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      Efficacy of an Enuresis Alarm, Desmopressin, and Combination Therapy in the Treatment of Saudi Children With Primary Monosymptomatic Nocturnal Enuresis

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          Abstract

          Purpose

          We evaluated and compared the effectiveness of an enuresis alarm, desmopressin medication, and their combination in the treatment of Saudi children with primary monosymptomatic nocturnal enuresis (PMNE).

          Materials and Methods

          A total of 136 children with PMNE were randomly assigned to receive an enuresis alarm alone (EA group, n=45), desmopressin alone (D group, n=46), or a combination of both (EA/D group, n=45). Patients were followed weekly during treatment and for 12 weeks after treatment withdrawal.

          Results

          During treatment, wetting frequencies were significantly reduced in all groups and remained significantly lower than pretreatment values until the end of follow-up. In the D and EA/D groups, an immediate reduction in wetting frequencies was observed, whereas a longer time was required to reach a significant reduction in the EA group. The full and partial response rates were 13.3% and 37.8% in the EA group, 26.1% and 43.5% in the D group, and 40.0% and 33.3% in the EA/D group. A significant difference was observed only between the EA and EA/D groups (p=0.025). Relapse rates were higher in the D group (66.6%) than in the EA (16.6%) and EA/D (33.3%) groups. A significant difference was observed between the D and EA groups only (p=0.019).

          Conclusions

          Desmopressin, an enuresis alarm, and combined therapy are effective in the treatment of Saudi children with PMNE. Desmopressin produced an immediate effect but relapses were common. The enuresis alarm provided gradual effects that persisted posttreatment. The combined therapy was superior to the alarm in achieving an immediate response; however, its effect was not better than that of the alarm long term.

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          Most cited references27

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          Diagnostic and Statistical Manual of Mental Disorders – DSM

          (2013)
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            Nocturnal enuresis: an international evidence based management strategy.

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              Nocturnal enuresis at 7.5 years old: prevalence and analysis of clinical signs.

              To determine the prevalence of nocturnal enuresis (NE) in a large cohort of children at 7.5 years old, and to examine the frequency of variables such as gender, severity, associated elimination problems, and clinical signs within the identified group. Of an original cohort of 13 971 infants alive at 12 months, 11 251 who were still active in the Avon Longitudinal Study of Parents and Children (ALSPAC) survey, were followed at 91 months. The mother or main carer was given a questionnaire which asked, amongst other items, about the presence and frequency of bedwetting, other elimination problems, and signs related to the wetting behaviour; 8269 (73.5%) questionnaires were returned and 8151 contained information on the frequency of bedwetting. In all, 1260 children (15.5%) at 7.5 years wet the bed, but most wet once or less a week, and only 215 (2.6%) met the Diagnostic and Statistical Manual of Mental Disorders (fourth edition) criteria of NE (wetting at least twice a week). A higher prevalence was reported in boys than girls and 266 children (3.3%) had both daytime wetting and bedwetting, with 189 (2.3%) having both daytime soiling and bedwetting. Daytime urgency increased with severity of bedwetting and occurred in 28.9% of children with NE. At 7.5 years old the incidence of bedwetting is high, but only 2.6% of this large population-based sample wet at a frequency meeting the definition of NE. Although a small percentage of children had both daytime wetting and bedwetting, the evidence suggests that these are discrete problems. Amongst children with NE, indicators of bladder overactivity were present, supporting the view of heterogeneity and the importance of individual assessment in deciding on appropriate treatment.
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                Author and article information

                Journal
                Korean J Urol
                Korean J Urol
                KJU
                Korean Journal of Urology
                The Korean Urological Association
                2005-6737
                2005-6745
                November 2013
                06 November 2013
                : 54
                : 11
                : 783-790
                Affiliations
                [1 ]Department of Urology, Al-Azhar University, Cairo, Egypt.
                [2 ]Department of Urology, Salman Bin Abdul-Aziz University, Al-Kharj, Kingdom of Saudi Arabia.
                [3 ]Royal Commission Hospital, Jubail, Kingdom of Saudi Arabia.
                [4 ]King Khalid Hospital, Tabouk, Kingdom of Saudi Arabia.
                [5 ]Department of Urology, Suez Canal University, Ismailia, Egypt.
                [6 ]Department of Urology, King Khalid hospital, Al-Kharj, Kingdom of Saudi Arabia.
                Author notes
                Corresponding Author: Abul-Fotouh Abdel-Maguid Ahmed. Department of Urology, Salman Bin Abdul-Aziz University, P.O. Box 173, Al-kharj 11942, Kingdom of Saudi Arabia. TEL: +96615886100, FAX: +96615886101, abulfotouhahmed@ 123456yahoo.com
                Article
                10.4111/kju.2013.54.11.783
                3830973
                24255762
                c6474057-ee77-40ac-89b2-fde994587bf0
                © The Korean Urological Association, 2013

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 May 2013
                : 06 September 2013
                Categories
                Original Article
                Pediatric

                Urology
                combined modality therapy,nocturnal enuresis,treatment efficacy
                Urology
                combined modality therapy, nocturnal enuresis, treatment efficacy

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