PRIMARY NOCTURNAL ENURESIS: A NEW APPROACH TO CONDITIONING TREATMENT FATHY GABER EL-ANANY, HESHAM ALI MAGHRABY, SALAH EL-DIN SHAKER, AND AHMAD MOHAMMAD ABDEL-MONEIM ABSTRACT Objectives. Conditioning treatment is the most effective therapy for nocturnal enuresis, precluding the use of drugs. An ordinary alarm clock can be used as an enuresis alarm. We sought to assess its clinical utility as a new means of conditioning treatment. Methods. Using the ordinary home alarm clock, 125 enuretic children were enrolled into two treatment groups. Group I included 70 children who set the alarm so as to get up and void in the toilet at a critical time when the bladder was full and they were still dry. Group II included 55 children who used the alarm to be awakened for voiding after 2 to 3 hours of sleep regardless of whether they were dry or wet. All children were motivated to use the alarm clock continuously for 4 months. Results. Initial success was achieved in 54 (77.1%) of 70 group I and 34 (61.8%) of 55 group II children. Three months after treatment was stopped, success was still maintained in 46 (65.7%) and 31 (56.4%) children in groups I and II, respectively, but dropped to 41 (58.6%) and 29 (52.7%), respectively, after 6 months. The relapse rate after 3 and 6 months was 14.8% and 24.1% for group I and 8.8% and 14.7% for group II, respectively. Conclusions. The ordinary alarm clock performs as well as currently used enuresis alarms. It is an effective, elective, noncontact alarm that does not wait for bedwetting to initiate a conditioning reflex. It is both reliable and safe. UROLOGY 53: 405–409, 1999. © 1999, Elsevier Science Inc. All rights reserved. T he problem of childhood nocturnal enuresis affects 15% to 20% of 5-year olds. 1 By adoles- cence, with or without treatment, the incidence rate drops to 1% to 2%. The condition is mostly medically benign and is subject to a high sponta- neous cure rate of approximately 15% annually. Conditioning therapy using the urinary alarm is the most effective treatment available for nocturnal enuresis. 2 However, it is not suitable for all pa- tients. Mature teenagers who are going to univer- sity or entering military service are eager to achieve a cure without calling attention to their problem. This critical group of enuretic patients provided the impetus for conditioning therapy using a readily available device—the ordinary home alarm clock. We sought to define its clinical usefulness as a new means of conditioning treatment. MATERIAL AND METHODS PATIENTS Over a 2-year period, 125 enuretic patients with mono- symptomatic, primary nocturnal enuresis participated in a new approach to conditioning therapy using the ordinary home alarm clock. A thorough history was taken, and a me- ticulous physical examination, urinalysis, and abdominal ul- trasound assessment were performed in all patients. Children younger than 7 years and those whose enuresis was secondary or polysymptomatic were not included. Patients with urinary, structural ultrasound, or clinical neurologic abnormalities were also excluded. Finally, we included only those patients who wet their beds a minimum of three times per week on average. The enuretic patients were randomly enrolled into two treatment groups and were encouraged to continue therapy over a 4-month period. Group I (70 patients) was instructed to adjust the alarm clock—with parental help—so as to allow the child to get up initially after 3 hours of sleep, either wet or dry. If wet, the 3-hour period was decreased by 15 minutes the next night. If dry, this period of sleep was increased by an extra 15 minutes. The trials were repeated until a critical time could be defined at which the child got up dry, with a full bladder, was fully awake, and went to the toilet to void. A trial period of 1 to 3 weeks was allowed to determine this optimal time. Group II (55 patients) was instructed to adjust the alarm From the Urology Department, Assiut University Hospital, As- siut, Egypt Reprint requests: Salah El-Din Shaker, M.D., Urology Depart- ment, Assiut University Hospital, Assiut, Egypt 71516 Submitted: July 15, 1998, accepted: September 14, 1998 PEDIATRIC UROLOGY © 1999, ELSEVIER SCIENCE INC. 0090-4295/99/$20.00 ALL RIGHTS RESERVED PII S0090-4295(98)00597-4 405