Treatment of monosymptomatic nocturnal enuresis: alarm or desmopressin?

Background. - Monosymptomatic nocturnal enuresis is common in healthy schoo l children. Treatment is often required because of social and psychological convenience. We therefore conducted a randomized prospective trial using e ither desmopressin (D) or alarm (A). Patients and methods. - Patients (n = 135) aged 6 to 16 years were enrolled between January 1992 and December 1994. Desmopressin (Minirin(R) spray, Fe rring SA) was given intranasally at a dose of 20 mu g at bedtime and increa sed to 40 mu g after 2 weeks if partial result was obtained. The alarm was a pad-bell device (Wet-stop(R), Sega) and the sound source was attached to the upper part of the pajamas. Inclusion criteria were: primary monosymptom atic nocturnal enuresis in healthy children, age greater than or equal to 6 years, absence of previous treatment using either desmopressin or alarm. T he aim of the treatment was to achieve 100% dry nights. Patients were evalu ated after 15 days on therapy by phone call and thereafter by attending the outpatient clinic at 2-3 and 4-6 months. At the time of the second evaluat ion, a switch from alarm to desmopressin (or vice-versa) was proposed to th ose who did not respond to the initial treatment. Results. - In group D (n = 62), only 27 children were included since 12 (19 %) were switched to alarm and 23 (37%) were excluded because they were eith er non-compliant or lost to follow-up. In group A (n = 73), only 31 were in cluded since sir (8%) were switched to desmopressin and 36 (49%) were exclu ded for the same reasons as in group D. Prior to inclusion, the percentage of dry nights was 21% in group D and 14% in group A. After 15 days on thera py patients from group D achieved 80% dry nights compared to 50% in group A (P = 0.001). After 3 months, patients from group D attained 85% dry nights vs 90% in group A. After 6 months, children from group A achieved 94% dry nights vs 78% in group D (P = 0.01). Conclusion. - Desmopressin offers better short-term results than enuresis a larm but the latter is significantly more efficient in the long term. In Pr ance, the alarm device is not reimbursed by the national health service and therefore is poorly accepted, as suggested from the high rate of patients lost to follow-up. (C) 1999 Elsevier, Paris.