Comparison of the efficacy of long-term treatment of primary monosymptomatic nocturnal enuresis of varying severity using traditional methods

Abstract

Background: Primary monosymptomatic nocturnal enuresis (PMNE) is a pathological state where the patient has no problem with bladder control in the waking state but does not awake from the urge to urinate. Very little is known about the prognostic factors regarding effective treatment of PMNE using methods recommended by the International Children's Continence Society. Objective: To compare the efficacy of long term treatment of PMNE using alarm intervention (AI) and desmopressin in children and adolescents and also to study the impact on it of the severity of disease, age and socio-economic factors. Method: Study was conducted from 15 th January to 30 th October, 2016 in the Far Eastern Federal University (Vladivostok) in children 7 to 14 years old having PMNE. At the preliminary stage, the clinical, socio-economic and demographic characteristics of the children were noted. All patients had blood and urine tests done and the level of antidiuretic hormone was determined. To exclude a hyperactive bladder, uroflowmetry and a questionnaire survey of OABq-SF were used. Monitoring of changes in the number of episodes of enuresis (EE) and independent awakenings was carried out using a voiding diary. In the active phase of the study, patients from group A underwent treatment by AI and patients from group B received desmopressin 0.4 mg per day. Results: There were 339 children aged 7 to 14 years with PMNE during the study period. Group A comprised 162 children treated with AI. At the end of the 4-month course, absence of PMNE was noted in 82.7% patients and after 6 months in 74.7% children. Group В comprised 177 children treated with desmopressin 0.4 mg/day. In group В the absence of PMNE was noted 4 months after the start of the experiment in 72.9% of children and after six months in 67.2% of children. Construction of a two-stage regression model and carrying out partial F-tests established that in group A, the EE level was significantly associated with age (p In addition, it was found that the effectiveness of AI was significantly higher in children who had a greater number of independent awakenings before treatment (p≤0.01). Conclusions: Use of AI in the treatment of PMNE is significantly associated with the number of independent awakenings. Use of both AI and desmopressin are significantly associated with age and severity of symptoms of PMNE. Socio-economic and demographic factors have no significant influence on treatment outcomes of PMNE. Sri Lanka Journal of Child Health, 2018; 47 : 249-256