In the first instance, the international medical literature
generally opts for therapy based on an
alarm system
together with professional monitoring, followed by treatment
with desmopressin.
Alarm system:
Consists of a device that issues an acoustic signal when
the first drops of urine are released, thereby creating
a conditional reflex. The cure rate is initially 80-90%
and around 75% in the long term.
Relapse generally requires a second treatment cycle, which
is effective in up to 98% of cases.
The average duration of this treatment is 8-10 weeks, and
we recommend starting treatment once children have reached
the age of five.
The treatment is also effective for adults, as demonstrated
by Dr. A. Van Londen of the University of Utrecht.
According to the Spanish paediatrician Dr. Luis Santos Serrano,
the reason for the low awareness levels of these systems
in Spain is simply a consequence of inadequate marketing.
Imprimine:
The medicines known as tricyclic antidepressants are no
longer recommended for the treatment of enuresis because
it is associated with several severe side-effects.
Desmopressin:
Intranasal desmopressin has certain side-effects and several
drawbacks. On the one hand It is expensive (€60-120
per month, if the manufacturer’s recommended dose
is followed), while, on the other, relapse is virtually
inevitable when the medication is discontinued.
The best treatment plan according to the latest scientific
knowledge:
The best treatment plan available today is, first, a medical
examination including analysis and professional evaluation
of the urine and sediment.
If a diagnosis of nocturnal enuresis is confirmed, treatment
will begin with advice and a schedule. This alone is sufficient
to solve the problem in 19% of cases.
During
a second stage the use of an alarm system is recommended
for children aged over five, plus—and this is very
important, as a considerable amount of international research
has shown—proper monitoring of this treatment to optimise
the results obtained.
A third stage will begin with a further cycle of the alarm
system, in cases that have not responded to treatment, once
a period of at least 6-8 months has elapsed since the end
of the first cycle. If possible, monitoring will be even
more intensive during this stage.
A fourth stage may feature the use of desmopressin for children
who need to stay dry for a certain period of time (during
camps or school trips, for example). This medication may
also be prescribed as a restricted maintenance arrangement
in teenagers resistant to other treatment, with constant
monitoring to watch out for any side-effects.
For such teenagers, the University of Utrecht has an
intensive Dry Bed Treatment Programme which has a 60% effectiveness
rate. This treatment combines Elther alarm systems
with one week’s hospital admission at the Kinderniercentrum
del Wilhel-mina Kinderziekenhuis (the children’s hospital
associated with the University).
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