ABSTRACT
Objective: To compare the efficacy of desmopressin plus tolterodine (D+T) with desmopressin plus indomethacin (D+I) for treating enuresis in children. Design: Open-label randomized controlled trial. Setting: Bandar Abbas Children’s Hospital, a tertiary care children’s hospital in Iran, from March 21, 2018, to March 21, 2019. Participants: 40 children older than five years with monosymptomatic and non-monosymptomatic primary enuresis resistant to desmopressin monotherapy. Intervention: Patients were randomized to receive either D+T (60 µg sublingual desmopressin and 2 mg tolterodine) or D+I (60 µg sublingual desmopressin and 50 mg indomethacin) every night before bedtime for five months. Outcome: Reduction in the frequency of enuresis was evaluated at one, three, and five months, and response to treatment at five months. Drug reactions and complications were also noted. Results: After adjustment for age, consistent incontinence from toilet training, and non-monosymptomatic enuresis, D+T was significantly more efficacious than D+I; mean (SD) percent in nocturnal enuresis reduction at 1 [58.86 (7.27)% vs 31.18 (3.85) %; P<0.001], 3 [69.78 (5.99)% vs 38.56 (3.31)%; P<0.000], and 5 [84.84(6.21)% vs 39.14 (3.63)%; P<0.001] months showing a large effect. At 5 months, complete response to treatment was only observed with D+T, while treatment failure was significantly higher with D+I (50% vs 20%; P=0.047). None of the patients in either group developed cutaneous drug reactions or central nervous system symptoms. Conclusion: Desmopressin plus tolterodine appears to be superior to desmopressin plus indomethacin for treating pediatric enuresis resistant to desmopressin.
ABSTRACT
Background: Urinary tract infection (UTI) is the second most prevalent pediatric infection, and if it is not recognized and treated properly, it can cause severe irreversible complications such as renal failure and hypertension. In this research, some of the risk factors of UTIs were compared in children with urinary tract infections.Methods: This is a cross-sectional study, with the urinary tract infection as the dependent variable and gender, circumcision status, history of urinary catheterization, family history, history of renal stone, hypercalciuria, constipation history, reflux, neurogenic bladder, phimosis, posterior urethral valves (PUV), ureteropelvic junction obstruction (UPJO), and ureterovesical junction obstruction (UVJO) as the independent variables. A total of 405 children were studied in this research. The data was collected using questionnaires, checklists, and examinations. Data analysis was also carried out using descriptive and analytical statistics method in SPSS.Results: This research revealed the prevalence of urinary tract infection among children with several risk factors, and the common factors were positive family history, history of urinary catheterization, constipation, and other non-anatomical disorders (history of renal stone and hypercalciuria. The most common risk factors regardless of gender and age were non-anatomic disorders that were observed in 147 cases (43.7%) (p-value<0.001). Among the non-anatomical factors, constipation was the most common factor observed in 66 cases (16.3%). A higher rate of urinary infection was observed in the uncircumcised male patients than the circumcised patients, and there was a significant relationship between circumcision and UTI.Conclusions: In this study, urinary tract infection staged a significant relationship with gender, circumcision status, urinary catheterization history, family history, renal stone history, hypercalciuria, history of constipation, reflux, neurogenic bladder, phimosis, PUV, UPJO, and UVJO.