Most controlled studies evaluating the efficacy of treatment for nocturnal enuresis exclude children who fail prior therapy while requiring motivated families to make several visits for further assessment. We evaluate the efficacy and satisfaction of a large population of children referred to a tertiary care center for enuresis. All patients were seen by the same pediatrician. The consultation lasted 45 minutes and included obtaining a history, physical examination, and urinalysis with discussion regarding etiology and treatment modalities. Specific treatments were demonstrated and pertinent literature was distributed. Contact was established with the families of 294 of 373 (79%) children seen between 1993 and 1996 followed at least 12 months after their initial evaluation. The mean age of the population contacted was 10.2 years (range 5-18 years) with 65% males. Over 90% wet at least 3 nights/week. A first degree relative with enuresis was reported in 50% of cases. Secondary enuresis was seen in 9% and 37% had mild diurnal symptoms(urgency and frequency). Prior therapy in the form of a nocturnal enuresis alarm was used in 87%, intranasal desmopressin (DDAVP) in 73% and imipramine in 20%. Only 15 children (5%) were untreated. After the consultation 31% chose an alarm, 22% DDAVP, and 21% combination therapy including, in 25/62, oxybutynin. No therapy was selected in 24%. At 12 months 56% using the alarm were cured, defined as at least one month of consecutive dry nights, compared to 18% using DDAVP, 16% using oxybutynin and 28% without therapy (p<.0001 alarm vs. DDAVP; p=.0002 alarm vs. none). No significant differences in response were seen when comparing ages, gender, primary vs. secondary onset and in those with diurnal symptoms vs. those with isolated enuresis. Of those responding to the alarm, 43% sleep through the night and 23% awaken almost every night. Over 92% of families expressed satisfaction with the consultation. We conclude that the alarm is superior to other treatments for nocturnal enuresis and should be considered even in recalcitrant cases. Satisfaction can be obtained if pediatricians familiarize themselves with the proper use of all forms of therapies and effectively impart this information to their families.