Written by Hannah Harp
Spoon Feed
Desmopressin and enuresis alarm (EA) had similar efficacy in treating uncomplicated night time enuresis, though EA had a lower adherence rate and desmopressin had a higher relapse rate.
Urine luck! There are dry nights ahead
Nocturnal enuresis that isn’t caused by neurological problems or that persists in spite of treatment of constipation or OSA is very common (between 8-16% of kids 6-12 years old). It can cause a lot of social distress, too––kids with nocturnal enuresis during grade school have lower self-esteem and higher rates of anxiety. Treatments include desmopressin (an antidiuretic medication) and enuresis alarms (EA), which have sensors that wake up the child when they detect wetness. EAs are a bit complicated to use, so adherence isn’t great, but they are very effective. Desmopressin is pretty easy to take and is very effective for the treatment of nocturnal enuresis, though it doesn’t have the same benefit of training a child to wake up when their body needs to pee, so its effects are more likely to wear off. So, which one is better?
This multicenter randomized controlled trial evaluated the 12-week efficacy of desmopressin vs. EA therapy in 185 children with primary monosymptomatic nocturnal enuresis. Both groups showed similar complete response rates (desmopressin 32.97%, EA 31.91%; P > 0.05). However, relapse was significantly lower in the EA group (3.3% vs. 20%; P < 0.05). Prognostic factors negatively affecting treatment success included family history (OR 2.37), enuresis frequency >4/week (OR 2.30), and reduced bladder capacity (OR 2.29). To be fair, the trial was only 12 weeks long, so patients may not have had sufficient time to respond to treatment or to get to the point that relapse was less likely.
How does this change my practice?
I learned from this article that desmopressin is more effective in kids with polyuria, while EA is more effective for kids with reduced bladder capacity or deep sleepers that don’t wake up when they need to go.
Source
Efficacy of desmopressin and enuresis alarm in the treatment of monosymptomatic nocturnal enuresis: a multicenter prospective randomized controlled study. Pediatr Nephrol. 2025 Jun 10. doi: 10.1007/s00467-025-06840-z. Epub ahead of print. PMID: 40494946
