled studies. We wanted to test if basic bladder advice is useful in enuresis.
Design:
Randomised, controlled trial.
Setting:
Paediatric outpatient ward, regional hospital.
Patients:
Treatment-naïve enuretic children aged ≥6 years, with no daytime incontinence.
Interventions:
Three groups, each during 8 weeks: (A) basic bladder advice-that is, voiding and drinking according to a strict schedule and instructions regarding toilet posture, (B) enuresis alarm therapy and (C) no treatment (control group).
Main Outcome Measures:
Reduction in enuresis frequency during week 7-8 compared with baseline.
Results:
The median number of wet nights out of 14 before and at the end of treatment were in group A (n=20) 12.5 and 11.5 (p=0.44), in group B (n=22) 11.0 and 3.5 (p<0.001) and in group C (n=18) 12.5 and 12.0 (p=0.55). The difference in reduction of enuresis frequency between the groups was highly significant (p=0.002), but no difference was found between basic bladder advice and controls.
Conclusions:
Urotherapy, or basic bladder advice, is ineffective as a first-line treatment of nocturnal enuresis. Enuretic children who are old enough to be bothered by their condition should be offered treatment with the alarm or desmopressin.
Trial Registration Number:
NCT03812094.
Related Concept Videos
01:19Urodynamic Studies: Uroflowmetry
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:17Urinary Tract Infection IV: Nursing Management
01:23Urinary Bladder
In males, the bladder is situated in front of the rectum, while in females, it is positioned anterior to the vagina and uterus. The bladder floor contains an inverted triangular area called the trigone, defined by the two ureteric...
01:26The Micturition Reflex
The process begins with bladder filling, where the bladder wall stretches as urine accumulates. This stretching activates the urine storage reflex, mediated by the sacral spinal segments and the pontine storage center. Efferent sympathetic impulses stimulate the detrusor muscle to relax and the internal urethral sphincter to contract, facilitating...
01:30Urinary Tract Calculi III: Medical Management