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A Sock Option: Compressive Externally Applied Stockings for Enuresis (CEASE Study)
David J. Chalmers, MD, Gregory J. Mills, BA, Chelsea Paterson, BSN, Brian M. Jumper, MD.
Maine Medical Center, Portland, ME, USA.

BACKGROUND: Primary nocturnal enuresis is a common condition which frustrates pediatric patients and their parents. There are many treatment options to accelerate resolution, which may be intrusive (alarm systems, acupuncture), expensive (hypnotherapy, mediations), or seem to pose unacceptable risks for a benign, self-limiting condition (medication adverse reactions).The authors examined a novel intervention which is simple, cheap and without serious side effects. The CEASE study explores the sequential use of compressive stockings in confirmed enuretic patients to decrease the number and volume of wet episodes associated with nocturnal enuresis.METHODS: Consecutive children between 6-12 years of age with a history of nocturnal enuresis were recruited from a single institution from November of 2015 to October of 2016. Inclusion criteria included primary nocturnal enuresis with a minimum of 3 enuretic events per week. Patients with less than 3 events per week or secondary enuresis were excluded. Patients were monitored over an 8 week baseline period with a calendar to confirm enuresis frequency. If the child qualified, they were given compressive, size-appropriate soccer stockings to wear at night and were asked to record their results over the subsequent 8 week intervention period. Patients were given a quality of life evaluation at the beginning, and again after a long term follow up at 24 weeks. Medication or alarm therapies were allowed to continue. Descriptive statistics and paired samples t-tests were calculated to compare the number of wet nights between the baseline and intervention periods. Results were analyzed using IBM SPSS 23.
RESULTS: A total of 71 patients met inclusion criteria and continued the study to completion. 71% (n=50) were male, and 73% (n=52) were age 8 or younger. There was a significant difference between wet nights during the baseline period (M=49.3, SD=7.86) and the intervention phase (M=43.17, SD=13.63); t (63) = 4.96, p<.001 (Frequency distribution of wet nights during each study period featured in Figure 1). Thus, there was an average reduction in 6 wet nights between the baseline period and the intervention phase; 95% CI (3.66, 8.59). Parents reported a significant decrease in volume in 25% of cases (n=18) during the intervention period. Furthermore, 59% of patients (n=38) reported some extent of reduction in wet nights, 21% reported no change (n=15), and 16% (n=11) reported an increase (see Figure 2).
CONCLUSIONS: Nighttime compressive stockings are a safe and appealing strategy for families hoping to reduce the morbidity of primary nocturnal enuresis while minimizing the expense, burden and side effects of more traditional interventions. The authors found a statistically and clinically significant benefit.

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