The primary treatment for nocturnal enuresis includes:

The primary treatment for nocturnal enuresis includes:

• A. DDVAP (desmopressin)
• B. Behavioral interventions
• C. Surgery to increase bladder capacity
• D. Double voiding

Answer: (B)

The approach that targets behavior and learning is the best first option because primary nocturnal enuresis often improves when children are trained to respond to a full bladder at night. Enuresis alarm therapy provides immediate feedback by waking the child when urine begins to flow, creating a conditioned response that helps the child wake up before or during urination. With consistent use, this behavioral method yields durable dryness because it changes the nighttime arousal pattern and bladder–wake association, addressing the underlying habit rather than simply reducing urine production. Desmopressin can help reduce nighttime urine production and may provide rapid improvement, but its effects typically stop when the medication is stopped and it doesn’t teach the child to wake up, which is why it isn’t considered the primary long-term solution. Surgery to increase bladder capacity isn’t a standard or routine approach for pediatric bedwetting and doesn’t address the waking mechanism. Double voiding focuses on emptying the bladder but isn’t a primary intervention for nocturnal enuresis.

The approach that targets behavior and learning is the best first option because primary nocturnal enuresis often improves when children are trained to respond to a full bladder at night. Enuresis alarm therapy provides immediate feedback by waking the child when urine begins to flow, creating a conditioned response that helps the child wake up before or during urination. With consistent use, this behavioral method yields durable dryness because it changes the nighttime arousal pattern and bladder–wake association, addressing the underlying habit rather than simply reducing urine production.

Desmopressin can help reduce nighttime urine production and may provide rapid improvement, but its effects typically stop when the medication is stopped and it doesn’t teach the child to wake up, which is why it isn’t considered the primary long-term solution. Surgery to increase bladder capacity isn’t a standard or routine approach for pediatric bedwetting and doesn’t address the waking mechanism. Double voiding focuses on emptying the bladder but isn’t a primary intervention for nocturnal enuresis.