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Behavioral interventions for childhood nocturnal enuresis: the differential effect of bladder capacity on treatment
Insights
This study found that urine alarms (UA) combined with retention control training (RCT) effectively treated nocturnal enuresis in children. Personalized treatment based on bladder capacity yielded the best results for bedwetting cessation.
Area of Science:
- Pediatric Urology
- Behavioral Pediatrics
- Sleep Medicine
Background:
- Nocturnal enuresis affects many children, impacting their quality of life.
- Treatment effectiveness can vary based on individual characteristics.
- Understanding optimal treatment strategies is crucial for clinical practice.
Purpose of the Study:
- To evaluate the efficacy of a urine alarm (UA) alone versus UA with retention control training (RCT) for treating childhood nocturnal enuresis.
- To investigate the role of maximum functional bladder capacity (MFBC) in treatment outcomes.
- To identify factors associated with treatment success and relapse.
Main Methods:
- Fifty children (5-13 years) with persistent nocturnal enuresis were randomly assigned to UA or UA plus RCT.
- Children were classified by pretreatment MFBC (small or large) based on norms.
- Treatment outcomes were assessed by consecutive dry nights, wetting frequency, nighttime awakenings, and MFBC changes.
Main Results:
- Overall, 92.5% of completers achieved 14 consecutive dry nights; 41% relapsed but responded to re-treatment.
- A significant interaction was found: small MFBC children benefited most from UA plus RCT, while large MFBC children did well with UA alone.
- These optimized groups showed fewer wetting episodes, less nighttime awakenings, and faster treatment times.
- RCT did not consistently increase MFBC; premature treatment termination was linked to lower self-esteem and conduct problems.
Conclusions:
- Both UA and UA plus RCT are highly effective for treating childhood nocturnal enuresis.
- Tailoring treatment based on MFBC (UA plus RCT for small capacity, UA alone for large capacity) optimizes outcomes and treatment speed.
- While effective, relapse can occur, but re-treatment is successful.
- Psychosocial factors like self-esteem and conduct problems may influence treatment completion.
Abstract:
Study participants were fifty 5- to 13-year-old children (33 boys and 17 girls) with nocturnal enuresis of at least 3 months duration. All wet their beds at least twice per week, were of normal intelligence, and were without demonstrable organic cause for their enuresis. Each youngster's pretreatment maximum functional bladder capacity (MFBC) was used to classify the child as having small or large MFBC based on available norms. Youngsters were then randomly assigned to treatment with the urine alarm (UA) alone or with the urine alarm supplemented with retention control training (UA plus RCT). Of the 40 youngsters who completed treatment, 37 (92.5%) achieved the treatment goal of 14 consecutive dry nights. Two additional children became dry during follow-up, leaving only one child who failed to stop wetting. Sixteen children (41%) subsequently relapsed, but all who reentered treatment became dry. Because treatment outcome was uniformly excellent across all groups, treatment progress was evaluated by analyzing wetting frequency and arising at night to use the bathroom during treatment, as well as prechange and postchange in MFBC For both wetting frequency and arising at night, there was a significant interaction between bladder capacity and treatment. Small MFBC children treated with the UA plus RCT and large MFBC youngsters treated with the UA alone had the fewest wetting episodes and got up at night to use the bathroom less often; these youngsters took less time to be successfully treated. Prechanges and postchanges in MFBC indicated that RCT did not lead to consistent increases in bladder capacity in the sample studies. The 10 children who terminated treatment prematurely had lower self-esteem and more parent-reported conduct problems than the 40 children who completed treatment.