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Effectiveness of an alarm intervention with overlearning for primary nocturnal enuresis

By B. Robertson, K. Yap, and S. Schuster

Journal of Pediatric Urology, Volume 10, Issue 2, April 2014, Pages 241–245

Editor’s comments:

This study addresses the issue of overlearning.  Overlearning refers to a conditioning process which begins with the consumption of additional fluid before sleep.  The extra fluid is believed to exert additional stress on the kidneys and in turn the bladder detrusor muscle involved in micturition.  The authors were able to conclude that there is a possible benefit to include overlearning to the alarm treatment, however they are unable to make conclusions on the relapse rate incidence, nor is this a prospective randomised controlled trial, which would have been interesting (4).


To explore the effectiveness of the enuresis alarm with overlearning for treatment of primary nocturnal enuresis (PNE). A key objective was to explore the effect of overlearning on treatment gains, and its impact on relapse.

Patients and methods
The RMIT University Psychology Clinic has been treating PNE in the community for more than 20 years following a standardized treatment protocol. The study analysed archival data of 126 participants, aged ≥5 years, presenting with PNE. A mean wetting frequency of 5.13 wet nights per week was observed at baseline.

Treatment significantly reduced mean wetting from baseline levels during both treatment and overlearning phases, F(1.41, 176.10) = 588.54, p < 0.001, r2 = 0.77, 95% CI (0.74–0.81). Wet nights per week reduced from a mean of 5.13 (SD = 1.77) during baseline to 1.88 (SD = 0.85) during treatment, and 0.64 (SD = 0.60) during overlearning. Alarm treatment with overlearning produced a treatment response of 87%, compared with 59% for alarm treatment only.

Evidence of improved treatment response with the addition of overlearning suggests overlearning should be considered as a potentially useful adjunct to alarm treatment for PNE. Overlearning was not unreasonably onerous for participants. Further research is required to explore the impact overlearning has on reducing relapse rates.