Abstract
This study is to compare the efficacy of enuresis alarm and desmopressin therapy in managing pediatric monosymptomatic enuresis. We performed systematic literature searches on different databases from inception until April 2017 without language restriction. All randomized control trials comparing an enuresis alarm and desmopressin in managing children with monosymptomatic enuresis were included. A total of 15 studies with 1502 participants (aged 5 to 16 years) were included for pooled analysis. Overall, an enuresis alarm outperformed desmopressin in achieving at least a partial response (>50% reduction in wet nights) in per-protocol analysis (OR: 1.53, 95% CI 1.05 to 2.23) but not in intention-to-treat analysis (OR: 0.97, 95% CI 0.73 to 1.30) as the alarm was hampered by a high dropout rate (OR: 2.20, 95% CI 3.41 to 4.29). However, alarm therapy yielded a better sustained response (OR: 2.89, 95% CI 1.38 to 6.04) and lower relapse rate (OR: 0.25, 95% CI 0.12 to 0.50). In the intention to treat analysis, the results revealed that alarm and desmopressin therapy are comparable in efficacy with regards to achieving >50% reduction in baseline wet nights in enuretic children. However, enuresis alarms offer a superior treatment response and a lower relapse rate in well-motivated children.
Highlights
Enuresis alarms have been used to treat pediatric nocturnal enuresis for decades
In both Partial response rate (PP) and including total response rate (ITT) analyses, there were no significant differences between alarm therapy and desmopressin in full response rate and response rate, while desmopressin therapy had a significantly higher partial response rate in ITT analysis (OR: 0.63, 95% confidence intervals (95% CIs) 0.42 to 0.93, P = 0.02; I2 = 22%)
The results demonstrated that alarm therapy had higher odds of achieving a >50% reduction in wet nights in PP analysis, and a lower relapse rate and better sustained response rate
Summary
Enuresis alarms have been used to treat pediatric nocturnal enuresis for decades. Alarm therapy warranted cooperative parents and children with proper training programs to improve compliance and success rate. Most randomized control trials comparing the two management strategies have included relatively small sample sizes with significant variations in participant characteristics and outcome measurements, they lack statistical power to assess differences between the two therapies. A systemic review and pooled analysis may help pediatric urologists to more clearly clarify the differences. The aim of this systemic review and meta-analysis was to compare the initial treatment response, relapse rate and sustained response rate between an enuresis alarm and desmopressin therapy in children with monosymptomatic nocturnal enuresis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
