Abstract General Information

Title

SITTA: A PROSPECTIVE SHORT AND INTENSIVE ENURESIS ALARM TREATMENT QUALITY IMPROVEMENT STUDY

Introduction and objective

Optimising the “Short and Intensive enuresis Treatment with one of Two Alarms” (SITTA) protocol, and obtaining preliminary outcomes of the SITTA program during a two-year study period. Presented at the Irish Paediatric Association annual conference in 2019.

Method

Prospective non-randomised paperless study, testing the effectiveness of two different high-quality enuresis alarms, in a maximum 12-week intensive (2-weekly appointments) bedwetting treatment programme, using the SITTA protocol. Either a body-worn (Malem, M024) or bell-and-mat alarm (Ramsey-Coote, RCA) was used, free of charge. The study protocol, prospective clinical data, and outcomes were recorded electronically on eHR EEF. ICCS standardised outcome measures used were enuresis type, Initial Success (IS), Complete Response (CR) based on percentage reduction in wet nights, Relapse Rate and Continued Success at 6 months. A comparison was made with the established local enuresis clinic outcome measures.

Results

The study population was 34 children with monosymptomatic enuresis (ME) or non-monosymptomatic enuresis (NME) with minimal LUTS. The mean time to achieve IS was 53 days versus 87 days in the local clinic. Overall mean time to IS was 48 days with RCA and 60 days with Malem024. 97.1% achieved IS compared to 59.5% in the local clinic. 91% achieved Complete Response at 12 weeks. Overall Relapse Rate was 24%; 17% for ME and 31% for NME. Initial Success and Relapse Rate were not affected by alarm type. As the study progressed, the protocol was refined to improve patient engagement with daily pre-sleep practice runs. DNA rate was close to 0% and dropout 0%. All equipment was returned when the treatment was completed.

Conclusion

The SITTA protocol achieves a very high rate of IS, within a shorter time-frame than our established local enuresis clinic. Relapse rates compare favourably with other studies. Alarm type does not affect Initial or Continued Success rates. A randomised study with larger numbers to confirm this initial result is required with the adjusted SITTA study protocol. Implementing SITTA in a day-to-day clinic setting with staff of variable expertise and assessing the effectiveness of SITTA in practice is critical.