Primary nocturnal enuresis affects 10–16% of seven-year-old children and has a social, emotional and psychological impact on the affected child. Pathogenesis involves abnormal bladder reservoir function, nocturnal polyuria and an inability to wake up before emptying of the bladder. Desmopressin and enuresis alarms are recommended by the International Children’s Continence Society (ICCS) as first-line treatments. However, treatment failure is common leading to further negative psychological impact. The aim of this randomised, controlled, international, multicentre study was to establish whether clinical characterisation including voiding diaries in treatment-naive children could predict a response to desmopressin and alarm treatment. In group one (tailored treatment group), desmopressin was administered to children with nocturnal polyuria and normal maximum voided volume and an enuresis alarm was prescribed for children with reduced maximum voided volume without nocturnal polyuria. Children with both nocturnal polyuria and reduced maximum voided volume were treated with a combination of desmopressin and alarm. In group two, treatment with desmopressin or alarm was randomly allocated. In total, 281 children were included in the analysis. One hundred and four (74%) whose treatment was based on characterisation utilising bladder diary data experienced a response to treatment compared to 85 (61%) whose treatment was randomly selected. If voiding diaries showed reduced maximum voided volume and no nocturnal polyuria, the chance of responding to an alarm was markedly higher than to desmopressin (77% vs. 45%). These children had a 46% higher chance of response treatment if treatment choice was based on voiding diary data compared to random selection. The DRYCHILD study showed that there was heterogeneity in the population i.e., not all night-wetters are the same (e.g., the prevalence of nocturnal polyuria in China is much higher than in Denmark – 41% vs. 13%) and therefore a tailored approach is beneficial to try and optimise outcomes.
Using bladder diary data to tailor treatments for night wetting
Reviewed by Neil Featherstone
Development of a novel prediction tool for response to first-line treatments of monosymptomatic nocturnal enuresis: a randomized, controlled, international, multicentre study (DRYCHILD).
CONTRIBUTOR
Neil Featherstone
Cambridge University Hospitals NHS Foundation Trust (Addenbrookes Hospital).
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