Conditioning with the enuresis alarm can convert enuresis to nocturia

Conditioning with an alarm is one of the first-line treatments for enuresis. It is safe and has well-documented efficacy. It has been debated, if conditioning leads to dryness by converting enuresis to nocturia at least in some children. The aim of this study was to evaluate the outcome of alarm treatment in children with treatment naïve, monosymptomatic enuresis (MNE).

We utilized data from the prospective RCT DRYCHILD and analyzed a case series of treatment-naïve children aged 6-14 years with MNE who received alarm treatment for 8 weeks. Inclusion required three or more wet nights per week during a two-week run-in period. The exclusion criteria were prior or ongoing treatment for MNE, ongoing constipation or fecal incontinence, and daytime lower urinary tract symptoms. All children were requested to complete home recordings prior to and following the treatment. We evaluated the effects of alarm treatment on clinical characteristics such as maximum voided volume (MVV), nocturnal urine production (NUP) and the occurrence of nocturia. Students t-tests were used to evaluate changes over time.

A case series of 123 children (75 % males, 8 ± 1 years of age) was analyzed. Aprox. 9 % of the children presented with nocturnal polyuria. Most children became dry following alarm treatment; 68 % (n = 83) had a complete response and 20 % (n = 25) had a partial response. We found a significant increase in MVV including first morning voided volume (P < 0.01) and a significant decrease in NUP (P < 0.01) from baseline to post-treatment among responders. Approximately a third (36 %) of complete responders without nocturia at baseline experienced nocturia after treatment. Of children with nocturia after treatment, 30 children (57 %) experienced nocturia more than three times per week. Finally, complete responders with nocturia following treatment had a significantly higher NUP before as well after treatment compared to complete responders without nocturia post-treatment.

We herein describe that one third of children who respond to conditioning with the enuresis alarm convert their enuresis to nocturia. Children with high NUP before treatment are more prone to experience nocturia after treatment. Finally, children who achieve dryness seem to improved their nocturnal bladder capacity and it appears also to be related to a reduction in NUP. Studies with longer follow-up are needed to evaluate relapse rates and whether nocturia episodes persist.