Pharmacological treatment of pediatric nocturnal enuresis: a systematic review and network meta-analysis.

Background: Nocturnal enuresis (NE) is a socially stigmatizing and stressful childhood condition. Many drugs have been applied for NE treatments. We aimed to assess the efficacy of multiple drugs in pediatric NE through a network meta-analysis (NMA).

Methods: Under PRISMA guidelines and the PROSPERO registration number CRD42024581022, we systematically searched the Cochrane Library, Embase, PubMed, and Web of Science from inception to September 9, 2024, for randomized controlled trials (RCTs). Studies involving patients aged 5 to 18 and diagnosed with NE and using at least one drug treatment were included. The NIH Quality Assessment Tools were used to assess the quality of the included studies. Bayesian NMA was organized with R software 4.3.3.

Results: Twenty-three RCTs with 1658 participants were enrolled. The complete and partial response rates of combination therapy were higher than those of monotherapy. SUCRA ranking showed that desmopressin (DES) plus propiverine (75.24%), DES plus solifenacin (68.83%), and DES plus tolterodine (66.46%) ranked among the top six in terms of complete response rate. None of the four included interventions significantly improved the relapse rate of NE. All treatments yielded few adverse events. Moreover, combination therapy with DES (RR [95%CrI] = 3.55 [2.28, 5.64]) or without DES (RR [95%CrI] = 3.74 [1.19, 12.06]) seemed to be superior to DES monotherapy in terms of complete response rate. Small number/sample size and inconsistency among included trials might impair the strength of evidence.

Conclusions: Combination therapy may be superior to monotherapy in NE management. The most frequently used combination therapy is desmopressin plus anticholinergic agents. All drugs seemed to be safe.