title: No effect of basic bladder advice in enuresis: A randomized controlled trial.
abstract: BACKGROUND
  There are two firstline, evidence-based treatments available for nocturnal enuresis: desmopressin and the enuresis alarm. Prior to use of these therapies, international experts usually recommend that the children also be given basic bladder training during the daytime. The rationale behind this recommendation is that daytime bladder training or urotherapy, is a mainstay in the treatment of daytime incontinence caused by detrusor overactivity. Still, there is, as yet, no firm evidence that daytime bladder training is useful against nocturnal enuresis.
  
  
  OBJECTIVE
  To explore whether basic bladder advice has any effect against nocturnal enuresis.
  
  
  METHODS
  The study was prospective, randomized, and controlled. The evaluated intervention was bladder advice, given in accordance with ICCS guidelines and focused on regular voiding, sound voiding posture, and sufficient fluid intake. Forty children aged 6 years or more with previously untreated enuresis, but no daytime incontinence, were randomized (20 in each group) to receive either first basic bladder advice for 1 month and then alarm therapy (group A) or just the alarm therapy (group B). Based on power calculations, the minimum number of children required in each treatment arm was 15.
  
  
  RESULTS
  The basic bladder advice did not reduce the enuresis frequency in group A (p = 0.089) and the end result after alarm therapy did not differ between the two groups (p = 0.74) (see Table). Only four children in group A had a partial or full response to bladder training, and two of these children relapsed immediately during alarm therapy.
  
  
  CONCLUSIONS
  This was the first study to evaluate, in a prospective, randomized manner, the value of daytime basic bladder training as a treatment of enuresis. It was found that the treatment neither resulted in a significant reduction in the number of wet nights, nor did it improve the success of subsequent alarm therapy.
  
  
  CONCLUSIONS
  The recommendation that all children with enuresis be given bladder training as a firstline therapy can no longer be supported. Instead, we recommend that treatment of these children start with the enuresis alarm or desmopressin without delay.
authors.affiliation: Dept. of Women's and Children's Health, Uppsala University, Uppsala, Sweden. Electronic address: maria.cederblad@kbh.uu.se.
authors.forename: Maria
authors.initials: M
authors.lastname: Cederblad
authors.affiliation: Dept. of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Sarkadi
authors.affiliation: Dept. of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Dept. of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Gunn
authors.initials: G
authors.lastname: Engvall
authors.affiliation: Dept. of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: Tryggve
authors.initials: T
authors.lastname: Nevéus
mesh_terms: D000367:Age Factors; D002648:Child; D037001:Directive Counseling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D053206:Nocturnal Enuresis / Q000628:therapy*; D010353:Patient Education as Topic; D011446:Prospective Studies; D017211:Treatment Failure
keywords: After treatment; Children; Nocturnal enuresis; Nursing; Primary care