Mechanistic insights into alarm therapy for nocturnal enuresis: a retrospective cohort study

PURPOSE: The gold standard treatment for nocturnal enuresis includes alarm treatment, although the exact mechanism behind its effectiveness remains uncertain. The aim of this study was to investigate whether the time to alarm activation progressively increases during treatment, and to explore whether alarm treatment causes a transition from enuresis episodes to nocturia. METHODS: We included children with nocturnal enuresis undergoing successful alarm treatment from 01.01.2016 - 10.01.2023 at Aalborg University Hospital, Denmark. Data, including alarm times and episodes of nocturia, was obtained using standardized forms and bladder diaries and analyzed using Kaplan-Meier plots and Poisson regression. RESULTS: The study included 141 children, with 50% achieving dryness after 42 days of treatment and 25% within 31 days. The time to first alarm increased by 37.4 min [95% confidence interval: 10.8-64.08] within the first 6 weeks of treatment. The proportion of children experiencing nocturia reduced from 40% in the first week of treatment to 28% in the final week. An inverse relationship was observed between pre-treatment maximum voided volume and treatment duration. CONCLUSION: A substantial proportion of children who underwent alarm treatment achieved complete dryness within a short period after initiating therapy. During treatment, enuresis episodes occurred progressively later in the night, and no shift from enuresis to nocturia was observed. These findings suggest that the mechanism of alarm treatment may involve changes in nocturnal voiding patterns, potentially reflecting an increase in functional bladder capacity.