Combined treatment with enuresis alarm and desmopressin for nocturnal enuresis

Seventy-one children with nocturnal enuresis were enrolled in a controlled trial. The children were allocated to two matched groups. Children in both groups used an enuresis alarm until the end of treatment. Children in the first group were treated with 40/^g of intranasal desmopressin (Desmospray) for up to 6 weeks at the start of treatment with the alarm. During the observation period before treatment there were 2.3 dry nights per week in both groups. At the end of treatment there was a significant difference in the mean number of dry nights per week between the two groups (6.3 in the alarm and desmopressin group and 4.8 in the alarm group) and also in the number of children becoming reliably dry. The combination of desmopressin and alarm was particularly helpful for children with severe wetting and those with family and behavioural problems. Desmopressin, enuresis alarm, nocturnal enuresis
MG Bradbury, Department of Paediatrics and Child Health, St James's University Hospital, Leeds LS9 7TF, UK     

Combined therapy of enuresis alarm and desmopressin in the treatment of nocturnal enuresis

Twenty-eight children with primary nocturnal enuresis were blindly allocated at random to a combination of enuresis alarm and 20 g intranasal desmopressin or alarm and placebo for 2 weeks. Patients received the other therapy after a 2-week treatment-free period. The combined treatment of desmopressin and alarm showed 5.1±0.4 (mean ± SEM) dry nights per week and resulted in significantly more dry nights per week during the 2 weeks of observation than placebo and alarm (4.1±0.4,P<0.05)Abbreviations DDAVP desmopressin - SEM standard error of mean     

Comparison of desmopressin and enuresis alarm for nocturnal enuresis.

Fifty children with primary nocturnal enuresis were randomised for a study comparing desmopressin (DDAVP) and enuresis alarm. Forty six completed the trial, 24 of whom were treated with 20 micrograms intranasal desmopressin nightly and 22 with enuresis alarm for three months. Failures were crossed over and relapses were continued on the same treatment for a further three months. The improvement rate was 70% in the group given desmopressin and 86% in the group treated with alarm; the difference was not significant. During the first week of treatment the group given desmopressin was significantly dryer, and at the end of the study 10 of these patients relapsed compared with one patient in the group given the alarm. No serious side effects were observed. This study confirms the role of conditioning treatment as preferable in long term treatment of nocturnal enuresis. When this fails or when a safe drug with rapid effect is needed, however, desmopressin is a useful alternative.     

Management of nocturnal enuresis in children with desmopressin and bladder physiotherapy

In the last 2 years, 29 children with nocturnal enuresis were treated in the outpatient departments of the Departments of Urology and Pediatric Surgery of the Aristotle University, Thessaloniki. There were 22 boys and 7 girls aged 7 to 12 years. The clinical examination was normal in all cases. All children had undergone various treatments with no beneficial effect, and relapses had occurred. The patients were given desmopressin (DDAVP) nasal drops in combination with bladder physiotherapy; 77% were cured after 12 months. Physiotherapy improves the percentage of cures as the functional capacity of the bladder increases. Accepted: 8 July 1997     

原发性遗尿症患儿治疗前后自我意识变化的初探

目的 分析评估儿童原发性遗尿症（PNE）自我意识评价状况以及遗尿治疗对自我意识的影响。方法 选择2005年7月至2006年1月在复旦大学附属儿科医院确诊的8~16岁PNE患儿为研究对象。排除患有可引起尿床的器质性疾病、治疗前存在高血压、单亲家庭、父母离异、有其他家庭问题及慢性疾病的患儿。指导PNE患儿自己填写Piers Harris儿童自我意识量表(PHCSS)。随后患儿分3组接受不同方法治疗遗尿:生物反馈治疗组、口服醋酸去氨加压素治疗组和口服中药治疗组，疗程均为1个月。治疗结束3个月后再次指导患儿自己填写PHCSS。通过心理分析软件分析两次自我意识评价结果。结果 研究期间共纳入PNE患儿54例，男29例，女25例，平均年龄（10.0±0.6）岁。其中轻度遗尿15例，中度遗尿20例，重度遗尿19例。治疗遗尿前54例患儿自我意识评价结果中焦虑得分显著低于常模（P<0.01）；并且轻、中和重度PNE患儿焦虑得分均显著低于常模（P<0.01），不同遗尿严重程度患儿得分差异无统计学意义。其中12例接受生物反馈治疗，14例接受醋酸去氨加压素治疗，28例接受中药治疗。治疗后有44例接受了自我意识评价随访，治疗遗尿后患儿焦虑得分较治疗前明显增加（P<0.05），其中口服醋酸去氨加压素组治疗后焦虑得分明显提高（P<0.05）。遗尿治疗有效的患儿得分明显高于治疗前（P<0.05），而治疗无效的患儿治疗前、后自我意识各项得分差异无统计学意义。结论 治疗前PNE患儿自我意识评价结果中焦虑得分低下，通过治疗遗尿其自我意识评价也可得到改善，并且临床疗效好的患儿自我意识改善明显。     

Treatment of isolated nocturnal enuresis: alarm or desmopressin?]

BACKGROUND: Monosymptomatic nocturnal enuresis is common in healthy school children. Treatment is often required because of social and psychological convenience. We therefore conducted a randomized prospective trial using either desmopressin (D) or alarm (A). PATIENTS AND METHODS: Patients (n = 135) aged 6 to 16 years were enrolled between January 1992 and December 1994. Desmopressin (Minirin spray, Ferring SA) was given intranasally at a dose of 20 micrograms at bedtime and increased to 40 micrograms after 2 weeks if partial result was obtained. The alarm was a pad-bell device (Wet-stop, Sega) and the sound source was attached to the upper part of the pajamas. Inclusion criteria were: primary monosymptomatic nocturnal enuresis in healthy children, age > or = 6 years, absence of previous treatment using either desmopressin or alarm. The aim of the treatment was to achieve 100% dry nights. Patients were evaluated after 15 days on therapy by phone call and thereafter by attending the outpatient clinic at 2-3 and 4-6 months. At the time of the second evaluation, a switch from alarm to desmopressin (or vice-versa) was proposed to those who did not respond to the initial treatment. RESULTS: In group D (n = 62), only 27 children were included since 12 (19%) were switched to alarm and 23 (37%) were excluded because they were either non-compliant or lost to follow-up. In group A (n = 73), only 31 were included since six (8%) were switched to desmopressin and 36 (49%) were excluded for the same reasons as in group D. Prior to inclusion, the percentage of dry nights was 21% in group D and 14% in group A. After 15 days on therapy, patients from group D achieved 80% dry nights compared to 50% in group A (P = 0.001). After 3 months, patients from group D attained 85% dry nights vs 90% in group A. After 6 months, children from group A achieved 94% dry nights vs 78% in group D (P = 0.01). CONCLUSION: Desmopressin offers better short-term results than enuresis alarm but the latter is significantly more efficient in the long term. In France, the alarm device is not reimbursed by the national health service and therefore is poorly accepted, as suggested from the high rate of patients lost to follow-up.     

Comparison of intranasal and oral desmopressin for nocturnal enuresis.

A single blind dose response study of the effects of treatment with tablets containing 50-400 micrograms of desmopressin was conducted in 15 children with primary nocturnal enuresis. A dose response effect was seen, with the 100, 200, and 400 micrograms doses resulting in significantly more dry nights than when a placebo was used. The response after 200 micrograms was significantly different from that after 100 micrograms (p less than 0.02) but not from that after 400 micrograms. A randomised, double blind, double dummy, cross over study was then carried out in 30 children to compare the effects of a 20 micrograms dose given through a nasal pipette, a 200 micrograms tablet, and a placebo. The numbers of dry nights were significantly greater during both periods of treatment with desmopressin when compared with that using placebo, but there were no differences between the methods of taking the drug. After oral and nasal treatment 41% and 52%, respectively, of the patients improved by more than 50%. Nine children (31%) remained completely dry after treatment.     

去氨加压素对单症状遗尿症患儿症状及睡眠质量影响

目的 探讨去氨加压素(DDAVP)治疗单症状遗尿症(MNE)患儿症状和睡眠改善情况.方法 选择2018—2020年门诊就诊的69例MNE患儿进行为期12周的DDAVP治疗随访研究,12周后根据遗尿改善情况将患儿分为治疗改善组和无改善组,分析DDAVP治疗对遗尿症状和睡眠质量的影响.结果 基线入组的69例MNE患儿中,7...     

儿童原发性遗尿症应用去氨加压素疗效的探讨

目的 研究应用去氨加压素（弥凝）治疗儿童原发性遗尿症（PNE）的临床疗效，并探讨其治疗指征。方法 对2003年4月至2006年8月在上海儿童医学中心发育行为儿科被确诊为PNE的160例患儿给予去氨加压素治疗，观察其近期疗效和远期疗效，以及治疗过程中的变化，并采用多因素分析利于疗效的指征。结果 去氨加压素治疗PNE的近期和远期治愈率分别为40.6% (65/160)和28.1%(45/160)，停止治疗3个月后的复发率高达57.5%。在治疗的第1个月末，患儿平均遗尿次数迅速减少，由每周(6.38±1.82)次降至每周（3.16±0.95）次；第2~4个月末，平均遗尿次数下降不明显，仅由每周（3.16±0.95）次降至每周（2.54±0.69）次。160例患儿中，85例治疗前从不夜间自行起床排尿，治疗后其中有23例出现夜间自行起床排尿。在治疗的第1个月末，患儿遗尿发生时间中位数明显后推，由原来的凌晨2：00～3：00时推后至清晨4：00～5：00时。回归分析显示降低药物治疗效果的危险因素为遗尿次数多，指每周>7次（RR=3.15，95%CI：2.84～4.64）；功能性膀胱容量小，指<5 mL?kg-1（RR=2.92，95%CI：1.86～3.93）；遗尿发生时间早，指早于清晨4：00时（RR=1.65，95%CI：1.16～2.55）。结论 应用去氨加压素治疗儿童PNE起效快，近期疗效较好，但复发率较高，使远期疗效降低；选取功能性膀胱容量大、夜间首次遗尿发生在清晨4时以后、遗尿次数少的患儿选用去氨加压素能极大地提高临床疗效。     

Reduced anti-diuretic response to desmopressin during wet nights in patients with monosymptomatic nocturnal enuresis

ObjectiveTo investigate why not all children with monosymptomatic nocturnal enuresis (MNE) treated with desmopressin give an adequate response.Materials and methodsWe included 114 children with MNE aged 5–15 years (9.8 ± 0.2 years) who experienced at least 1 wet night and more than 2 dry nights during desmopressin treatment. The patients made home recordings for 2 weeks as baseline and for 2–4 weeks of desmopressin titration. Nocturnal urine production during wet and dry nights, and maximum voided volumes (MVVs) were documented in all patients.ResultsSixty-four patients were desmopressin non-responders, 29 were either partial responders or responders, while 21 patients were full responders. Desmopressin reduced nocturnal urine production dramatically during dry nights compared with pre-treatment wet nights. Nocturnal urine production during desmopressin treatment was significantly greater during wet nights compared to dry nights (243 ± 9.32 vs 176 ± 5.31 ml, P < 0.001). There was a highly significant correlation between individual nocturnal urine output and MVV, and dry nights were characterized by nocturnal urine output/MVV ratios well below 1.0.ConclusionThe anti-enuretic response to desmopressin seems to be dependent upon the degree of reduction in nocturnal urine production. Research on desmopressin bioavailability in children is needed.     

Efficacy and safety during long-term treatment of primary monosymptomatic nocturnal enuresis with desmopressin. Swedish Enuresis Trial Group

The Swedish Enuresis Trial (SWEET) was conducted to evaluate the long-term safety and efficacy of intranasal desmopressin treatment in children with primary, monosymptomatic nocturnal enuresis (PMNE). The study had an open, multicentre design and comprised a 4-wk observation period, a 6-wk dose titration period (with 20-40 microg desmopressin) and a 1-y, long-term treatment period. A treatment-free week was introduced every 3 mo to identify dry patients. In total, 399 children aged 6-12 y with PMNE were recruited. Of these, 245 patients (61%) experienced > or = 50% reduction in the number of wet nights during the last 4 wk of dose titration compared with the observation period. These responders entered the long-term phase of the trial. The mean number of wet nights per week decreased from a median of 5.3 (range 1.3-7.0) during the observation period to a median of 0.8 (range 0.0-5.0) during the last 3-mo period. Seventy-seven children became dry, 63 (83%) within 6 mo of treatment initiation. The percentage of children who became dry was similar in all age groups. Significantly fewer children in the lowest age group were defined as responders (52%; 95% CI 45, 59) among the 6-7-y-olds compared to 65% (56, 74) and 81% (72, 90) in the two older age groups. Desmopressin was well tolerated. No serious drug-related adverse events were recorded and no clinical symptoms of hyponatraemia were reported. The SWEET trial has demonstrated that desmopressin is both safe and effective for the long-term treatment of PMNE, with a significant therapeutic effect also in children of 6-7 y of age.