Discontinuing absorbent pants in children with bedwetting: a randomized controlled trial

Area of Science:

• Pediatric Urology
• Sleep Medicine
• Quality of Life Research

Background:

• Severe childhood nocturnal enuresis (NE) affects many children, often necessitating nighttime protection.
• Absorbent pyjama pants (APP) are commonly used for managing NE, but their long-term impact on spontaneous resolution is unclear.
• Understanding the effects of discontinuing APP is crucial for guiding treatment decisions in pediatric NE management.

Purpose of the Study:

• To investigate the efficacy of discontinuing absorbent pyjama pants (APP) in children with severe nocturnal enuresis (NE).
• To evaluate the impact of APP discontinuation on the rate of wet nights, quality of life (QoL), and sleep.
• To assess the clinical relevance and potential side effects of stopping APP use in pediatric NE.

Main Methods:

• A multicenter, parallel, randomized controlled trial involving 105 children (4-8 years) with severe NE.
• Participants underwent a 4-week run-in period using APP, followed by randomization to either continue or discontinue APP for 4-8 weeks.
• Primary outcome: difference in wet nights during the final intervention week; secondary outcomes: QoL and sleep.

Main Results:

• Children who discontinued APP experienced significantly fewer wet nights (2.3 fewer nights, p<0.0001) compared to those who continued.
• A ~10% complete resolution rate was observed in the no-pants group, with clinical improvement noted within 2 weeks.
• APP discontinuation negatively impacted QoL and sleep in the extension period, though not in the core 4-week period; 21% stopped due to stress.

Conclusions:

• Discontinuing absorbent pyjama pants (APP) shows a statistically significant reduction in wet nights for children with severe nocturnal enuresis (NE).
• While a ~10% complete resolution rate was observed, the clinical relevance is debatable, and the intervention requires motivated families.
• APP discontinuation may negatively affect quality of life and sleep, and should be approached cautiously, with no severe side effects reported.