The efficacy of early urotherapy for severe intolerable nocturnal enuresis before the age of 5 years: A prospective randomized trial.

Introduction: Assessment of the efficacy of early urotherapy for severe intolerable NE before the age of 5 years was the main objective. Material and methods: A total of 120 children, aged between 4 and 4.5 years, with intolerable NE (bedwetting ≥5 nights/ week) were included in our study. They were randomized into group A (early urotherapy regularly until age 5.5 years) and group B (deferred urotherapy started at age 5 years for 6 months). Only 107 (54 in group A, 53 in group B) were interviewed twice, at the age of 5 and 5.5 years, to determine treatment response, categorized as complete response (100% reduction), ≥90%, 50-89%, or <50% reduction in bedwetting during the preceding month. Parental adherence to urotherapy was evaluated using a structured 7-day diary and adherence checklist. In addition, their distress was evaluated and followed up using general health questionnaire-12 (GHQ-12) score. Results: Complete response through the last month was significantly higher in group A than group B at 5-year-old or 5.5-year-old visits (12 vs 6, 25 vs 10 children, respectively, p <0.05). Also, <50% reduction of bedwetting was significantly higher in group B than in group A in both visits (32 vs 27 and 23 vs 9 children, respectively, p <0.05). Both groups showed comparable levels of adherence to their protocol. CHQ-12 scores were significantly lower in group A than in B at the first visit, while no difference was observed at the second visit. Conclusions: Early urotherapy in children with intolerable nocturnal enuresis could enhance rapid recovery and reduce psychological distress.