Daytime urotherapy in nocturnal enuresis: a randomised, controlled trial

OBJECTIVE: According to international guidelines, children with enuresis are recommended urotherapy, or basic bladder advice, before treatment with evidence-based alternatives such as the enuresis alarm is given. The efficacy of this strategy has, however, not been supported by controlled studies. We wanted to test if basic bladder advice is useful in enuresis. DESIGN: Randomised, controlled trial. SETTING: Paediatric outpatient ward, regional hospital. PATIENTS: Treatment-naïve enuretic children aged ≥6 years, with no daytime incontinence. INTERVENTIONS: Three groups, each during 8 weeks: (A) basic bladder advice—that is, voiding and drinking according to a strict schedule and instructions regarding toilet posture, (B) enuresis alarm therapy and (C) no treatment (control group). MAIN OUTCOME MEASURES: Reduction in enuresis frequency during week 7–8 compared with baseline. RESULTS: The median number of wet nights out of 14 before and at the end of treatment were in group A (n=20) 12.5 and 11.5 (p=0.44), in group B (n=22) 11.0 and 3.5 (p<0.001) and in group C (n=18) 12.5 and 12.0 (p=0.55). The difference in reduction of enuresis frequency between the groups was highly significant (p=0.002), but no difference was found between basic bladder advice and controls. CONCLUSIONS: Urotherapy, or basic bladder advice, is ineffective as a first-line treatment of nocturnal enuresis. Enuretic children who are old enough to be bothered by their condition should be offered treatment with the alarm or desmopressin. TRIAL REGISTRATION NUMBER: NCT03812094.