The role of adenoidectomy and/or tonsillectomy in the treatment of nocturnal enuresis in OSA children: a single-arm meta-analysis

Purpose: To evaluate the efficacy of tonsillectomy and/or adenoidectomy for the treatment of nocturnal enuresis (NE) in children with obstructive sleep apnea (OSA).

Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to December 2023. We included all studies of children with OSA and NE who underwent adenoidectomy and/or tonsillectomy. Risk of bias assessment and meta-analyses of included studies were performed. The sources of heterogeneity were explored through subgroup analyses.

Results: The combined overall remission (OR), complete remission (CR), and partial remission (PR) were 67%, 57%, and 4%, respectively, in NE children who underwent adenoidectomy and/or tonsillectomy. Therein, the pooled OR and CR of primary nocturnal enuresis in children with OSA were 67% and 59%, respectively. The pooled OR and CR of children who were treated with adenotonsillectomy (T&A) were 72% and 65%, respectively. The pooled OR and CR of children with OSA aged > 5 years were 67% and 58%, respectively. The pooled OR and CR of postoperative follow-up of ≤ 3 months were 64% and 52%, respectively. The pooled OR and CR of NE based on RCT studies were 37.3%.

Conclusion: The remission rate of NE children who underwent adenoidectomy and/or tonsillectomy was more than half. While the remission rate was significantly lower when RCT studies were included. This suggested that the actual NE remission rate may be lower than expected. Further studies with large sample sizes and control groups are expected to confirm the position of adenoidectomy and/or tonsillectomy in NE treatment.