Research and Clinic Results
TheraPee is built on the treatment model developed by Dr. Jacob Sagie, Ph.D., at the Enuresis Clinic of Schneider Children's Medical Center (SCMCI). This page publishes the clinic's outcome report in full, along with the published work of Dr. Jacob Sagie and Dr. Tal Sagie, Ph.D.
Summary of the SCMCI clinic report (1994 to 2002)
- 3,004 patients aged 4 to 35 started treatment at the clinic between November 1994 and October 2002.
- 2,308 patients had completed treatment by the report date (October 2002).
- Of the 2,308 who completed treatment, 2,119 stopped wetting (91.8%), 44 improved (1.9%) and 145 did not improve (6.3%).
- In most cases, treatment lasted 3 to 5 months.
Some of the 3,004 patients were still in active treatment when the report closed, since treatment lasts 3 to 5 months. The 91.8% figure refers to patients who completed treatment in the clinic. It is a clinic result, not a trial of the TheraPee online program, which is built on the same treatment model.
View the original report (scan, PDF)
Full text of the report
Transcribed from the original two-page report. Wording and figures are reproduced as in the original, except that the hospital name is given in short form and the report footer with the hospital's address and contact details is left out. The original scan is linked above.
ENURESIS CLINIC IN SCMCI, NOVEMBER 1994 - OCTOBER 2002
JACOB SAGIE, Ph.D.
BACKGROUND
The Enuresis Clinic at "Schneider Children's Medical Center" (SCMCI) was opened in November 1994. According to initial estimations approximately 200 patients would be seen in the Enuresis Clinic during the first year of operation. In fact 562 patients were referred. This enormous increase in number of patients led to extension of the clinic's activity by 15 hours each week.
This report, summarizes 8 years of operation of the Enuresis Clinic at SCMCI.
Until October 2002 3004 patients, aged 4-35 years, started their treatment at the Enuresis Clinic, of whom 2308 patients completed their treatment. In most cases duration of treatment was 3 - 5 months. 2119 ceased wetting - a 91.8% success rate.
TABLE 1
| Age | Male | Female | Total | % |
|---|---|---|---|---|
| Up to 5 | 132 | 54 | 186 | 6.2% |
| 5.1-6 | 172 | 102 | 274 | 9.1% |
| 6.1-8 | 419 | 243 | 662 | 22.0% |
| 8.1-10 | 349 | 222 | 571 | 19.0% |
| 10.1-12 | 288 | 197 | 485 | 16.0% |
| 12.1-14 | 239 | 181 | 420 | 14.0% |
| 14.1-16 | 118 | 108 | 226 | 7.5% |
| 16.1-18 | 52 | 41 | 93 | 3.1% |
| 18.1-35 | 31 | 56 | 87 | 2.9% |
| TOTAL | 1800 | 1204 | 3004 | 100% |
| % | 59.9% | 40.1% |
The treated population included enuretic patients age 4-35. 25.9% were in the age-group of 12-29 years and most of them were treated previously elsewhere, without success.
- 0.6% had anatomic problems related to enuresis.
- 22.4% had Psychological problems.
- The rest (77%) of the patients had neither anatomic nor psychological problems, and were classified as idiopathic enuretics.
- 97.5% were described by their parents as very heavy sleepers.
- 74% had family pattern of enuresis among siblings.
- 82% were primary enuretics.
- 67% had a frequency of 7 or more enuretic episodes per week.
- 83% had normal development.
- 17% had a developmental delay.
- 0.8% reported urinary tract infection in the past.
- 22% of the younger patients (up to 8 years old) had dribbling during the day. This problem was resolved in most cases during the treatment process.
- 6% had also diurnal enuresis.
- 3.2% had also encopresis.
TABLE 2: TREATMENT RESULTS
| Patients | % | |
|---|---|---|
| Ceased wetting | 2119 | 91.8% |
| Improvement | 44 | 1.9% |
| No improvement | 145 | 6.3% |
| TOTAL | 2308 | 100% |
THE TREATMENT MODEL
The treatment model is unique and takes into consideration all aspects of enuresis (organic, psychological and learning). The model encompasses behavioral therapy of enuresis, including enuresis alarm, short and mid term positive reinforcements, measurements of reflex and arousal response and daily training to increase bladder capacity and strengthen sphincter muscles. In some cases, we utilize other therapeutic techniques, such as forced intake, relaxation, drug therapy (mainly Imipramine), placebo and more.
Published research by Dr. Jacob Sagie, Ph.D.
Sagie J. The Relationship Between Nocturnal Enuresis, Time of Night and Waking Response in the Process of Treatment with Enuresis Alarm. Children's Hospital Quarterly 8(1), 1996, pp. 7-9. Human Sciences Press. Also presented at the European Sleep Society conference.
Summary in our own words: the study followed 257 patients aged 5.5 to 16 and about 4,800 wetting episodes during treatment with an enuresis alarm. Wetting peaked around 2 AM. The alarm did not change the children's sleep pattern; instead it conditioned a response to a filling bladder, and this reflex response improved even in children who did not wake up. The waking response rose from 33% in the first 2 hours of sleep to 78% in the last 2 hours. Patients with no physical or psychological cause (idiopathic) responded better than patients with psychological problems.
What this means for parents: a child does not need to wake up to the alarm in order to become dry, and accidents that move later in the night are a good sign of progress.
Publications and talks by Dr. Tal Sagie, Ph.D.
- Sagie T. "The Gap between Social Functioning to Emotional Functioning among Young Adolescents with Nocturnal Enuresis." Studia Edukacyjne 32/2014, pp. 357-373 (published 2015).
- Sagie T. "THERAPEE: Behavioral Cyber Therapy for Enuresis (Bedwetting)." Chapter in H. Krauze-Sikorska, M. Klichowski (eds.), The Educational and Social World of a Child. Wydawnictwo Naukowe UAM, Poznań 2015, pp. 478-489.
- Conference talk, II International Conference "The Educational and Social World of a Child", Poznań, 26 March 2014.
- Conference talk on enuresis as a risk factor among young people in the school system, International Conference "Challenges of Today's Education", Poznań, 6 July 2015.
Independent sources on bedwetting treatment
- How common bedwetting is by age: About 1 in 6 children still wet the bed at age 5, about 1 in 8 at age 6, 1 in 10 at age 7, and 1 to 2 in 100 at age 15 (NIDDK, U.S. National Institutes of Health).
- Alarms: Used alone, a bedwetting alarm helps about two in three children become dry while it is in use, but many relapse after stopping, and only about half stay dry after treatment ends (Cochrane review). Results improve when the alarm is part of guided behavioral treatment: an audit of 2,861 children treated with a practitioner-assisted alarm reported 76% success and 23% relapse (Journal of Pediatrics, 2018), and one clinic study found 78% of children dry with a multimodal approach versus 51% with the alarm alone (2009 study). In Dr. Sagie's clinical experience, a child who has already failed with a self-guided alarm comes to structured treatment more skeptical, and part of the alarm's conditioning effect is already worn out. His clinical recommendation is that treatment with an alarm alone should not last more than five to six months.
- Medication: Many clinics treat enuresis as a medical problem and prescribe medication, typically desmopressin (DDAVP). It works quickly while it is taken, but most children relapse when it is stopped; a review in American Family Physician puts relapse at 80 to 100 percent (source). In December 2007 the FDA removed bedwetting from the approved uses of desmopressin nasal spray, after reports of severe low blood sodium and seizures in children. Desmopressin tablets are still prescribed for bedwetting (FDA alert).
Questions about the research: support@bedwettingtherapy.com