COMMENTARY

Nocturnal Enuresis in Children: Do Alarm Systems Work?

William T. Basco, Jr., MD, MS

Disclosures

May 07, 2018

Bell-and-Pad Alarms for Nocturnal Enuresis

The evidence-based management of enuresis in children includes desmopressin and enuresis alarms (level 1, grade A recommendation), and existing data suggest that alarm therapy with practitioner assistance can improve the outcomes of treatment over alarm therapy alone.[1]

A "bell-and-pad" alarm system is considered first-line treatment in Australia, where practitioners provide alarms (and presumably training and monitoring) to the parents of children with enuresis. A recent retrospective review[2] evaluated the treatment efficacy of practitioner-assisted bell-and-pad alarm therapy among children with enuresis as well as the relapse rate after such treatment.

The medical records of children aged 5-16 years who received care at multiple medical centers were reviewed. Data included demographics, the patients' history of enuresis and constipation, whether the wetting was diurnal or nocturnal, as well as other clinical features of importance. The reviewers defined success as at least 14 consecutive dry nights and no subsequent relapse for at least 6 months. All children were treated with a specific alarm system that consisted of a rubber pad connected to an alarm box that produced a ring. These systems are reused and are often owned by the clinical sites.

Findings From a Retrospective Review

Data were obtained from 2861 children, 64% of whom were boys. Almost all (91%) of the children had primary enuresis. Constipation was reported in 16%, and 11% had previously tried desmopressin. The mean time that the children used the alarm system was 62.1 days.

With respect to outcomes, 76.8% of the children experienced a complete resolution after only one treatment period. The reviewers noted no significant association between age and the likelihood of response to treatment. Treatment response after two to three treatment periods was roughly 81%; it reached 91% for children who had more than three treatments, but this was a very small group.

In the discussion section of the article, the reviewers commented that these findings differ from those of previously published series. This review found a generally higher success rate and a lower relapse rate compared with earlier studies. However, this review included a large group of children compared with previous studies, and it's one of the few studies that reported on success after second or third treatments in children who relapse.

Viewpoint

I'll raise the caution that this is a retrospective review, and it's not clear that a prospective trial would demonstrate the same results. It's also very important to note that the same alarm system was used for monitoring every child, and that is very important when judging the generalizability of the results. First, it may mean that the results are more valid because the use of the same device eliminates many variables that might otherwise affect the results, but it also means that any parent using a different device may not experience the same degree of success. Second, the level of practitioner involvement, instruction, and follow-up visit frequencies are not clear in the report, so it is difficult to parse out the actual contribution of the "practitioner-assisted" portion of the interventions. Nevertheless, this review is encouraging in regard to the use of monitors for children with enuresis, and these data suggest that additional provider monitoring along with use of the alarms can avoid desmopressin treatment for many children.

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