Background: Conditioning is one of the first line treatments for enuresis. The efficacy is well established and it appears that at least in some children conditioning converts enuresis to nocturia. The extent to which conditioning leads to nocturia is debatable. The aim of this study was to evaluate the outcome of alarm treatment in children with treatment naïve, monosymptomatic enuresis (MNE). Methods: We utilized data from the RCT DRYCHILD study (Jørgensen et al., unpublished data) and analyzed a cohort of 123 treatment-naïve children aged 6 to 14 years with MNE who received alarm treatment for 8 weeks. Inclusion required three or more wet nights per week during a two-week run-in period. The exclusion criteria were prior or ongoing treatment for MNE, ongoing constipation or fecal incontinence, and daytime lower urinary tract symptoms. All children were requested to complete home recordings following the treatment. We evaluated the effects of alarm treatment on clinical measurements such as maximum voided volume (MVV), nocturnal urine production (NUP) and nocturia. We performed t-tests to examine the effects of the alarm treatment. Results: A cohort of 123 children (75% males, 7.8+1.4 years of age) was analysed. The majority of children became dry after the alarm treatment; 68% (n=83) had a complete response, 20% (n=25) had a partial response, and 12% (n=14) were non-responders. We found a significant increase in MVV (80.7±27.0% of expected bladder capacity (EBC) vs 91.3±32.0% of EBC, P<0.01) and a significant reduction in NUP (84.9±25.3% of EBC vs 74.0±26.0% of EBC, P<0.01) following treatment in children with complete response to treatment. An increased prevalence of nocturia among the children post-treatment (54% vs 24%) was seen. Approximately a third (36%) of complete responders without nocturia at baseline experienced nocturia after treatment. Conclusions: Complete response to alarm treatment seems to be related to an increased bladder capacity and a reduction in NUP in children with enuresis. The occurrence of nocturia increases following the treatment in both children with complete response and no-response.
