Stratifying Treatment-Resistant Monosymptomatic Nocturnal Enuresis: Identifying the Subgroup Most Responsive to...

Area of Science:

• Pediatric Urology
• Behavioral Therapy
• Clinical Predictors

Background:

• Monosymptomatic nocturnal enuresis (MNE) in children can be resistant to standard treatments like desmopressin and alarm therapy.
• Identifying predictors for alternative therapies is crucial for managing treatment-resistant MNE.

Purpose of the Study:

• To identify clinical predictors of response to biofeedback therapy in children with treatment-resistant MNE.
• To assess the role of bladder capacity, specifically age-adjusted maximal voided volume (MVV), as a stratification parameter for biofeedback therapy success.

Main Methods:

• Prospective study involving 89 children with treatment-resistant MNE.
• Six weekly sessions of biofeedback therapy with visual pelvic floor feedback.
• Classification of patients into complete responders versus partial/non-responders based on outcomes.

Main Results:

• Complete responders showed significantly lower baseline and age-adjusted maximal voided volumes (MVV) (p < 0.001).
• Nocturnal overactivity was more prevalent in responders (60.6% vs. 33.9%, p = 0.017), while nocturnal polyuria was more common in non-responders (p = 0.027).
• Age-adjusted MVV was the sole independent predictor of treatment success in multivariate analysis (p = 0.045), with ROC analysis confirming its predictive value (AUC = 0.767).

Conclusions:

• Reduced bladder capacity and frequent nighttime wetting are key indicators for successful biofeedback therapy in refractory MNE.
• Bladder capacity assessment, particularly age-adjusted MVV, can guide personalized management strategies for children with treatment-resistant MNE.