Abstract General Information

Title

PREDICTORS OF RESPONSE AND ADHERENCE TO ENURESIS ALARM THERAPY – A CONFIRMATORY STUDY

Introduction and objective

The enuresis alarm is a potentially curative first-line enuresis therapy. Two major problems are 1) the amount of work required by the children, families and healthcare professionals and 2) the lack of predictors for response and adherence to therapy. We previously found, via a pilot study on approximately 200 patients, that alarm response and adherence could be predicted by looking at the results during the first 3-4 weeks of therapy. We now wanted to see if those results hold firm when looking at a new, larger group

Method

Using the Pjama® enuresis alarm, which is linked to an app downloaded to patients’/carers’ smartphones, anonymized data were gathered from patients around Europe who purchased the alarm independently. The users recorded baseline anamnestic data on the app, which then recorded alarm usage and wet/dry nights, minimizing the risk for recall bias.

Results

So far 1530 subjects have provided data during treatment. Their response/adherence to therapy is listed in Table 1.

RESPONSE NUMBER
Full response (at least 14 consecutive dry nights): 46
Intermediate response (≥50% reduction of wet nights): 103
Nonresponse (<50% reduction of wet nights): 160
Dropout before 8 weeks: 1177
Sporadic use (impossible to determine response): 44

Nonresponders (full or intermediate) tended to be younger than nonresponders (p = 0.019). Other background data, such as gender, concomittant daytime incontinence, primary/secondary enuresis and previous therapy did not give predictive information. The same was true of data gathered during the first week of therapy. However, from treatment week two and onwards the full, intermediate and nonresponders differed in the number of wet nights per week (p =0.031, <0.001, and <0.001, for weeks 2, 3 and 4, respectively). Young age and primary enuresis where predictors of therapy adherence (p < 0.001 for both), whereas non-adherent subjects had a higher likelihood of nights without therapy already during the first two weeks of treatment (p<0.001)

Conclusion

The extreme number of patients dropping out from therapy probably reflects the fact that most families were not supported by a healthcare professional. The results confirm our earlier findings, indicating that alarm therapy should be assessed after four weeks. Patients who have not, at this time, experienced a decrease in enuresis frequency, as well as patients with several unregistered nights, should be recommended to discontinue alarm treatment and receive pharmacotherapy instead. This way, the number of families having to undergo labor-intensive, unsuccessful therapy for several months will decrease.