Factors influencing the efficacy and self-discontinuation of alarm therapy for Japanese patients with nocturnal enuresis.

Abstract

Background: Alarm therapy is the recommended first-line treatment for nocturnal enuresis (NE). This study aimed to investigate the effectiveness of alarm monotherapy, identify predictors of treatment success, and examine factors contributing to self-discontinuation in Japanese patients with NE.

Methods: We retrospectively analyzed the treatment course of 112 patients with NE who received alarm monotherapy between January 2017 and September 2024. The primary outcome was the predictors of treatment effectiveness, and the secondary outcome was factors contributing to self-discontinuation of alarm therapy.

Results: At 3 months after initiating alarm monotherapy, treatment was effective in 49 patients (≥50% reduction in NE), while 41 showed poor response (<50% reduction in NE), 10 switched to pharmacotherapy, and 4 self-discontinued alarm therapy. By 6 months, only 9 of 41 patients who had shown poor response at 3 months achieved an effective outcome, while 11 self-discontinued alarm therapy. No factors predicting effectiveness were identified in the per-protocol analyses. During the entire study period, 30 patients self-discontinued alarm therapy, with 12 citing reluctance to wear the device. Refusal and self-discontinuation rates were higher among patients with daytime urinary incontinence (DUI) (p = 0.006), developmental disabilities (p = 0.004), no prior NE treatment (p = 0.011), and ineffective treatment at 3 and 6 months (p = 0.001 and 0.045, respectively).

Conclusions: Alarm monotherapy can be recommended for any patient as no factors predicting effectiveness were identified. However, patients with no prior treatment, DUI, neurodevelopmental disorders, or ineffective alarm therapy may struggle to continue treatment with alarm monotherapy.