Real-world treatment adherence and dropout across pediatric enuresis subtypes: A retrospective cohort study

Pediatric enuresis is a heterogeneous condition in which treatment adherence and family engagement vary widely across clinical subtypes. While the efficacy of individual therapies is well described, real-world data on adherence and dropout patterns remain limited.

To evaluate subtype-specific differences in treatment adherence, dropout, and early response in a large real-world pediatric enuresis cohort.

We conducted a retrospective cohort study of children aged 5-18 years diagnosed with enuresis at a tertiary pediatric urology center between 2019 and 2024. Patients were classified according to International Children's Continence Society criteria into monosymptomatic nocturnal enuresis (MNE), non-monosymptomatic enuresis (NMNE), secondary enuresis (SE), and bowel-bladder dysfunction (BBD). Primary outcomes were treatment adherence and dropout at initial follow-up (8-12 weeks). Secondary outcomes included early treatment response, defined as complete resolution or ≥50 % reduction in wet nights. Multivariate logistic regression identified independent predictors of dropout.

The cohort included 961 patients (mean age 8.6 ± 2.8 years; 53.2 % male). BBD represented 48.0 % of cases, reflecting referral complexity in a tertiary setting. Overall treatment success was 43.8 %, while dropout occurred in 51.4 % of patients. Dropout rates were highest in BBD (58.0 %) and lowest in MNE (45.0 %, p = 0.003). In multivariate analysis, BBD was independently associated with increased dropout compared with MNE (OR 1.42; 95 % CI 1.10-1.84; p = 0.007), while lower initial treatment response was the strongest predictor of dropout (OR 3.24; 95 % CI 2.51-4.18; p < 0.001). MNE demonstrated the highest early response rate (53.1 %), whereas NMNE and BBD showed lower and comparable response rates.

In real-world pediatric practice, treatment adherence and dropout vary substantially by enuresis subtype. Complex phenotypes, particularly BBD, are associated with higher dropout independent of early response. These findings highlight the importance of accurate subtype classification, realistic family counseling, and early structured follow-up to improve engagement and outcomes in pediatric enuresis management.