Office management of pediatric primary nocturnal enuresis: a comparison of physician advised and parent chosen alternative treatment outcomes.
OBJECTIVE
We compared the remission of pediatric primary nocturnal enuresis in groups of children who used a physician advised practice plan vs a parent chosen alternative.


METHODS
Between January 2004 and January 2006 there were 119 patients with primary nocturnal enuresis enrolled in this prospective, nonrandomized study. For this study primary nocturnal enuresis was defined as wetting at night during sleep during any 6-month interval without any known causative problem. A total of 76 children received the physician advised treatment plan and used an alarm, oxybutynin, desmopressin, an elimination diet and a bowel program, as indicated. A total of 43 children received a parent chosen alternative treatment plan, which consisted of any single or combination of treatments involving an alarm, oxybutynin, desmopressin and an elimination diet or bowel program. Parents from each group completed an intake survey that measured functional bladder capacity using a 3-day home diary and they identified demographic variables. Followup occurred at 2 weeks and then monthly for 12 weeks to study end.


RESULTS
We found that the probability of remission by the end of the study for the physician advised treatment group was significantly higher than that of the parent choice group (88% vs 29%, Kaplan-Meier curve p <0.0001).


CONCLUSIONS
The group of children who followed physician advised treatment for primary nocturnal enuresis showed significantly earlier remission of primary nocturnal enuresis than children who followed the parent choice treatment (25th percentile 2 vs 10 weeks).
Diaz Saldano
Dawn
D
Children's Memorial Hospital, Chicago, Illinois 60614, USA. dsaldano@childrensmemorial.org
Chaviano
Antonio H
AH
Maizels
Max
M
Yerkes
Elizabeth B
EB
Cheng
Earl Y
EY
Losavio
Jennifer
J
Porten
Sima P
SP
Sullivan
Christine
C
Zebold
Kerry F
KF
Hagerty
Jennifer
J
Kaplan
William E
WE
D000293:Adolescent; D000328:Adult; D050034:Antidiuretic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002755:Choice Behavior; D003131:Combined Modality Therapy; D003248:Constipation / Q000517:prevention & control; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D004032:Diet; D004775:Enuresis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008333:Mandelic Acids / Q000627:therapeutic use; D008991:Monitoring, Physiologic / Q000295:instrumentation; D010276:Parasympatholytics / Q000627:therapeutic use; D010290:Parents / Q000523:psychology*; D018579:Patient Selection; D011446:Prospective Studies; D016896:Treatment Outcome
D050034:Antidiuretic Agents; D008333:Mandelic Acids; D010276:Parasympatholytics; D003894:Deamino Arginine Vasopressin; C005419:oxybutynin