[Treatment of isolated nocturnal enuresis: alarm or desmopressin?]. Behavioral interventions for childhood nocturnal enuresis: the differential effect of bladder capacity on treatment progress and outcome. Methedrine as an adjunct to conditioning treatment of nocturnal enuresis in normal and institutionalized retarded subjects. A clinical trial of continuous, intermittent and overlearning 'bell and pad' treatments for nocturnal enuresis. Dry-bed training: rapid elimination of childhood enuresis. The body-worn alarm in the treatment of childhood enuresis. Improvements in self-concept after treatment of nocturnal enuresis: randomized controlled trial. A controlled comparison of two treatments for nocturnal enuresis. [Results of a therapeutic strategy against monosymptomatic nocturnal enuresis]. Comparing alarms, desmopressin, and combined treatment in Chinese enuretic children. [Effect of Uristop in children with enuresis. A prospective randomized clinical trial]. Symptom treatment and symptom substitution in enuresis. A controlled trial of the treatment of nocturnal enuresis in residential homes for children. Behavioral and self-concept changes after six months of enuresis treatment: a randomized, controlled trial. Efficacy of desmopressin combined with alarm therapy for monosymptomatic nocturnal enuresis. The treatment of nocturnal enuresis: a controlled comparison of two models of urine alarm. Effects of different methods of treatment of primary enuresis on psychologic functioning in children. ENURESIS--AN ETIOLOGIC AND THERAPEUTIC STUDY. Arousal training for children suffering from nocturnal enuresis: a 2 1/2 year follow-up. Combined treatment with enuresis alarm and desmopressin for nocturnal enuresis. Effect of Uristop on primary nocturnal enuresis. A prospective randomized double-blind study. A comparative study of amphetamine, ephedrine-atropine mixture, placebo and behavioral conditioning in the treatment of nocturnal enuresis. Primary enuresis: relative success of three methods of treatment. A comparison of two approaches to the treatment of nocturnal enuresis and the prediction of effectiveness using pre-treatment variables. Psychological changes associated with conditioning functional enuresis. Overlearning in the conditioning treatment of enuresis. Auditory intensity as a variable in the conditioning treatment of enuresis nocturna. Enuresis: a descriptive analysis and a controlled trial. The effect of continuous, intermittent, and "placebo" reinforcement on the effectiveness of the conditioning treatment for enuresis nocturna. A component analysis of dry-bed training for treatment for bedwetting. A comparison of two enuresis alarms. [Treating enuresis nocturna by a combination of medicines and conditioning]. Combined therapy of enuresis alarm and desmopressin in the treatment of nocturnal enuresis. Evidence against a synergistic effect of desmopressin with conditioning in the treatment of nocturnal enuresis. Pharmacological and behavioral management of enuresis. Institutionalized retarded nocturnal enuretics treated by a conditioning technique. A comparison of dry-bed training and standard urine-alarm conditioning treatment of childhood bedwetting. Comparison of desmopressin and enuresis alarm for nocturnal enuresis. Enuresis: comparison of two treatments. Treatment of nocturnal enuresis by conditioning techniques.
Monosymptomatic nocturnal enuresis is common in healthy school children. Treatment is often required because of social and psychological convenience. We therefore conducted a randomized prospective trial using either desmopressin (D) or alarm (A).
                Patients (n = 135) aged 6 to 16 years were enrolled between January 1992 and December 1994. Desmopressin (Minirin spray, Ferring SA) was given intranasally at a dose of 20 micrograms at bedtime and increased to 40 micrograms after 2 weeks if partial result was obtained. The alarm was a pad-bell device (Wet-stop, Sega) and the sound source was attached to the upper part of the pajamas. Inclusion criteria were: primary monosymptomatic nocturnal enuresis in healthy children, age > or = 6 years, absence of previous treatment using either desmopressin or alarm. The aim of the treatment was to achieve 100% dry nights. Patients were evaluated after 15 days on therapy by phone call and thereafter by attending the outpatient clinic at 2-3 and 4-6 months. At the time of the second evaluation, a switch from alarm to desmopressin (or vice-versa) was proposed to those who did not respond to the initial treatment.
                In group D (n = 62), only 27 children were included since 12 (19%) were switched to alarm and 23 (37%) were excluded because they were either non-compliant or lost to follow-up. In group A (n = 73), only 31 were included since six (8%) were switched to desmopressin and 36 (49%) were excluded for the same reasons as in group D. Prior to inclusion, the percentage of dry nights was 21% in group D and 14% in group A. After 15 days on therapy, patients from group D achieved 80% dry nights compared to 50% in group A (P = 0.001). After 3 months, patients from group D attained 85% dry nights vs 90% in group A. After 6 months, children from group A achieved 94% dry nights vs 78% in group D (P = 0.01).
                Desmopressin offers better short-term results than enuresis alarm but the latter is significantly more efficient in the long term. In France, the alarm device is not reimbursed by the national health service and therefore is poorly accepted, as suggested from the high rate of patients lost to follow-up. Study participants were fifty 5- to 13-year-old children (33 boys and 17 girls) with nocturnal enuresis of at least 3 months duration. All wet their beds at least twice per week, were of normal intelligence, and were without demonstrable organic cause for their enuresis. Each youngster's pretreatment maximum functional bladder capacity (MFBC) was used to classify the child as having small or large MFBC based on available norms. Youngsters were then randomly assigned to treatment with the urine alarm (UA) alone or with the urine alarm supplemented with retention control training (UA plus RCT). Of the 40 youngsters who completed treatment, 37 (92.5%) achieved the treatment goal of 14 consecutive dry nights. Two additional children became dry during follow-up, leaving only one child who failed to stop wetting. Sixteen children (41%) subsequently relapsed, but all who reentered treatment became dry. Because treatment outcome was uniformly excellent across all groups, treatment progress was evaluated by analyzing wetting frequency and arising at night to use the bathroom during treatment, as well as prechange and postchange in MFBC For both wetting frequency and arising at night, there was a significant interaction between bladder capacity and treatment. Small MFBC children treated with the UA plus RCT and large MFBC youngsters treated with the UA alone had the fewest wetting episodes and got up at night to use the bathroom less often; these youngsters took less time to be successfully treated. Prechanges and postchanges in MFBC indicated that RCT did not lead to consistent increases in bladder capacity in the sample studies. The 10 children who terminated treatment prematurely had lower self-esteem and more parent-reported conduct problems than the 40 children who completed treatment. nan nan nan Two studies examined the effectiveness of the body-worn alarm in out-patient treatment of childhood nocturnal enuresis. The first involved 40 children, previously untreated by conditioning methods, treated with either the body-worn alarm or the traditional pad and bell alarm. The second study compared the body-worn alarm with modified dry-bed training with 48 children previously resistant to treatment. Results of both studies indicated the body-worn alarm was as effective as other methods in terms of the proportion of children successfully treated and was superior with respect to rapidity of response and consumer appeal. Such findings indicate that the body-worn alarm could become the treatment of choice for nocturnal enuresis. To determine whether changes in attitude and behavior occur after treatment of nocturnal enuresis, we randomly assigned 121 children aged 8 to 14 years to receive conditioning therapy (n = 66) or a 3-month waiting period (n = 55). All children completed the Piers-Harris Self-Concept Scale (P-H), the State-Trait Anxiety Scale (STAIC), and the Nowicki-Strickland Locus of Control test (NSLC) at entry and after treatment or delay. Parents completed the Achenbach Child Behavior Checklist (CBCL). There were no significant group differences in background demographic variables. Significant improvements in the P-H Scale (P = 0.04) and three of its subscales occurred in children in the treatment group compared with those in whom treatment was delayed. The changes were greatest for those who had the largest decreases in wetting frequency. Changes in CBCL, STAIC, and NSLC scores were not statistically significant. We conclude that there may be mental health benefits in children helped to master the symptom of enuresis, which in this age group is probably a chronic stressor. This study assessed change in the frequency of primary nocturnal enuresis as produced by either behavioral conditioning with a urine alarm, pharmacotherapy with imipramine hydrochloride, or assignment to a clinical waiting list. The study also investigated the effect of treatment method and outcome on subjects' level of emotional and behavioral adjustment. An attempt was made to identify pretreatment predictors of treatment outcome and premature withdrawal from the treatment program. The results indicated a significantly more effective outcome for the conditioning approach. Comparison of pre- and post-treatment measures of adjustment provided insufficient evidence to support the hypotheses that either change in the frequency of nighttime wetting or the method of treatment received would influence the subject's level of emotional and behavioral adjustment. The enuresis tolerance scale was found to be a highly significant predictor of early termination from conditioning treatment. There are many therapeutic options against enuresis.
                To evaluate several therapies introduced progressively to treat monosymptomatic nocturnal enuresis.
                Eighty-four patients, aged 6 to 14 years old, were studied. The 67 year olds were treated with desmopressin and oxybutynin was added in nonresponders. If enuresis persisted, Alarm was given. Children over 7 years of age were randomly divided and treated with Alarm or Alarm plus desmopressin. Nonresponders were treated with desmopressin alone.
                In children aged 6-7 years the cumulative response was 72%. Those who wetted themselves less responded to desmopressin. In children over 7 years of age, response to Alarm was 73.3% and response to Alarm plus desmopressin was 58.6%. In nonresponders the cumulative response after desmopressin treatment increased to 80% and 62% respectively.
                In the group of 6 to 7 year-olds desmopressin was indicated as first line therapy. Treatment efficacy was increased by adding oxybutynin especially in the children who wetted themselves the most. In children over 7 years of age Alarm was the most effective treatment and relapses were fewer. No advantages were observed with the combination of Alarm and desmopressin in our protocol. The objective of this multicenter randomized controlled trial was to compare the efficacy of enuresis alarms, oral desmopressin, and combined treatment in Chinese children with monosymptomatic primary nocturnal enuresis. We assigned 105 children aged 7-15 years to receive alarms (group 1, 35 patients), oral desmopressin 400 mug (group 2, 38 patients), or combined therapy (group 3, 32 patients) for 12 weeks; patients were then followed for 12 weeks after treatment. The wetting frequency decreased during treatment by 46%, 52%, and 73% in groups 1, 2, and 3, respectively. In groups 2 and 3, but not in group 1, there was rebound post treatment, but significant improvements persisted at 12 weeks. The complete and partial response rates were 22.9% and 20%, respectively in group 1, 42% and 10.5% in group 2, and 62.5% and 15.6% in group 3. By Kaplan-Meier analysis, group 1 had a significantly poorer response than groups 2 and 3. Of the responders, 20%, 60%, and 40% in groups 1, 2, and 3, respectively, relapsed after stopping treatment. In conclusion, enuresis alarms and/or oral desmopressin were less efficacious in Chinese than in Western societies. Desmopressin produced an immediate effect but relapses were common. Alarms took several weeks to produce a benefit, which was persistent on follow-up. nan nan nan Previous studies have suggested changes in self-concept with successful treatment of primary nocturnal enuresis (PNE), but behavioral changes have not been reported as a consistent associated finding.
                To determine if self-concept and behavior change after 6 months of treatment of monosymptomatic PNE by conditioning alarm or desmopressin acetate (DDAVP).
                Randomized, controlled trial in an inner-city hospital clinic. Subjects were 182 children referred or recruited through media publicity, randomly assigned both to 1 of 8 pediatricians and 1 of 3 treatment groups (alarm, DDAVP, or placebo). Included were children >7 years old with PNE, no daytime symptoms, bladder capacity >50% expected, and wetting >3 times a week. Excluded were children with central nervous system disorders or developmental delays, and those currently on DDAVP or alarm. Subjects completed the Piers-Harris Children's Self-Concept Scale and Harter's Perceived Competence Scale for Children (PCSC) at initial visit and after 6 months of treatment. Parents completed the Achenbach Child Behavior Checklist (CBCL) at the same times.
                After 6 months of treatment the Piers-Harris total score showed a highly significant treatment by period interaction effect for DDAVP, a significant effect for alarm, and no effect for placebo. For children who achieved 75% dryness the CBCL showed a treatment by improvement interaction effect that was highly significant for DDAVP and placebo with no effect for alarm. For the PCSC there were no treatment or outcome interaction effects. After 6 months of treatment there were significant changes over time unrelated to outcome or treatment in the Piers-Harris Subscales and in the CBCL Internalizing and Externalizing Scores, and the Social Thought and Attention Problems Subscales. The PCSC was more stable with no changes in total score, and positive changes over time in only 2 Subscales, Scholastic and Social.
                Children's self-concept improved with the type of treatment and amount of success. Parents' perceptions of behavior improve with type of treatment and amount of success. Children rate their self-concept and some physical attributes better after treatment with any of DDAVP, alarm, or placebo regardless of outcome. Frequent follow-up with emotional support and encouragement appear to be important components of an efficacious intervention for children with nocturnal enuresis. We evaluated the combination of alarm and desmopressin versus alarm monotherapy for the treatment of nocturnal enuresis.
                A double-blind, placebo controlled study of alarm therapy combined with desmopressin for children with nocturnal enuresis is described. Of 93 patients 47 were randomized to receive alarm therapy and 40 microg. intranasal desmopressin for 3 weeks followed by 20 microg. desmopressin for 3 weeks (group 1) and 46 received alarm therapy and placebo (group 2). After 6 weeks on alarm therapy and medication or placebo, both groups received an additional 3 weeks of alarm monotherapy. A specialized nurse practitioner advised patients and families of the treatment to be given at home and in the outpatient department. Bed-wetting frequency was evaluated before during and 2 weeks and 6 months after treatment.
                A significantly greater reduction in the number of wet nights was observed after the first 3 weeks of treatment in group 1. However, after long-term followup no significant differences in bed-wetting frequency were noted.
                There is a temporary, positive effect on enuresis using desmopressin combined with alarm therapy. However, both treatment modalities have a low long-term success rate of 36% to 37%. This study examined the effectiveness of two models of urine alarm that are commercially available for the treatment of nocturnal enuresis. A total of 39 children who exhibited primary nocturnal enuresis was assigned to one of three experimental groups: behavioral conditioning with a contiguous model of alarm, behavioral treatment with a delayed model of alarm, or a clinical waiting list. Results for the 12-week program indicate that after the second week of treatment, the contiguous and delayed models of alarm produced comparable reductions in weekly wetting frequency that were significantly better than no treatment at all. Results indicated a significantly higher rate of apparatus malfunction for the delayed model of alarm. It is proposed that the contiguous alarm is the treatment of choice at the present time because of its significantly lower rate of malfunction. Sixty-two children with primary nocturnal enuresis were assigned randomly to one of two groups. Group 1 was treated with imipramine hydrochloride, and group 2 received a course of treatment with the Mozes Detector. Seventeen children from group 1 and 18 from group 2 were tested with the age-appropriate form of the Cattell personality questionnaire on three occasions: at the time of entry into the study, 2 months later and at follow-up, an average of 16 months later. The patients in group 2, who were older, had a higher rate of cure than did the patients in group 1. They also had significantly higher levels of extroversion and significantly lower levels of neuroticism at follow-up than did those in group 1. These findings indicate that better results are seen with the Mozes Detector than with imipramine in older children with primary nocturnal enuresis. nan Arousal Training is a fast, simple, and effective form of bibliotherapy for nocturnal enuresis with non-clinical children between 6 and 12 years of age. The parents act as therapists. They reward the operant behavior-pattern following the urine alarm. The success rate is 98% (N = 41), which is significantly high when compared to the control conditions (79%, N = 86). There was a response rate of 100% and no drop-out from therapy. All parents (N = 127) completed and returned the record. The results of a follow-up of this bibliotherapy (N = 113) 2 1/2 years later are presented. The success rate of Arousal Training was still significantly higher (92% continent) when compared to the urine device with specific instructions (77%) and urine alarm only (72%). Arousal Training is the treatment of choice for non-clinical enuretic children between 6 and 12 years of age. Seventy-one children with nocturnal enuresis were enrolled in a controlled trial. The children were allocated to two matched groups. Children in both groups used an enuresis alarm until the end of treatment. Children in the first group were treated with 40 micrograms of intranasal desmopressin (Desmospray) for up to 6 weeks at the start of treatment with the alarm. During the observation period treatment there were 2.3 dry nights per week in both groups. At the end of treatment there was a significant difference in the mean number of dry nights per week between the two groups (6.3 in the alarm and desmopressin group and 4.8 in the alarm group) and also in the number of children becoming reliably dry. The combination of desmopressin and alarm was particularly helpful for children with severe wetting and those with family and behavioural problems. Primary nocturnal enuresis (PNE) is a very common problem in pediatric and child psychiatric practice. Many treatments have been tried, but none has proved entirely successful. Uristop, a commercially available alarm device based on a theory somewhat different from those used in the common alarm devices, was tried in a prospective randomized double-blind study. Of 134 enuretic children who were examined on an out-patient ward, 53 were selected for inclusion in this study on the basis of certain criteria. The children were randomized either in a treatment group with a functioning device, or in a control group with a non-functioning device. They used their devices for 6 weeks and were followed for an additional 12 weeks. The sex, age, history of previous urinary tract infection (UTI) or treatment of PNE and a family history of PNE were compared between the groups and no statistical differences were found. In the control group, however, there was significantly more often a history of upsetting life events and previous child psychiatric contact. This difference was not considered as having any effect on the results. The results showed that the device had no effect on the study group as compared with the control group. However, both groups improved significantly as compared with the expected sponaneous cessation of bedwetting. nan A total of 169 children with primary enuresis were treated by one of three methods--use of a special diet, imipramine, or a waking device (the Mozes detector). Of 64 who received the diet 1 (1.6%) was cured; of 62 who were treated with imipramine 13 (20.9%) were cured; and of 43 who used the detector 23 (53.5%) were cured. Results at follow-up remained substantially unchanged for cure. Improvement rate without cure during treatment was higher for the children treated with imipramine than for those treated with the detector, but at follow-up the reverse was true. Parents of children who received the special diet, because they were unimpressed by the rate of improvement, would not permit their children to continue this form of therapy for longer than 1 or 2 months. This study compared the effectiveness of the enuresis alarm alone with a brief version of Dry Bed Training in treating 74 enuretic children. Both procedures were equally effective, and in the total sample a better response to treatment was predicted by the child's report of being teased by siblings. Maternal anger was associated with a greater drop-out rate. nan nan nan nan nan nan This randomized experiment was undertaken to determine if any difference in success occurred between an audio versus a vibration alarm for nocturnal enuresis. Similar rates of success were achieved for 47 children, aged 6 to 12 years, who partially or totally completed the 3-month period of alarm use. nan Twenty-eight children with primary nocturnal enuresis were blindly allocated at random to a combination of enuresis alarm and 20 micrograms intranasal desmopressin or alarm and placebo for 2 weeks. Patients received the other therapy after a 2-week treatment-free period. The combined treatment of desmopressin and alarm showed 5.1 +/- 0.4 (mean +/- SEM) dry nights per week and resulted in significantly more dry nights per week during the 2 weeks of observation than placebo and alarm (4.1 +/- 0.4, P less than 0.05). To test the hypothesis that desmopressin facilitates acquisition of continence, we aimed to establish whether, in children with nocturnal enuresis who are desmopressin nonresponders, adjunct desmopressin increases the rate of sustained continence after treatment with a conditioning alarm. Study design Patients with nocturnal enuresis (n=358; age range, 6-16 years) completed a 4-week "run-in" course of intranasal desmopressin (20-40 microg). Of these, 207 defined as nonresponders (<50% reduction in wet nights) were randomly assigned to receive either desmopressin (n=101) or placebo (n=106) nasal spray, together with conditioning alarm therapy for 8 weeks. Principal outcome measures were remission (28 continuous dry nights) and relapse (>2 wet nights in 2 weeks after having achieved remission).
                Remission rates were similar in both groups (51.5% desmopressin, 48.1% placebo; 95% CI on difference, -10%, 17%; P=.63), and relapse rates were not significantly different (13.5% vs 5.9%; 95% CI on difference, -3.7%, 19%; P=.19). Although remission rates were similar, children treated with desmopressin had significantly more dry nights during treatment than those in the placebo group.
                Desmopressin did not act synergistically with alarm treatment to achieve remission. Therefore, we infer that in partial or nonresponders, desmopressin does not enhance learning. nan nan nan Fifty children with primary nocturnal enuresis were randomised for a study comparing desmopressin (DDAVP) and enuresis alarm. Forty six completed the trial, 24 of whom were treated with 20 micrograms intranasal desmopressin nightly and 22 with enuresis alarm for three months. Failures were crossed over and relapses were continued on the same treatment for a further three months. The improvement rate was 70% in the group given desmopressin and 86% in the group treated with alarm; the difference was not significant. During the first week of treatment the group given desmopressin was significantly dryer, and at the end of the study 10 of these patients relapsed compared with one patient in the group given the alarm. No serious side effects were observed. This study confirms the role of conditioning treatment as preferable in long term treatment of nocturnal enuresis. When this fails or when a safe drug with rapid effect is needed, however, desmopressin is a useful alternative. Despite long-standing claims that the conditioning method of treating enuresis is based on the classic conditioning paradigm, research explicitly investigating this claim has been limited. This study compares two conditioning methods of treating enuresis, both using the bell and pad, one in a classic conditioning paradigm and the other in an operant paradigm with an unconditioned stimulus delay of 3 minutes together with an operant reinforcement for wet or dry behavior. Sixty children were randomly assigned to one of the 2 treatment groups or a control group. Using Dunn's procedure, a planned comparison showed the control group and delay group did not differ significantly, but both differed significantly from the classic conditioning group (p less than 0.05). Fifty percent of the classic conditioning group reached criterion of 14 consecutive dry nights while 17% of the delay group reached criterion. None of the control group reached criterion. Results suggest that the operant procedures are a much weaker form of treatment than the bell and pad. This study indicates that enuresis in children can be successfully managed with a short duration outpatient program. nan