The Role of Timed Awakening in Treatment of Enuresis

• Nightly Timed Awakening (Behavioral), also known as Lifting: Patients in this arm will be awakened 1-hr after going to bed by their caregiver(s) to use the restroom and then returned to sleep. This awakening will occur every night.

Primary outcomes

• Mean number of wet nights reported in electronic survey weekly for 12-weeks [Baseline to 12-weeks]: All study participants will report bed wetting via redcap electronic survey 1x/week for a 12-week period.

Secondary outcomes

• Mean change from baseline in the number of wet nights/week reported in electronic survey [Baseline to 12-weeks]: All study participants will report bed wetting via redcap electronic survey 1x/week for a 12-week period.
• Percentage of patients with increased number of wet nights at 24-week follow-up as reported in electronic survey. [24-weeks post-intervention]: All study participants will report bed wetting via redcap electronic survey 24-week after completion of intervention
• Mean number of nights reported weekly in electronic survey with timed awakening for 12-week period for intervention arm. [Baseline to 12-weeks]: Intervention arm will report bed wetting via redcap electronic survey 1x/week for a 12-week period.
• Mean number of daytime accidents/week at baseline, end of 12-weeks and 24-weeks follow-up. [Baseline to 24-week follow-up]: All study participants will report bed wetting via redcap electronic survey 24-week after completion of intervention
• Mean satisfaction score obtained from patient and parental satisfaction questionnaire. [Baseline to 12-weeks]: Mean Patient and Parental Satisfaction Scores (Pq-EnU behavioral sub-score) will be collected via telehealth sessions.

Sex: All, ages: 6 Years to 17 Years

Inclusion Criteria:

* Our inclusion criteria are new and recently evaluated (within past 6 months) patients who are English-speaking
* aged 6-17
* referred to the urology clinic for enuresis (Enuresis in our study is defined as nocturnal or diurnal enuresis (more than 1 bedwetting episode/week) for greater than 3 months)

Exclusion Criteria:

* Diagnosis of enuresis with comorbid diagnosis of diabetes mellitus (type 1 and 2), diabetes insipidus, chronic kidney disease, polyuria and/or polydipsia
* Structural urologic disease (evaluated via baseline imaging)
* Diagnosis of neurodevelopmental delays or conditions (i.e. celebral palsy, autism spectrum disorder) that hinders inability to follow age-appropriate instructions
* Not potty trained
* Improved or resolved enuresis for patients recently evaluated (within the past 6 months)
* Non-English speaking
* Patients currently on any over-active-bladder (OAB) medications (b3- agonists, antichloingerics) or alpha blockers for urinary symptoms (i.e. alfuzosin, tamsulosion, etc) or anti-diurectic medications for urinary symptoms (i.e.: desmopression (DDAVP))
* Patients currently using bed-wetting alarms
* Patients and families who are actively seeing Pediatric Clinical Urologic Psychologist.
* Inability or unwillingness of individual or legal guardian/representative to give written informed consent or participate in the study

• Evalynn Vasquez, MD, Principal investigator, Children's Hospital Los Angeles