初始治療超過三個月卻沒有顯著進步則可稱為頑固性尿床。頑固性尿床常常讓醫師、家長,甚至兒童也會沮喪。

用在尿床的第一線治療為抗利尿激素以及鬧鈴。當發生治療效果不佳需要更用心檢視飲水習慣及詢問是否遵從醫囑的時間、方式吃藥,更重要的是確定家長及小朋友的治療意願。研究也發現,有線鬧鈴的成功率比無線鬧鈴的成功率低。在一線治療之後,若效果仍不佳,抗膽鹼藥物可作為第二線治療。抗膽鹼藥物的效果來自於增加膀胱容量。但其伴隨的副作用如便秘或使殘尿量增加則不可不慎。第三線的治療包含了三環抗憂鬱劑。除了以上治療之外,頑固性尿床的小朋友必須注意有無其他共病的可能。最常見與尿床息息相關的如:注意力不足及過動症、阻塞型呼吸中止症。

頑固性尿床如果都沒有改善,那麼重要的是不要無限期地繼續使用DDAVP制劑或鬧鐘療法的單一治療。在尿床長期沒有改善的情況可能會使患者對治療失去動力並停止就醫。因此,切換到其他治療方法,例如同時使用其他藥物,是非常重要的。

Nocturnal enuresis is defined as intermittent urinary incontinence during sleep in children 5 years of age and older, occurring at least once a month for at least 3 months.

In Japan, pediatricians who do not specialize in nocturnal enuresis have become more proactive in treating the condition since 2016, when the guidelines for treating it were revised for the first time in 12 years. For monosymptomatic nocturnal enuresis, the first step is lifestyle guidance, with a focus on the restriction of fluid intake at night; however, if lifestyle guidance does not decrease the frequency of nocturnal enuresis, aggressive treatment should be added. The first choice of aggressive treatment is oral desmopressin, an antidiuretic hormone preparation, or alarm therapy. However, there remain patients whose wet nights do not decrease with oral desmopressin or alarm therapy. In such cases, it is necessary to reconfirm the method of desmopressin administration and check for factors that may decrease the efficacy of desmopressin.

If alarm therapy does not increase the number of dry nights, it is possible that the patient is fundamentally unsuitable for alarm therapy. If dry nights do not increase with oral desmopressin or alarm therapy, the next treatment strategy should be considered immediately to keep the patient motivated for treatment.