Alarm therapy or desmopressin? Insight for pediatric monosymptomatic nocturnal enuresis in meta-analysis approach

Abstract

Monosymptomatic nocturnal enuresis (MNE) is a common pediatric problem. MNE is defined as involuntary urine voiding during sleep without other LUTS, such as daytime urinary frequency, urgency, or incontinence of urine. Most of nocturnal enuresis patients are MNE. Various interventions have been used for treatment and problems are emerging from desmopressin withdrawal and alarm therapy continuation issue. Study aims to compare efficacy of alarm therapy and desmopressin, also strategy to improve it. Studies searched throughout Medline, PubMed, Embase, and Cochrane since 2010 until 2019. Keywords were desmopressin, alarm therapy, pediatric, and monosymptomatic enuresis. Inclusion criteria were RCT in english language and no drop-out subject. Trials without specific number of subjects were not eligible. Studies using response rate as dependent variable. Total 12 studies were eligible for this meta-analysis with 9 studies collected for response rate and 3 studies for desmopressin withdrawal strategy. From those 9 studies comparing response rate showed alarm therapy significantly outperformed desmopressin in well-motivated parent and patients (p=0.02) with pooled Risk Ratio was 1.10, Z score was 2.31 and pooled heterogeneity (I2) was 32%. Strategy to improve desmopressin withdrawal portrayed by 3 was fully favored for structured strategy than abrupt in dose dependent matter (p=0.001; I2=0%; Z score = 3.26) but not in time dependent parameter (p=0.24; I2=0%; Z score = 1.17). This meta-analysis study showed alarm therapy is superior to desmopressin regarding response rate in well-motivated parents, but in opposite subjects, desmopressin still be the choice. In addition, it is necessary to use structured dose withdrawal strategy to optimize therapy.