Exploring clinical and urinary factors in treatment-resistant vs. treatment-responsive childhood enuresis: a comparative study

Abstract

Abstract Background Nocturnal enuresis represents a persistent pediatric health challenge characterized by variable treatment responses. Despite established therapeutic interventions, a substantial proportion of children fail to achieve successful management, highlighting the critical need for a deeper understanding of treatment resistance mechanisms. This study sought to systematically examine the multifaceted factors underlying differential treatment outcomes in childhood enuresis. Methods A cross-sectional analytical study was conducted in 2017 at Mohammad Kermanshahi Hospital, Iran. The study included 144 children aged 5–8 years with nocturnal enuresis, divided into treatment-controlled (n = 85) and treatment-resistant (n = 59) groups. Participants received Desmopressin nasal spray (DDAVP) at 10 mcg/spray nightly. Demographics, clinical characteristics, sleep patterns, urination habits, and ultrasound findings were analyzed. Results The prevalence of controlled nocturnal enuresis was higher than treatment-resistant cases. Factors, including abnormal residual urine volume (P-value = 0.04), one episode of bedwetting per night (P-value = 0.03) and more than one episode of bedwetting per night (P-value = 0.02) were found to be statistically significant in our findings. Factors more common in the treatment-responsive group included deep sleep (85.9%), daytime urinary control (77.6%). Conversely, treatment-resistant children exhibited higher rates of poor medication adherence (94.9%), high urine volume per episode (86.4%), although these parameters were identified as non-statistically significant in our study. Conclusion This study highlights critical factors differentiating treatment-resistant from treatment-responsive nocturnal enuresis in children. Key factors such as deep sleep, daytime urinary control, and effective fluid management were associated with controlled enuresis, while treatment-resistant cases were marked by poor adherence to medication, high urine volume per episode, and frequent enuresis. Future research should explore long-term efficacy and innovative approaches to enhance the management of nocturnal enuresis. Clinical trial number Not applicable (This was a cross-sectional analytical study and did not involve a clinical trial).

Keywords

• Nocturnal enuresis
• Treatment resistance
• Childhood
• Desmopressin
• Urinary incontinence