Association between winter season and desmopressin treatment efficiency in children with monosymptomatic nocturnal enuresis: a pilot study

ABSTRACT Objectives: The purpose of our study was to assess the association between the winter season and desmopressin treatment failure in South Chinese children with monosymptomatic nocturnal enuresis (MNE). Materials and Methods: A retrospective study was conducted to analyze the clinical data of children with monosymptomatic nocturnal enuresis who have visited our urology clinic from January to December 2019. All patients received desmopressin treatment. Final treatment outcomes were categorized as successful (complete response) or failed (absent and partial response). The relationship between winter season and treatment response to desmopressin was evaluated. Additionally, associated risk factors were investigated with both univariate and multivariate regression analysis. Results: In total, 393 patients diagnosed with MNE were included in the present study. There were no statistically significant differences in pretreatment variables at first visit between patients who visited the clinic in winter and those who did so in other seasons. However, the treatment failure rate of MNE in the winter season was higher than that of other seasons (77.50% vs. 52.74%). Multivariate logistic regression analysis demonstrated that the severity of symptoms and an initial clinic visit in the winter season were significantly related to desmopressin treatment failure in MNE patients. Conclusion: Winter season and severity of symptoms are two risk factors associated with desmopressin treatment failure in MNE patients.

A comparison of the efficacy and tolerability of treating primary nocturnal enuresis with Solifenacin Plus Desmopressin, Tolterodine Plus Desmopressin, and Desmopressin alone: a randomized controlled clinical trial

ABSTRACT Introduction: Nocturnal enuresis (enuresis) is one of the most common developmental problems of childhood, which has often a familial basis, causes mental and psychological damage to the child and disrupts family solace. Objectives: In this study, we compared therapeutic efficacy and tolerability of treating primary nocturnal enuresis (PNE) with solifenacin plus desmopressin, tolterodine plus desmopressin, and desmopressin alone. Because we don't have enough information about this comparison especially about solifenacin plus desmopressin. Patients and Methods: This clinical trial study was performed on 62 patients with enuresis aged 5-15 years who referred to the urology clinic of Imam Khomeini Hospital in Ahwaz in 2017-2018. Patients were randomly assigned to one of the three different therapeutic protocols and any participants were given a specific code. After that, we compared the therapeutic response and the level of satisfaction of each therapeutic group in different months. Data were analyzed using SPSS 22 software and descriptive and analytical statistics. Results: The mean age of patients was 8.70±66 years. In the therapeutic group with desmopressin and solifenacin, 19 of 20 patients (95%) achieved complete remission (1) after a 3-month treatment in comparison with monotherapy group in which 14 of 22 patients (63.63%) achieved complete remission; and in the combination therapy group of desmopressin and tolterodine, in the study and the evaluation of the consequences of 3-month treatment of this group, it was found that 17 of 20 patients (85%) had complete remission. Overall, the therapeutic response in combination therapy groups of desmopressin plus anticholinergic was higher than the monotherapy group of desmopressin alone. Conclusion: Our results demonstrate that the combination of desmopressin and an anticholinergic agent is highly effective in treatment of children with PMNE. Although desmopressin has long been a first - line treatment for PMNE, desmopressin monotherapy often fails to achieve a successful response in patients with PMNE.

Enuresis infantil tratada con imipramina / Imipramine-treated infant enuresis

Introducción: la enuresis, que se define como la emisión involuntaria de orina después de la edad en que el control vesical debía haberse alcanzado, alrededor de los 5 años, es un trastorno conocido desde épocas remotas, que ha merecido la atención de numerosos investigadores, y sobre el cual se plantean aún en la actualidad criterios muy disímiles en relación con su etiología. Objetivo: identificar la efectividad de la imipramina en la enuresis nocturna. Métodos: se investigan 150 niños de ambos sexos procedentes del área de salud del Policlínico Docente Plaza de la Revolución que presentaban enuresis nocturna, previamente estudiados, sin encontrar lesión orgánica. Se les impuso tratamiento con imipramina durante un año. Se analizan en estos pacientes variables como la edad y el sexo, se estudió la escolaridad, la clasificación de la enuresis, la frecuencia de las micciones y el umbral de sueño recogido de forma muy subjetiva. Resultados: se obtuvo que el grupo mayor de niños osciló entre los 6 a 8 años de edad, con predominio del sexo femenino en todos los grupos de edades. La escolaridad fue normal en 145 niños, que representa la inmensa mayoría de la muestra. Predominó ampliamente la enuresis primaria, que se manifestó en 148 pacientes, y fueron más frecuentes las micciones diarias y más de una vez por semana en el grupo de 6 a 8 años de edad. Casi todos los pacientes (132) permanecían dormidos después de orinarse. El tratamiento con imipramina se realizó con dosis crecientes de acuerdo con la edad, hasta una dosis máxima de 75 mg, y resultó eficaz en el 48,6 por ciento de los pacientes, en los cuales desapareció totalmente la sintomatología, y en un 28 por ciento se produjo mejoría en la presentación del síntoma. Conclusiones: la imipramina fue eficaz en la mayoría de los pacientes, pues desapareció totalmente la sintomatología

Introduction: enuresis, which is said to be the involuntary discharge of urine after the age at which the urinary control should has been achieved, that is, around 5 years-old, is a well-known disorder since ancient times. It has deserved the attention of numerous researchers but there are still very different criteria about its etiology at the present time. Objective: to identify the effectiveness of imipramine to treat night enuresis. Methods: one hundred and fifty children of both sexes with no previous lesions and night enuresis, who were attended at Plaza de la Revolucion teaching polyclinics, were studied. They were treated with imipramine for a year. Several variables such as age, sex, schooling, classification of enuresis, frequency of urination and sleep threshold, the latter being determined in a very subjective way, were all analyzed. Results: the elder group of children aged 6 to 8 years, with females predominating in all the age groups. Schooling was normal in 145 children who accounted for the vast majority of the sample. Primary enuresis extensively prevailed and the most frequent forms were daily involuntary urination and once a week in the 6-8 years-old group. Almost all the patients (132) remained asleep after urination. The imipramine-based treatment was given at growing doses, according to the age, up to maximum dose of 75 mg, and proved to be effective in 48.6 percent of patients, whose symptoms completely disappeared and in 28 percent of them who experienced some improvement in the presentation of symptoms. Conclusions: imipramine was effective in most of patients since the symptoms disappeared completely

Oral versus nasal vasopressin in the treatment of nocturnal enuresis in 5-to 12-year-old children

Nocturnal enuresis is a common childhood problem and has various treatments. This study was carried out to compare oral and nasal vasopressin in the treatment of nocturnal enuresis in 5-to 12-year-old children who were referred to the Shahid Beheshti Clinic in 2008. This study included 100 children [62 males and 38 females] with nocturnal enuresis. One group [50 patients] received 20 mcg nasal vasopressin which increased up to 40 mcg, depending on the patients' response. The other group [50 patients] received 0.2 mg oral vasopressin which increased up to 0.4 mg. The patients were followed up for one month after response to the last dose of drug. Data were recorded in prepared forms and analyzed using Chi-Square and Fisher Test. The success rate with oral and nasal method was 80% and 92%, respectively [P=0.08]. Only 2% of the children had complications during the treatment; one child treated orally developed gastroenteritis and another child treated with the nasal method developed convulsions [P=1]. Sixteen percent of the children treated with the oral method and 28% of the children treated with the nasal method had recurrence [P=0.148]. Oral and nasal forms of vasopression have equal therapeutic effects. However, oral form of the treatment has fewer serious side effects and is easier to use. Therefore, the use of oral medicine is recommended

[Evaluation of theraputic effect of desmopressin on enuresis in children aged 5-14 years]

Nocturnal enuresis, the involuntary passing of urine during sleep after the age at which bladder control would normally be anticipated, is a widespread and potentially disabling disorder of children. Treatment of enuresis includes non-pharmacologic and pharmacologic procedures. Imipramine, anticholinergics, and desmopressin are appropriate drugs for treatment. Desmopressin is a synthetic analogue of vasopressin, which decreases urine output. Since efficacy and side effects of desmopressin-therapy differ in various studies, this research was conducted to evaluate the efficacy of desmopressin in enuretic children in Zanjan. In this quasi-experimental study, 126 children aged 5-14 suffering from primary nocturnal enuresis, referring to pediatric nephrology clinic were entered into the study during 2002-2006. Following the written consent a questionnaire concerning the personal data and physical examination was completed for each patient. Clinical tests including U/A, U/C, Cr and serum electrolytes were carried out and after rejecting the secondary causes of enuresis 10-20 micro-g intransal desmopressin was prescribed according to the age and weight of the children. The effect and complications of the drug were followed up monthly for six months. Of 126 children, 56 [44.4%] obtained full recovery, and 48 [38.1%] partial recovery from nocturnal enuresis. The total recovery was 82.5%. 22 patients [17.4%] did not respond to the drug. No significant difference was observed between age, gender, existence of stress, and effect of the drug on child enuresis. Children with familial history of nocturnal enuresis responded better to the drug. No complications were observed in patients. Desmopressin is an effective drug against nocturnal enuresis of children. The drug is more effective in children with familial history of primary nocturnal enuresis