Predictors of response and adherence to enuresis alarm therapy-a confirmatory study.

AIM: To look for predictors to response and adherence to the enuresis alarm while exploring the possibility of families managing therapy independently. METHODS: We used a body-worn alarm linked to a smartphone app. Subjects with enuresis were recruited both via paediatric nurses and independently as families bought the alarm and downloaded the app on their own. RESULTS: We recruited 385 nurse-supported and 1125 independent subjects. Many (79.9%) dropped out before 8 weeks, but among adherent subjects 48.2% had a full or partial response. Age was a predictor of non-response (p = 0.019). Daytime incontinence did not influence response. If enuresis frequency did not decrease during the first 4 weeks of therapy the chance of response was very small (p < 0.001). Adherence was higher among subjects supported by a nurse (p < 0.001), but for adherent subjects the outcome was similar regardless of nurse support (p = 0.554). CONCLUSIONS: Daytime incontinence is no contraindication to enuresis alarm therapy. Treatment can be managed independently by the families, but adherence is enhanced by nurse support. Alarm treatment should be reassessed after 4 weeks. Enuresis alarm treatment guidelines need to be updated.

Can enuresis alarm therapy be managed by the families without the support of a nurse? A prospective study of a real-world sample.

AIM: The alarm is the first-line treatment of nocturnal enuresis. However, the therapy is labour-intensive for both families and healthcare providers. Our aim was to see whether the treatment could be successfully used by the families, without support from healthcare providers. METHODS: An alarm linked to an application on a parent's smartphone was used. The app recorded enuretic events and gave instructions. Group A were children supported by a nurse. Group B were patients whose families had bought the alarm and downloaded the app independently. RESULTS: There were 196 children in group A and 202 in group B. The percentages of full responders, partial responders, non-responders and dropouts were 18.4%, 20.4%, 22.4% and 38.8% in group A and 13.4%, 11.4%, 14.9% and 60.4% in group B. The risk for dropping out of therapy was higher in group B (p < 0.001), whereas the chance for adherent children to become dry did not differ between the groups (p = 0.905). CONCLUSION: For families who are able to adhere to alarm therapy the chance of success is just as good when managed independently as when supported by a nurse. But the latter children will have a greater chance of adhering to the full treatment.

The value of case history and early treatment data as predictors of enuresis alarm therapy response.

BACKGROUND AND AIM: Two central problems with the enuresis alarm are the family workload and the lack of predictors of therapy response. We wanted to look at predictors of alarm response in a setting reflecting clinical reality. METHODS: An alarm linked to a smartphone app was provided to enuretic children managed at pediatric outpatient wards. Baseline data (sex, age, daytime incontinence, urgency, previous therapies, arousal thresholds and baseline enuresis frequency) were recorded. Further information, such as enuretic episodes and actual alarm use, was gathered via the app during therapy. Therapy was given for 8-12 weeks or until 14 consecutive dry nights had been achieved. RESULTS: For the 196 recruited children the outcome was as follows: full responders (FR) 18.4%, partial responders (PR) 20.4%, nonresponders (NR) 22.4% and dropouts 38.8%. We found no clear predictors of response or adherence among baseline data. But as treatment progressed responders reduced their enuresis frequency as compared to NR (week two P = 0.003, week three and onwards P < 0.001). This is further illustrated in the Figure below. Furthermore, the children unable to complete the full treatment had more non-registered nights already from the second week (week two P = 0.005, week three P = 0.002 and so on). DISCUSSION: Anamnestic data give little predictive information regarding enuresis alarm response or adherence. Contrary to common belief neither daytime incontinence nor previous alarm attempts influenced treatment success. But after 2-4 weeks of therapy the children with a good chance of treatment success could be discerned by decreasing enuresis frequency, and the families that would not be able to comply with the full treatment showed incomplete adherence already during the first weeks. CONCLUSIONS: Maybe the enuresis alarm strategy should be changed so that the treatment is reassessed after one month and only children with a high chance of success continue. This way, unnecessary frustration for the families of therapy-resistant children may be reduced.

The Abbé flap in cleft lip and palate repair.

The Abbé flap is a procedure where the volume of the upper lip is increased at the expense of the lower lip. This study reviewed the Abbé flaps done at Skåne University Hospital during the years 1991-2006 and identified 14 patients. Data was collected from medical records. Eleven patients were deemed fit for interviews and were called to the hospital by standard mail. Six patients responded and were interviewed, examined, and photographed. One patient was interviewed over the telephone. Median age at surgery was 14 years (range = 6-22). The operation time was 152 minutes (range = 90-215). The Abbé flap was divided after 12 days (range = 11-16). All 14 flaps survived and no complications were noted. Secondary corrections were done in nine patients. Three patients experienced having their lips sutured together as difficult, and four patients described this period as easy. All patients described their lips as having better appearance after the operation and, in three of four cases, where a simultaneous columella lengthening was done, the patients described their noses as having better appearance. The scar on the lower lip was negative but also a prerequisite for the operation. All seven patients said the operation was worth all the effort and would recommend it to patients in similar situations. This data supports that the Abbé flap is a safe technique that effectively improves the appearance of the upper lip and satisfies the cleft lip and palate patients.