Singapore Med J 2009; 50(9) : 879
O r i g i n a l A r t i c l e
Ankara Gazi Hospital,
Özgür BC, MD
Dr Sami Ulus
Özgür S, MD
Doğan V, MD
Örün UA, MD
Dr Berat Cem Özgür
Tel: (90) 312 417 8421
Fax: (90) 312 212 6675
The efficacy of an enuresis alarm in
monosymptomatic nocturnal enuresis
Özgür B C, Özgür S, Doğan V, Örün U A
Introduction: Monosymptomatic nocturnal
enuresis (MNE) is a frequent problem in children
older than five years of age. Of the various
treatment options, the enuresis alarm has been
widely advocated for treating nocturnal enuresis.
This study was designed to evaluate the success
rates of the enuretic alarm device in patients with
Methods: 40 patients who had significant MNE
(three or more wet nights per week) were included.
They used an enuretic alarm for 12 weeks initially.
If a relapse was observed, reusage of the device was
provided. A success criterion was defined as “14
consecutive dry nights” and a relapse criterion was
“more than one wet night a week”.
Results: The patients’ mean age was 8.1 (range
6–16) years and the mean follow-up time was 10.2
(range 6–19) months. 27 patients became dry at
night at the end of three months. In the follow-up
period, a relapse was observed in 66.7 percent of
the initial responders. For recovery, 14 patients
started to reuse the device, and seven of them
responded positively. At the end of the treatment,
a total of 13 of the patients had benefited from the
Conclusion: During the follow-up, the enuretic
alarm device provided acceptable initial and
long-term complete dryness in patients with
primary nocturnal enuresis. Without the need
for expensive pharmacological intervention, the
alarm treatment is an effective choice for children
with nocturnal enuresis.
Keywords: enuresis alarm, monosymptomatic
nocturnal enuresis, nocturnal enuresis, primary
Singapore Med J 2009; 50(9): 879-880
Monosymptomatic nocturnal enuresis (MNE) is a very
common clinical problem that affects up to 20% of children
at five years of age, and nearly up to 2% of young adults.
It can be defined as the involuntary voiding during sleep
beyond the age of five years when night-time bladder control
is expected. This very common clinical problem may be
frustrating to the affected children and their parents.(1) The
literature reports a variety of potential treatments (e.g.
enuresis alarms, imipramine, desmopressin, oxybutinin,
and complex regimens such as dry-bed training). The
present study was conducted to evaluate the success rates
of alarm therapy on nocturnal enuresis.
The trial was conducted in healthy children aged 6–16
years, referred to the urology or paediatric clinics of two
different centres, for significant MNE (defined as three
or more wet nights per week). The female/male ratio was
1:2. After detailed history-taking and careful physical
examination, patients with obvious growth retardation,
positive urinanalysis and positive urine cultures were
excluded. Both the parent and child were given an
explanation of the treatment rationale and a demonstration
of the alarm system being used. The device consists of a
battery-operated detector which is activated by urine. Fluid
intake was not restricted. The children were then asked to
use the same type of enuresis alarm every night until they
had completed a maximum trial period of 12 weeks. Our
criterion of initial success was14 consecutive dry nights
before the conditioning therapy was stopped. According to
the number of wet nights after 12 weeks of treatment, the
patients were defined as responders or non-responders. A
relapse was defined as the reappearance of > 1 wet night
per week for responders. Further follow-up data was
maintained by hospital visits or via telephone. The results
were assessed statistically using routine statistics and
expressed as mean ± standard deviation.
The mean age of the patients was 8.1 (range 6–16) years and
the mean follow-up time was 10.2 (range 6–19) months. At
the end of treatment at 12 weeks, all patients were seen in
the clinic, and it was noted that 27 patients had benefited
from the enuretic alarm. In the follow-up period at three
months, a relapse was observed in 66.7% (18/27) of these
Singapore Med J 2009; 50(9) : 880 Download full-text
patients. 14 patients reused the enuretic alarm device for
another three months after the relapse and seven (50%)
patients responded. Although a re-relapse was observed in
three of them three months later, four patients had a full
response. In total, 32.5% (13/40) of the patients maintained
a full response after the enuretic alarm treatment in the long-
term follow-up. The results are summarised in Fig. 1.
As MNE is a disease that often results in many psychological
problems both for the parents and the child, it is important
for the condition to be treated. Enuresis alarms have
played a very easy and effective role in the treatment of
bed-wetting in children over the past five decades, and they
undoubtedly effect a cure in a high proportion of enuretic
children. With moisture-detecting fasteners that attach to
the child’s underwear, one or two drops of moisture will
set off the alarm before the bed gets wet. A matchbox-
sized light (nearly 40 g) portable alarm device is used like
a watch by the patient. The alarm is connected to a very
small moisture-sensitive plate. The plate is placed inside
an absorbent disposable towel and attached to the child’s
underwear. The plate has no contact with the skin. With
the onset of urination, the sensor and the buzzer activate in
order to awake the child. With repetition, an unconscious
reflex is usually developed. Primarily, nocturnal enuretic
children with supportive parents have a better prognosis.
Our study was based on a success criterion of 14
consecutive dry nights. In our series, an initial arrest of bed-
wetting in 40 children was 67.5%, compared to other trials
which have reported an initial success rate of 30%–70%.(2-4)
The relapse criterition was defined as more than one wet
night per week after dryness was achieved. Our long-term
data showed that relapse is the main problem of this therapy.
Due to the variable length of the treatment period for both
child and parents, the possibility of a family disruption is an
important detail which should not be overlooked. It is also
crucial for both parents and child to actively take part in
the treatment.(5) Unfortunately, treatment with bed-wetting
alarms has a dropout rate of 10%–30% because of familial
factors like the family situation, behavior deviance in the
child and the educational level of the parents.(6)
In our study, at the end of the third month, 13
patients were in the non-responders group and most did
not complete the treatment period because of the above-
mentioned reasons. While deciding the optimal treatment
for a child with nocturnal enuresis, the family’s motivation,
financial status and home situation must be kept in mind.
In our study, at the end of a one-year period, 32% (13/40)
patients achieved complete dryness. In consideration of its
acceptable success and relapse rates, an alarm system can
easily be the first-line treatment for many children. It should
however be noted that MNE could be the cause of multiple
factors like nocturnal polyuria or a small bladder capacity,
unless complete dryness exists.(7-8) Treatment can also be
combined with medical therapy to create an individual
treatment in cases of refractory monotherapy or to increase
the success rates.(9) Pharmacotherapy can provide the
dryness early, while a behavioural intevention leads to long-
term benefits. The patients would also be encouraged after
achieving early onset success with pharmacotherapy.
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treatment and nontreatment. J Pediatr 1989; 114(4 Pt 2):697-704.
2. Fai-Ngo Ng C, Wong SN; Hong Kong Childhood Enuresis Study
Group. Comparing alarms, desmopressin, and combined treatment
in Chinese enuretic children. Pediatr Nephrol 2005; 20:163-9.
3. Butler RJ, Robinson JC. Alarm treatment for childhood nocturnal
enuresis: an investigation of within-treatment variables. Scand J
Urol Nephrol 2002; 36:268-72.
4. Van Leerdam FJ, Blankespoor MN, Van Der Heijden AJ, Hirasing
RA. Alarm treatment is successful in children with day- and night-
time wetting. Scand J Urol Nephrol 2004; 38:211-5.
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Nurs 2000; 14:4-6.
6. Rocha MM, Costa NJ, Silvares EF. Changes in parents’ and self-
reports of behavioral problems in Brazilian adolescents after
behavioral treatment with urine alarm for nocturnal enuresis. Int
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7. Lottmann HB, Alova I. Primary monosymptomatic nocturnal
enuresis in children and adolescents. Int J Clin Pract Suppl 2007;
8. Yeung CK, Chiu HN, Sit FK. Bladder dysfunction in children with
refractory monosymptomatic primary nocturnal enuresis. J Urol
1999; 162(3 Pt 2):1049-54.
9. Zaffanello M, Giacomello L, Brugnara M, Fanos V. Therapeutic
options in childhood nocturnal enuresis. Minerva Urol Nefrol
Fig. 1 Timeline chart shows the distribution of the patients by
relapse and response.
7 did not
13 did not