Folic acid supplementation and observed clinical outcomes in pediatric primary monosymptomatic nocturnal enuresis: a prospective single-arm cohort study from Gaza (2023-2025).

BACKGROUND

Primary monosymptomatic nocturnal enuresis (PMNE) is a common pediatric condition characterized by involuntary nighttime urination with high spontaneous remission rates.

OBJECTIVE

To describe observed changes in PMNE frequency following folic acid supplementation combined with behavioral therapy.

METHODS

A prospective single-arm cohort study was conducted in Gaza (2023-2025). Children aged 5-15 years with PMNE received folic acid (5 mg/day for 3 months) and standardized behavioral therapy. Data were collected using parental bladder diaries. The study is reported in accordance with the STROBE statement for observational cohort studies. All analyses were performed using individual-level paired pre-post data, with no aggregated datasets used for inferential statistics.

RESULTS

A total of 612 children were screened; 500 completed follow-up (loss to follow-up: 5.7%). Mean enuresis frequency decreased from 5.7 ± 1.2 to 2.4 ± 1.1 episodes/week (mean difference: 3.2; 95% CI: 3.0-3.4; p < 0.001; Cohen's dz = 2.78). Complete remission occurred in 42% of participants.

CONCLUSION

A reduction in PMNE frequency was observed; however, causal inference cannot be established due to the uncontrolled design and confounding factors.