Naitoh Y et al. (2005) Combination therapy with alarm and drugs for monosymptomatic nocturnal enuresis not superior to alarm monotherapy. Urology 66: 632–635

In contrast to previous findings, a new study by Naitoh and colleagues in Japan has shown that alarm monotherapy is just as effective as alarm and drug combination therapy at treating monosymptomatic primary nocturnal ENURESIS.

The authors divided 105 enuretic patients (76 boys and 29 girls, aged 6 to 13 years) into three treatment groups: alarm therapy alone (n = 37), combination therapy with alarm and desmopressin (n = 35), and combination therapy with alarm and imipramine (n = 33). Patients kept an enuresis diary which was assessed at hospital visits every 1.5 months. The efficacy of the treatments was evaluated at 3 and 6 months from the start of the study.

When the team statistically analyzed the results, they found that the frequency of wet nights had significantly decreased in all three groups, but there were no significant differences among the groups. The improvement rates were greater in the combination-therapy groups, while the cure rates were greater and the relapse rates lower in the alarm monotherapy group. The authors concluded that there are no advantages in combination therapy over monotherapy. Predictive factors were investigated but none was identified.

The main improvements in the monotherapy group occurred during the first 3 months of treatment, with little improvement seen over the following 3 months. Based on their findings, the authors advocate treating patients with alarm therapy initially, but considering other therapies if insufficient improvement is seen after 3 months of treatment.