Comparing alarms, desmopressin, and combined treatment in Chinese enuretic children

The objective of this multicenter randomized controlled trial was to compare the efficacy of enuresis alarms, oral desmopressin, and combined treatment in Chinese children with monosymptomatic primary nocturnal enuresis. We assigned 105 children aged 7–15 years to receive alarms (group 1, 35 patients), oral desmopressin 400 g (group 2, 38 patients), or combined therapy (group 3, 32 patients) for 12 weeks; patients were then followed for 12 weeks after treatment. The wetting frequency decreased during treatment by 46%, 52%, and 73% in groups 1, 2, and 3, respectively. In groups 2 and 3, but not in group 1, there was rebound post treatment, but significant improvements persisted at 12 weeks. The complete and partial response rates were 22.9% and 20%, respectively in group 1, 42% and 10.5% in group 2, and 62.5% and 15.6% in group 3. By Kaplan-Meier analysis, group 1 had a significantly poorer response than groups 2 and 3. Of the responders, 20%, 60%, and 40% in groups 1, 2, and 3, respectively, relapsed after stopping treatment. In conclusion, enuresis alarms and/or oral desmopressin were less efficacious in Chinese than in Western societies. Desmopressin produced an immediate effect but relapses were common. Alarms took several weeks to produce a benefit, which was persistent on follow-up.This study was carried out by the Hong Kong Childhood Enuresis Study Group. Other members are: Sonia Chang (Kwai Chung Hospital), Stella Chim (Queen Mary Hospital), Man-Chun Chiu (Princess Margaret Hospital), Kwok-Wai Lee (Queen Elizabeth Hospital), Lettie Leung (Kwong Wah Hospital), Kei-Chiu Tse (Princess Margaret Hospital), Esther Wong (Prince of Wales Hospital), Fai-To Yau (Alice Ho Miu Ling Nethersole Hospital), Chung-Kwong Yeung (Prince of Wales Hospital), and Pa-Shing Yeung (Caritas Medical Center)