Unlocking the puzzle of primary monosymptomatic nocturnal enuresis: a comprehensive study on the management of Thai children through alarm therapy and medication.

BACKGROUND

Primary monosymptomatic nocturnal enuresis (PMNE) is a common pediatric condition that can improve with age but can profoundly impact self-esteem and quality of life. Despite the availability of treatment options in Thailand, there are no standardized guidelines. This study aimed to evaluate the efficacy of three approaches: enuresis alarm, pharmacological intervention, and their combination, to provide evidence-based recommendations for culturally relevant clinical guidelines for PMNE and explore factors influencing treatment efficacy.

METHODS

A 5-year retrospective study was conducted on 300 children aged 5-18 years treated for nocturnal enuresis at Queen Sirikit National Institute of Child Health from 2020 to 2024. Of these, 140 children with PMNE underwent an initial 2-week trial of alarm therapy, followed by further treatment based on response. Non-responders received either medication alone or a combination of alarm and pharmacological intervention. Outcomes, recurrence rates, and predictive factors were analyzed.

RESULTS

Among the 140 children (mean age 11 years, predominantly male), 52 showed improvement with alarm therapy. Forty-eight out of 88 non-responders opted for combined treatment and 40 for medication alone. All groups demonstrated improvement at 3 months. Recurrence rates at 6 months were highest in the medication group (50%), compared to combined therapy (13.79%) and alarm therapy (7.69%).

CONCLUSIONS

Alarm therapy is highly effective for PMNE and normal nighttime urination. For children with nocturnal polyuria, combined therapy is recommended. Medication alone is less effective due to higher recurrence rates.