Abstract General Information

Title

A PROSPECTIVE FEASIBILITY STUDY OF IMPLEMENTING SITTA METHOD IN THE MANAGEMENT OF ENURESIS

Introduction and objective

Aim was to determine the efficacy of the SITTA (Short and Intensive Treatment with one of Two Alarms) method in a clinic setting and inform the development of national guidelines for the management of enuresis.

SITTA comprises fortnightly appointments to evaluate progress and modify alarm therapy for a maximum of 12 weeks. It incorporates a pre-sleep practice, the ‘Magic 3’s’, of three ‘dry runs’ each night before bed, following the correct order of steps in response to alarm activation. This conditions wakening to the alarm and following the appropriate regime to achieve behavioural change.

Method

Prospective 22-month feasibility study of SITTA using body-worn (Malem M024) or bell-and-mat (Ramsey-Coote) alarms, in a Paediatric Continence Clinic with staff of variable expertise, overseen by an experienced practitioner. Primary outcome was Initial Success (IS), 14 consecutive dry nights within the period of treatment. Secondary outcomes were time to IS, total number of clinic appointments, and Continued Success at 6 months. Clinical information was recorded in a dedicated electronic health record (EEF), displaying progress in a graph. Figures were compared to SITTA used in a research environment by a single expert consultant.

Results

70 children with monosymptomatic or non-monosymptomatic enuresis were recruited between March 2021 and January 2023 and commenced on our SITTA protocol. Initial success (IS) was achieved in 85.7%. 65% had Continued Success. The average time to achieve IS was 8.2 weeks, requiring 6 clinic appointments.

Conclusion

Prior to SITTA, our low-intensity enuresis clinic achieved 42.9% IS at 16 weeks. In 2019, SITTA was used in a preliminary controlled study by a single experienced consultant paediatrician in our hospital and had 97.1% IS. The implementation of SITTA in a clinic with staff of variable expertise demonstrates similar favourable outcomes.

To date, no standardised protocol for the treatment of enuresis exists in Ireland. This study indicates that SITTA may be more effective than current low-intensity practices, and is feasible in a clinic setting.

Results of this study will be used to implement a national guideline to standardise alarm therapy for enuresis in Ireland.