AIM To retrospectively evaluate the combination treatment with alarm and desmopressin in a population of children with monosymptomatic enuresis nocturna (MNE). MATERIAL AND METHODS 218 children with MNE (age 5-14y) treated in our outpatient clinics were investigated in the present study. All children had completed the diagnostic procedures of our center comprising 2-week home recordings, desmopressin titration, uroflowmetry and urinalysis. The latest ICCS standardization was used for characterizations. All children were treated with the enuresis alarm alone or in combination with desmopressin. Desmopressin was added to alarm if no effect was seen after minimum 2 weeks of alarm treatment. RESULTS Of the initial 218 children, 45 children received combination treatment (CO) whereas the remaining showed improvement on alarm as monotherapy (AL). Of the children receiving combination treatment 35 achieved complete dryness. We found no differences with regards to age, gender, enuresis frequency, average and maximal voided volumes between children that achieved dryness with alarm or combination of alarm and desmopressin. However, children ending in combination treatment shared significantly higher nocturnal urine volumes at wet nights (318 ±100 compared to 276 ± 82 ml, p<0.01). In the AL group 27 children (15%) had nocturnal urine production that could qualify for nocturnal polyuria whereas 11 children (24 %) receiving combination treatment were nocturnal polyurics the difference being not statistical significant. CONCLUSION Addition of desmopressin during treatment of MNE with the enuresis alarm may improve the efficacy and it should be considered especially in children with large nocturnal urine production.