Efficacy of desmopressin and enuresis alarm in the treatment of monosymptomatic nocturnal enuresis: a multicenter prospective randomized controlled study.

Background: To compare the therapeutic effect of desmopressin (DDAVP) and enuresis alarm (EA) in treating primary monosymptomatic nocturnal enuresis (MNE) and identified prognostic factors.

Methods: A total of 213 children (6-16 years) with MNE were randomized to the DDAVP or EA group at five hospitals in mainland China from January 2019 to December 2023. Comprehensive medical histories were collected, and voiding diaries were maintained for two consecutive weeks. All participants underwent 12-week follow-up evaluations, with therapeutic outcomes assessed at the endpoint. Children achieving complete response were monitored for relapse for an additional 3 months post-treatment.

Results: After excluding 28 patients (16 lost to follow-up, 12 incomplete diaries), 185 completed the study (63.24% male, mean age 10.25 ± 2.36 years). The loss to follow-up rate in the EA group was higher than in the DDAVP group (11.71% vs. 2.94%, P < 0.05). Ninety-four children were treated with EA and 91 children with DDAVP. After 12 weeks, there was no significant difference in the therapeutic effect between the DDAVP and EA group (P > 0.05). Relapses occurred in 1/30 children in the EA group and 6/30 children in the DDAVP group (P < 0.05). Family history (OR = 2.37, 95%CI: 1.16-4.84), enuresis frequency > 4 times/week (OR = 2.30, 95%CI: 1.08-4.89), and reduced bladder capacity (OR = 2.29, 95%CI: 1.12-4.66) were negative prognostic factors.

Conclusion: Both therapies showed comparable short-term efficacy, but EA exhibited superior durability with lower relapse. Family history, severity of enuresis, and reduced bladder capacity are negative prognostic factors for therapeutic effect.