This is an orginal multicenter prospective randomized controlled study on comparing the efficacy of desmopressin (DDAVP) and enuresis alarm (EA) in treating children with monosymptomatic nocturnal enuresis (MNE) in mainland China.

A total of 213 children (6–16 years) with primary MNE from five hospitals were enrolled. Exclusion criteria included prior enuresis treatment, daytime urinary symptoms, or comorbidities. Participants were randomized into DDAVP (n=91) or EA (n=94) groups. DDAVP was administered nightly (0.2 mg), while EA utilized the Wet-Stop3 Blue alarm. Efficacy was assessed at 12 weeks using ICCS criteria: complete response (0 enuresis), partial response (50–99% reduction), or no response (<50% reduction)[1]. Relapse rates were recorded 3 months post-treatment. Univariate and multivariate logistic regression analyzed prognostic factors.

Of 185 children completing follow-up, no significant difference in efficacy was observed between DDAVP and EA groups at 12 weeks (complete response: 32.97% vs. 31.91%, p>0.05). However, relapse rates were significantly higher in the DDAVP group (20.00% vs. 3.33%, p=0.044). Loss to follow-up was higher in the EA group compared to DDAVP group (11.71% vs. 2.94%, p<0.05). A univariate logistic regression analysis was conducted to explore the factors influencing the prognosis of enuresis treatment at the 12 – week mark, with complete or partial response as the treatment outcome. The results indicated that a family history of enuresis, enuresis frequency of more than 4 nights per week, reduced bladder capacity, and nocturnal polyuria were correlated with the treatment effect in enuretic children. Conversely, factors such as age, body mass index (BMI), gender, constipation, and difficulty awakening did not show a significant correlation with the treatment outcome, as evidenced byp – values greater than 0.05 for these variables (Table 1). Multivariate analysis identified family history (OR=2.37, 95% CI:1.16–4.84), enuresis frequency >4/week (OR=2.30, 95% CI:1.08–4.89), and reduced bladder capacity (OR=2.29, 95% CI:1.12–4.66) as negative prognostic factors (Table 2).

Both therapies demonstrated comparable short-term efficacy, but EA showed superior sustainability with lower relapse. Compliance challenges in the EA group may explain higher attrition, while DDAVP’s pharmacological limitations likely contributed to relapse. Prognostic factors highlight the need for personalized treatment strategies, particularly for children with familial predisposition, severe symptoms, or bladder dysfunction.

DDAVP and EA are equally effective for MNE, yet EA offers long-term advantages with fewer relapses. Clinicians should consider family history, symptom severity, and bladder capacity when selecting therapies. Extended treatment duration or combination regimens may improve outcomes for high-risk patients.

Pedersen MJ, Rittig S, Jennum PJ, Kamperis K. The role of sleep in the pathophysiology of nocturnal enuresis [J]. Sleep Med Rev, 2020, 49: 101228. DOI: 10.1016/j.smrv.2019.101228.