title: Examination of the structured withdrawal program to prevent relapse of nocturnal enuresis.
abstract: OBJECTIVE
  A variety of treatment options are available for children with nocturnal enuresis. The success of any intervention depends on if the child remains dry once the treatment is withdrawn. All interventions for children with nocturnal enuresis are vulnerable to some degree of relapse. Pharmacological interventions, involving either desmopressin or imipramine, seem particularly susceptible to relapse occurring rapidly once medication is withdrawn. The usual practice is to taper the dose gradually although this is time-consuming and of questionable effectiveness. An alternative approach is to use a time-limited structured withdrawal program, the success of which has been recently documented. We investigated the effectiveness of the structured withdrawal program to understand the variables related to success.
  
  
  METHODS
  A total of 51 patients 7 to 16 years old were included 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 using 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 after cessation of treatment.
  
  
  RESULTS
  At weeks 9 and 10 with complete cessation of medication 74.5% of children remained dry, and success was not related to use of an enuresis alarm.
  
  
  CONCLUSIONS
  The structured withdrawal program significantly reduces relapse rates, and offers an alternative and rapid means of successfully withdrawing medication. It is argued that the influential variable concerns the ability of the child to shift attribution for success from an external source (that is medication) to an internal focus (that is changes in themselves).
authors.affiliation: Leeds Community and Mental Health (NHS) Trust and Leeds Acute Hospitals Trust, Leeds, United Kingdom.
authors.forename: R J
authors.initials: RJ
authors.lastname: Butler
authors.forename: P
authors.initials: P
authors.lastname: Holland
authors.forename: J
authors.initials: J
authors.lastname: Robinson
mesh_terms: D000293:Adolescent; D002648:Child; D004775:Enuresis / Q000188:drug therapy* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D012008:Recurrence