Comparative study of drugs used for treating primary nocturnal enuresis

ABSTRACT

To study the effect of different drugs used in the treatment of primary nocturnal enuresis. This prospective study was conducted on 120 patients between 7 and 16 years. All patients had nocturnal enuresis without any previous treatment taken before. After proper history taking and careful clinical examination, investigations as urine analysis, abdominopelvic US, plain UT and voiding diary were asked for. These patients were randomly divided into 3 groups, each group included 40 patients. The first group was given desmopressin, second group was given oxybutynin and the third group was given imiprami ne. Behavioral therapy was advised for all groups.Follow up was done for 6 months and 83 patients maintained this follow up. Failed treated patients [37] were subjected to urodynamic evaluation to detect bladder instability and evaluation of functional bladder capacity for age, however, 22 only maintained follow up. Desmopressin had the best cure rate [44%] compared to oxybutynin and imipramine, that had a cure rate of 27% and 33.3% respectively. The cure rate of desmopressin was dose related with no reported side effects. Decreased functional bladder capacity and bladder instability were detected in 20 [90%] and 9[40%] patients respectively Out of the 22 patients who were nonresponding to single drug therapy. Combined treatment of desmopressin and oxybutynin gives a cure rate of 40.8% in resistant cases. Thirteen patients refused urodynamics because of invasive nature of procedure. Relapse rate was the highest with imipramine [64.7%] and lowest with desmopressin [37%]. It is recommended that behavioral therapy is advised in all cases in addition to pharmacotherapy Using desmopressin, it gave the highest cure rate [44%] in short time with minimal relapse while combined desmopressin and oxybutynin were effective in patients resistant to single drug use with a cure rate of 41% approximately. Urodynamics are of value only in resistant cases. Although imipramine is of low cost, yet its highest relapse rate limits its use