Treatment of enuresis: alarm monotherapy versus a multi-modal treatment approach in a multi-disciplinary clinic

The objective of this study was to compare outcomes between alarm monotherapy and multi-modal treatment for enuresis and to identify predictors of treatment failure. Consecutive children with enuresis were referred to an alarm clinic or a multi-disciplinary clinic and followed over 1 year. In the alarm clinic, children received bed alarm therapy for 3 months. In the multi-disciplinary clinic, children were assessed and advised regarding fluid consumption, with treatment of daytime bladder symptoms and bowel dysfunction. Persisting enuresis after daytime symptoms were addressed were treated with alarm therapy. From January 2003 to December 2004, 269 children were referred - 86 to the alarm clinic and 183 to the multi-disciplinary clinic (of which 56% received alarm therapy). Groups were similar at baseline (mean age 9 years, 65% boys and 86% primary monosymptomatic nocturnal enuresis), but more from the multi-disciplinary clinic had previously received enuresis treatment (79% vs 59% p=0.001). There was no difference in outcomes between groups at completion of treatment (51% versus 66% dry, p=0.07) and at 12 months (65% versus 60%, p=0.7), but more from the multi-disciplinary clinic were lost to follow-up. Those who received multi-modal treatment incorporating alarm therapy had improved outcomes compared with alarm monotherapy (78% versus 51% dry, p=0.01). Children previously treated with desmopressin (OR 0.11), bladder training (OR 0.35) or who had a history of soiling at presentation (OR 0.28) were less likely to respond to treatment. It was concluded that, in a multi-modal treatment approach, delayed commencement of alarm therapy may affect treatment outcomes.