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Compliance with Enuresis Alarm for Nocturnal Enuresis
Jessica Schuh, MPAS, PA-C, Jacqueline Broda, PA-C, Jinae Spear, PA-C, Alaina Dozar, NP, Alex Borden, PA-C, Sarah Phillips, PA-C, Duong Tu, MD.
Texas Children's Hospital, Houston, TX, USA.

BACKGROUND: Primary nocturnal enuresis is often a source of significant patient and parent distress and is therefore one of the most common reasons for visits to pediatric urology (2). An enuresis alarm can be a curative option for many patients, with a success rate reported as high as 80% (1). However, our patients did not report this level of success. Duration of alarm use is a significant factor in success, with some suggesting a duration of 16-20 weeks is optimal (1). We recommend a duration of at least 6 weeks, preferably 12-16 weeks. This study aims to obtain more complete information on patients' and families' experience with the enuresis alarm. We hypothesize that many of the "nonresponders" do not use the alarm as directed, and that many families who have been counseled about the alarm do not actually purchase it. METHODS: After obtaining IRB approval for a retrospective chart review, we were able to obtain the information for all patients seen in our primary outpatient Urology Clinic from 2013-2017 for all diagnoses related to nocturnal enuresis. We excluded patients with significant comorbidities which affect nocturnal enuresis, such as neurogenic bladder, diabetes, and significant daytime incontinence. We conducted a phone survey for the parents of our patients with questions regarding their usage and experience with the enuresis alarm, and the current status of the patient's enuresis.
RESULTS: Of 1006 charts which were reviewed, 234 were excluded due to comorbid conditions or nonmonosymptomatic nocturnal enuresis. Of 774 included, 442 chose enuresis alarm as primary management strategy after our consultation. 60 of the 442 patients purchased the alarm (13.5%). We were able to reach 58 of these by phone to complete our survey. Reasons provided by the parents surveyed for not purchasing the alarm were other treatment preferred (67.16%), cost (13.43%), previously failed alarm therapy (3.98%), and other (15.42%). There was no significant difference in nights per week wet in the groups of patients who did and did not purchase the alarm (2.33 2.79 vs 2.15 2.7). 34 of 58 patients (58.62%) used the alarm for at least 5 nights a week for at least 4 weeks; half still wet the bed and half did not (17 vs 17). 24 of 58 patients (41.38%) used the alarm for the recommended 7 nights a week for at least 6 weeks; 54.17% no longer wet the bed vs 45.83% still wet the bed (13 vs 11).
CONCLUSIONS: Our retrospective study found that a majority of patients who were interested in and counseled about the alarm during our office consultation didn't purchase it. Of those who purchased the alarm, a significant number did not use the alarm for the recommended length of time. However, more of the patients who used the alarm for the recommended time achieved dryness than those who did not, though this did not reach statistical significance. To our knowledge, this is the first study looking at compliance with the enuresis alarm.


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