Unlocking the puzzle of primary monosymptomatic nocturnal enuresis: a comprehensive study on the management of Thai children through alarm therapy and medication.

Background: Primary monosymptomatic nocturnal enuresis (PMNE) is a common pediatric condition that can improve with age but can profoundly impact self-esteem and quality of life. Despite the availability of treatment options in Thailand, there are no standardized guidelines. This study aimed to evaluate the efficacy of three approaches: enuresis alarm, pharmacological intervention, and their combination, to provide evidence-based recommendations for culturally relevant clinical guidelines for PMNE and explore factors influencing treatment efficacy. Methods: A 5-year retrospective study was conducted on 300 children aged 5-18 years treated for nocturnal enuresis at Queen Sirikit National Institute of Child Health from 2020 to 2024. Of these, 140 children with PMNE underwent an initial 2-week trial of alarm therapy, followed by further treatment based on response. Non-responders received either medication alone or a combination of alarm and pharmacological intervention. Outcomes, recurrence rates, and predictive factors were analyzed. Results: Among the 140 children (mean age 11 years, predominantly male), 52 showed improvement with alarm therapy. Forty-eight out of 88 non-responders opted for combined treatment and 40 for medication alone. All groups demonstrated improvement at 3 months. Recurrence rates at 6 months were highest in the medication group (50%), compared to combined therapy (13.79%) and alarm therapy (7.69%). Conclusions: Alarm therapy is highly effective for PMNE and normal nighttime urination. For children with nocturnal polyuria, combined therapy is recommended. Medication alone is less effective due to higher recurrence rates.