Establishment of working definitions in nocturnal enuresis.

Studies of childhood nocturnal enuresis have traditionally used various criteria both to select children for treatment and measure its outcome. To make comparison possible among studies an agreed set of working definitions are needed.' The figure gives a flow chart by which the terms used in this paper are placed in context. Inclusion criteria The following characteristics of enuretics being studied should be included: * Age, including the range for acceptance in the study, and the mean and actual age range of those children enrolled * Number of boys and girls * Presence or absence of organic disease * Number of children with associated diurnal enuresis (such children may respond differently to treatment interventions).2 'Daytime wetting' requires definition and may be the occurrence of one or more daytime wetting incidents over a two week period * The severity of bedwetting before treatment. In a review of 32 studies,' only 38% of papers reported severity: moreover the number of wet nights/week to be included in the study ranged from one to seven.23 A baseline period of observation is recommended: from Referral with nocturnal enuresis Criteria for inclusion Outcome of treatment Initial success Lack of success Drop out Continued success (6 months) Yes No Relapse Complete success (2 years) No Replase A flonv chart ofnomenclature. the patient's point of view four weeks is probably the maximum length. The suggested inclusion criterion for an individual child is 50% or more wet nights in a two week period. When the emphasis of a study is focused on those children who wet less than 50% of nights and are more difficult to treat, the degree of severity of wetting should be clearly stated. Initial success Initial success is usually described as the achievement of 'an extended number of dry nights'. A working definition requires consideration of two issues: an agreement on what constitutes 'an extended number of dry nights', and the necessity to specify the duration of treatment. I reviewed a range of published reports to clarify the criteria used in practice (table 1). Reports were included in the analysis if they fulfilled the following criteria: * They were published since 1969 (covering the last 20 years) * At least 12 children in the study received treatment * A definition of 'initial success' was included in the methods section * Treatment was of a 'conditioning' nature (that is, pad and bell, body alarm or dry …