Efficacy Of Desmopressin And Enuresis Alarm In Monosymptomatic Nocturnal Enuresis Children

BackgroundNocturnal enuresis(NE)is defined as incontinence of urine during sleep at least once a month for at least three month.Monosymptomatic nocturnal enuresis(MNE)is one of the subtypes and it is common among children.There are many factors in the pathogenesis of MNE,like inheritance,abnormal bladder function,abnormal endocrine function,arousal disorder,and so on.MNE not only influence the patients at nights,but MNE also interfere with children’s quality of life and even impact on psychological heath.In addition to children,parents also feel worried for MNE and even perform physical punishment on children.Nowadays,there are many options for curing MNE.Whereas,the first-line treatment for MNE recommended by International Continence Society(ICS)and International Children’s Continence Society(ICCS)are desmopressin(DE)and enuresis alarm(EA).However,the effects of both treatment options on the MNE remain controversial and it is difficult to determine which one should be the first choice for the patients.Therefore,further studies are warranted to investigate the efficacy of two treatment options for MNE patients,especially through a prospective study.The aim of this study is to investigate the short-time clinical outcome of DE and EA for children with MNE and provide a reference for clinical precision treatment.ObjectiveTo evaluate the short-time efficacy of desmopressin(DE)and enuresis alarm(EA)for children with monosymptomatic nocturnal enuresis(MNE)and compliance to treatment.MethodFrom September 2018 to October 2019,118 children,aged 6-14 years,who were diagnosed with MNE via outpatient was randomized into DE treatment group and EA treatment group by random number method.Both groups needed to undergo treatment for 12 weeks.The follow-ups were performed at 4 weeks(1st),8 weeks(2nd),and 12 weeks(3rd)after the initiation of treatment,and enuresis was recorded in the week prior to follow-up for evaluation of efficacy.In DE group,all children were treated with initial dose 0.2 mg.Caregivers needed to attend an outpatient visit to adjust the drug dose after two weeks of therapy.If the child was completely dry,the dose was still 0.2 mg otherwise would be increased to 0.4mg.Water restriction was performed from 1 hour before to 8 hour after taking medication.In EA group,children need wear the alarm before going to bed and at least one caregiver should accompany them to rest in the same room at night.When the alarm went off,the caregiver need to help wake the child up to exhaust the remaining urine.After two weeks of treatment,caregivers should attend an outpatient visit to evaluate whether the alarm was used correctly.The reasons for withdrawal from the study were recorded.The children with percentage reduction over 99%in enuresis frequency was considered complete response(CR),while the others was considered as not complete response.After the completion of therapy,the children with CR need to attend an outpatient visit for evaluating MNE recurrence 12 weeks later.ResultsThe median age of children in DE and EA groups was 10.00(8,13)and 9.00(7,12),with no statistical significance(U=1565.50,P=0.461).The proportion of males in DE group and EA group was 67.65%and 56.00%,of which difference was not statistically significant(χ2=1.672,P=0.196).There was no statistically significant difference in compliance rate in DE and EA group at the first follow-up(85.29%VS 76.00%,χ2=1.641,P=0.200).At the second and third follow-up,compliance rate in DE group was more than in the EA group(80.88%VS 56.00%,χ2=8.551,P=0.003),(77.94%VS 52.00%,χ2=8.763,P=0.003),of which difference was statistically significant.The reason for withdrawal from study in DE group was suffering other disease during treatment(60.00%)and the reason for withdrawal from study in EA group was unsatisfactory clinical outcome(50.00%).At the first and second follow-up,the CR rate in DE group was higher than in the EA group with significant difference(43.10%VS 0.00%,χ2=22.147,P<0.001),(52.73%VS 14.29%,χ2=11.448,P=0.001).At the third follow-up,CR rate in DE group and EA group was 54.72%and 61.54%,respectively,and there was no statistically significant difference(χ2=0.331,P=0.565).The relapse rate was lower in the EA group than in the DE group(18.75%VS 51.72%,χ2=4.671,P=0.031)at 12weeks after completion of treatment.ConclusionDE and EA show equal efficacy for MNE children and there is a higher recurrence rate in DE treatment option.EA should be the first choice for family with good compliance and DE is appropriate for family with poor compliance.It indicates that when clinicians select the treatment option not only depend on children’s condition but also for children’s family compliance.