Examination of the structured withdrawal program to prevent relapse of nocturnal enuresis

Purpose: A variety of treatment options are available for children with noc turnal enuresis. The success of any intervention depends on if the child re mains dry once the treatment is withdrawn. All interventions for children w ith nocturnal enuresis are vulnerable to some degree of relapse. Pharmacolo gical interventions, involving either desmopressin or imipramine, seem part icularly susceptible to relapse occurring rapidly once medication is withdr awn. The usual practice is to taper the dose gradually although this is tim e-consuming and of questionable effectiveness. An alternative approach is t o use a time-limited structured withdrawal program, the success of which ha s been recently documented. We investigated the effectiveness of the struct ured withdrawal program to understand the variables related to success. Materials and Methods: A total of 51 patients 7 to 16 years old were includ ed in the 8-week structured withdrawal program. Patients were 90% dry with medication taken for 4 to 24 months before the program and had experienced 2 unsuccessful withdrawal attempts. Patients were offered the choice of usi ng an enuresis alarm on medication-free nights. Progress was monitored at 2 , 5 and 8 weeks, and long-term success was defined as no relapse 6 months a fter cessation of treatment. Results: At weeks 9 and 10 with complete cessation of medication 74.5% of c hildren remained dry, and success was not related to use of an enuresis ala rm. Conclusions: The structured withdrawal program significantly reduces relaps e rates, and offers an alternative and rapid means of successfully withdraw ing medication. It is argued that the influential variable concerns the abi lity of the child to shift attribution for success from an external source (that is medication) to an internal focus (that is changes in themselves).