Investigating the three systems approach to complex childhood nocturnal enuresis
Medical treatment interventions

Abstract

Objective: Nocturnal enuresis is a heterogeneous condition with various treatment options of both pharmacological and psychological origin. The three systems model previously proposed by us suggests a framework to facilitate understanding, identify a child's needs and specify the appropriate treatment option. In this study we sought to investigate the model in clinical practice in a group of children with severe nocturnal enuresis, with particular reference to pharmacological treatment.

Material and Methods: A total of 66 children were assessed using a schedule for identifying mono‐ and non‐monosymptomatic nocturnal enuresis, and were administered either desmopressin (0.4 mg) or anticholinergic medication (5–10 mg), respectively. Children were assessed at 4 weeks, with those failing to meet the success criterion being offered combination treatment for a further 4 weeks.

Results: Success rates for monotherapy were 49% and 33% for desmopressin and anticholinergic medication, respectively, with an overall success rate of 74.5%, including those who went on to combination treatment. Good clinical signs were identified for those successfully treated with anticholinergic medication.

Conclusions: This study endorses the three systems approach in clinical practice.

• nocturnal enuresis
• pharmacological treatment
• three systems approach