Treatment Algorithm

OFFICE MANAGEMENT OF PEDIATRIC PRIMARY NOCTURNAL ENURESIS - A COMPARISON OF PHYSICIAN ADVISED AND PARENT CHOSEN ALTERNATIVE TREATMENT OUTCOMES

Dawn Diaz Saldano MSN, CPNP, Antonio H. Chaviano MD, Max Maizels MD, Elizabeth Y.Yerkes MD, Earl Y. Cheng MD, Jennifer Losavio BS, Sima P. Porten MD, Christine Sullivan MS, Kerry F. Zebold MSN, CPNP, William E. Kaplan MD

Table 1 – Algorithm of Try for Dry Treatment of Bedwetting

ABSTRACT

Purpose
We compared the remission of pediatric PNE in groups of children who used a physician advised practice plan versus a parent chosen alternative.

Material and Methods
There we 119 children enrolled in this prospective non-randomized study. Seventy-six children received the physician advised treatment plan and used alarm, oxybutynin, desmopressin, an elimination diet and a bowel program, if indicated. Forty-three children received a parent chosen alternative treatment plan which consisted of any single or combination of treatments involving alarm, oxybutynin, desmopressin, and elimination diet or bowel program. Parents from each group completed an intake survey which measured functional bladder capacity by 3-day home diary and they identified demographic variables. Follow up occurred at 2 weeks then monthly for 12 weeks (end of study).

Results
We found that the probability of remission by the end of the study for the physician advised treatment group (88%) is significantly higher than the parent choice group. (29%) (p<0.0001, Kaplan Meier curve)

Conclusions
We conclude that the group of children who followed the physician advised treatment of PNE showed a significantly earlier remission of PNE (25th percentile is 2 weeks) than children who followed parent choice treatment (25th percentile is 10 weeks).

Sharing Study Results with Families
In order to make it easy to share the results of this study with parents, we presented a simplified version of the Kaplan Meier curve in the Parent Resource section of this site.