Parasacral Transcutaneous Electrical Nerve Stimulation with Desmopressin Acetate for Treating Primary Monosymptomatic Enuresis: A Randomized Controlled Clinical Trial.

Purpose: Approximately one-third of the children with primary monosymptomatic enuresis (PMNE) do not respond to first-line treatment. We aimed to investigate the short-term and six-month effectiveness of combining desmopressin acetate with parasacral transcutaneous electrical nerve stimulation (PTENS) in these children and adolescents.

Materials and methods: Participants aged six-17 years with PMNE were randomly assigned to receive desmopressin acetate with active or sham PTENS. Both groups participated in weekly 30-minute electrotherapy sessions for 15 weeks. The intervention group (IG) received electrotherapy at a frequency of 10 Hz and pulse width of 700 µs. A dry and wet nights calendar assessed the frequency of wet nights in the short term and six months after the intervention ended.

Results: Of 66 participants, 34 were randomized to the IG. The median age was 10.3 years (8.8 - 12), and 53% were male. Intention-to-treat analysis showed a significant reduction in the frequency of wet nights after the interventions (p < 0.001) in both groups, with the IG demonstrating significant improvement, immediately after the interventions (p=0.005) and after six months (p< 0.001) compared to the placebo group (PG). The Kaplan-Meier survival analysis showed improvement in the IG that became more pronounced from the 15th week onwards (log-rank test, p < 0.01).  Conclusions: A 15-week treatment with desmopressin acetate and PTENS significantly reduced wet nights in children and adolescents with PMNE, and this improvement was maintained six months after the interventions.