Evidence on nocturnal enuresis

Abstract

Uncomplicated nocturnal enuresis is one of the most common dysfunctional problems of childhood. It can cause significant family distress, discord and conflict between parents and child. Childhood enuresis is a complex symptom. Those who voiced concerns that evidence-based medicine and systematic reviews would result in ‘cook-book’ medicine need look no further than this condition for an example of where the healing art of medicine is as important as the scientific evidence, and a challenge to integrate. The process of gathering the history, listening for and understanding the values of the patient and family, de-mystifying the problem, and explaining the prognosis and the treatment options are all a part of the therapeutic process and when done well, there is often considerable stress relief, which is appropriate for a condition with a good prognosis. Both families and clinicians can find that integration very satisfying. In this issue of Evidence-Based Child Health, we are profiling the issue of nocturnal enuresis in two ways. First, we have commissioned an ‘umbrella review’ of seven Cochrane reviews on a wide range of interventions. Umbrella reviews, compiling evidence from multiple Cochrane reviews into one accessible and usable document, will be a regular feature of this Journal. Our aim for each umbrella review is to focus on the treatment question, ‘which treatment should I use for this condition?’, and to highlight the Cochrane reviews and their results in doing so. One aim of an umbrella review is to serve as a ‘friendly front end’ to The Cochrane Library, allowing the reader a quick overview (and an exhaustive list) of Cochrane reviews relevant to the clinical decision at hand. We are also featuring the 2005 review by Glazener et al. ‘Alarm interventions for nocturnal enuresis in children’ (1). This review, which is very well done and quite comprehensive, finds that the alarm is superior to all the other treatment modalities currently available, including a long list of pharmaceuticals and a host of behavioural modalities. When the technique of ‘overlearning’ is added, the relapse rate is reduced. There is a suggestion that combining the alarm with some behavioural modalities like ‘Dry Bed Training’ may increase the effect, but the evidence is based