Desmopressin compared to alarm for treatment

Evans, Malmsten, Maddocks, Popli, and Lottmann (2011) compared long term (6 month) desmopressin with alarm treatment for bedwetting.    Thirty-two percent of patients will have a 50% reduction in wet nights and 37% of patients will be dry with the alarm.  This is compared with desmopressin having 37.5% had a 50% reduction of wet nights and 32% had a complete resolution.  The drop out rate is very high with the alarm, 32% compared to desmopressin of only 7%. Those in the alarm therapy group lost 1 hour of sleep a night. At 12 months ~50% of both groups that responded to therapy (14 dry consecutive nights) remained dry.  Unfortunately, more of the alarm patients were lost to follow up.

My opinion: Desmopressin and alarm therapy have comparable results.  It all boils down to your social situation.  If you are commited to using the alarm and prepared to lose 1 hour of sleep a night my preference would be the alarm over medication.  The most common reason for stopping alarm therapy was patient preference. This is why it’s so important to have your child engaged before starting treatment.  If you know with certainty you are not able to get up in the middle of the night with you child to help them void and clean up, desmopressin would be a reasonable treatment plan.

Evans, J., Malmsten, B., Maddocks, A., Popli, H. S., & Lottmann, H. (2011). Randomized comparison of long-term desmopressin and alarm treatment for bedwetting. Journal of Pediatric Urology, 7(1), 21-29. doi:10.1016/j.jpurol.2010.04.018

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