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Treatment Dropout in Pediatric Enuresis: A Retrospective Cohort Study at a Tertiary Children's Hospital
Sebastián Tobía-González1, Natalie Barganski1, Melissa Miller1
1Division of Pediatric Urology, Driscoll Children's Hospital, Corpus Christi, Texas, USA.
Insights
Over half of children with pediatric enuresis drop out of treatment. Lack of early improvement strongly predicts dropout, highlighting the need for better adherence strategies and early reassessment in enuresis management.
Area of Science:
- Pediatric Urology
- Clinical Effectiveness Research
- Patient Adherence Studies
Background:
- Pediatric enuresis is a common condition leading to urology referrals.
- Current treatment effectiveness is limited by high patient dropout rates.
- Adherence patterns and dropout predictors in enuresis management are not well understood.
Purpose of the Study:
- To determine treatment dropout rates in pediatric enuresis.
- To identify clinical predictors of dropout across different enuresis phenotypes.
- To analyze enuresis treatment outcomes in a tertiary care setting.
Main Methods:
- Retrospective cohort study of 961 children (aged 5-18) treated for enuresis (2019-2024).
- Patients classified into phenotypes per International Children's Continence Society guidelines.
- Multivariate logistic regression used to identify dropout predictors.
Main Results:
- Overall treatment dropout rate was 51.4%, varying significantly by phenotype (p=0.003).
- Bladder Bowel Dysfunction (BBD) had the most dropouts; secondary enuresis had the highest relative dropout rate.
- Lack of early clinical improvement was the strongest dropout predictor; age showed a minor association.
Conclusions:
- Treatment dropout exceeds 50% for pediatric enuresis in tertiary care.
- Early clinical improvement is critical for treatment continuation.
- Strategies to reduce dropout include early reassessment, expectation management, and targeted adherence support.
Background:
Pediatric enuresis is a frequent reason for referral to pediatric urology clinics; however, the real-world effectiveness of available therapies is limited by high treatment dropout. Despite multiple validated interventions, adherence patterns and predictors of dropout remain poorly characterized.
Objective:
To quantify treatment dropout rates in pediatric enuresis and identify clinical predictors of dropout across enuresis phenotypes in a tertiary care setting.
Methods:
We conducted a retrospective cohort study including children aged 5-18 years treated for enuresis between 2019 and 2024 at a tertiary pediatric hospital. Patients were classified according to the International Children's Continence Society principles into clinically relevant phenotypes. Treatment dropout was defined as failure to initiate, continue, or complete prescribed therapy, or absence from scheduled follow-up without documented resolution or formal discharge. Multivariate logistic regression was used to identify independent predictors of dropout.
Results:
A total of 961 patients were included. Overall treatment dropout occurred in 51.4% of cases, with significant variation among clinical phenotypes (p = 0.003). Bladder bowel dysfunction (BBD) accounted for the largest absolute number of dropouts, whereas secondary enuresis showed the highest relative dropout rate. Lack of early clinical improvement was the strongest independent predictor of treatment dropout. Age showed a small but statistically significant association, whereas sex and BBD phenotype were not independently associated with attrition after adjustment.
Conclusion:
Treatment dropout affects more than half of children undergoing management for enuresis in a tertiary referral setting. Lack of early clinical improvement was the strongest predictor of attrition. Reducing dropout will likely require structured early reassessment, realistic-expectation counseling, and adherence-support strategies targeted to higher-risk patients.
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