Treatment Dropout in Pediatric Enuresis: A Retrospective Cohort Study at a Tertiary Children's Hospital

BACKGROUND: Pediatric enuresis is a frequent reason for referral to pediatric urology clinics; however, the real-world effectiveness of available therapies is limited by high treatment dropout. Despite multiple validated interventions, adherence patterns and predictors of dropout remain poorly characterized. OBJECTIVE: To quantify treatment dropout rates in pediatric enuresis and identify clinical predictors of dropout across enuresis phenotypes in a tertiary care setting. METHODS: We conducted a retrospective cohort study including children aged 5-18 years treated for enuresis between 2019 and 2024 at a tertiary pediatric hospital. Patients were classified according to the International Children's Continence Society principles into clinically relevant phenotypes. Treatment dropout was defined as failure to initiate, continue, or complete prescribed therapy, or absence from scheduled follow-up without documented resolution or formal discharge. Multivariate logistic regression was used to identify independent predictors of dropout. RESULTS: A total of 961 patients were included. Overall treatment dropout occurred in 51.4% of cases, with significant variation among clinical phenotypes (p = 0.003). Bladder bowel dysfunction (BBD) accounted for the largest absolute number of dropouts, whereas secondary enuresis showed the highest relative dropout rate. Lack of early clinical improvement was the strongest independent predictor of treatment dropout. Age showed a small but statistically significant association, whereas sex and BBD phenotype were not independently associated with attrition after adjustment. CONCLUSION: Treatment dropout affects more than half of children undergoing management for enuresis in a tertiary referral setting. Lack of early clinical improvement was the strongest predictor of attrition. Reducing dropout will likely require structured early reassessment, realistic-expectation counseling, and adherence-support strategies targeted to higher-risk patients.