Anticholinergics Do Not Improve Cure Rate of Alarm Treatment of Monosymptomatic Nocturnal Enuresis

Abstract

To determine whether previous anticholinergic therapy or a combination of anticholinergics and alarm treatment could increase the success rates for monosymptomatic nocturnal enuresis. Alarm treatment of monosymptomatic nocturnal enuresis is the treatment of choice, with the greatest lasting success. It has been proposed that failures are related to a patient's small bladder volume. During a 3-year period (July 2004 to July 2007), all bed-wetting patients presenting to our pediatric urology clinic were retrospectively evaluated. Of 221 enuretic patients, 142 were monosymptomatic and 85 of them had had no previous treatment. The children were treated conservatively, and those with treatment failure were given either alarm treatment or anticholinergics, as chosen by the parents. The patients with failure to the second-line treatment were given a combination of alarm therapy and anticholinergics. The mean age of the 85 children was 8.2 years. Of the 85 children, 30 were first given anticholinergics and 55 alarm treatment. Anticholinergics alone resulted in a 10% success rate and alarm treatment alone, a 56.3% success rate. Previous anticholinergic medication did not increase the success rate of alarm treatment (33.3%). Similarly, adding anticholinergics after alarm treatment had failed did not result in treatment success. We observed no difference in the changes in the mean functional bladder capacities among the anticholinergic treatment arm, alarm treatment arm, or combination arm. Switching from previous anticholinergic treatment that has failed to alarm treatment or using a combination of alarm treatment and anticholinergics did not improve the functional bladder volume or cure rate of children with monosymptomatic nocturnal enuresis.