role of addition of diclofenac sodium to imipramine in treating children with nocturnal enuresis

ABSTRACT

Nocturnal enuresis presents a common medical problem all over the world, over many years various therapeutic options have been tried; none was proved to be superior, because the defect occurs at many levels in the urinary tract and its neuronal control. Nowadays prostaglandins have been proved to play a role at renal, bladder, urethral and sympathetic control of urinary system. We evaluated the role of diclofenac sodium when added to the conventional imipramine therapy in treating patients with primary nocturnal enuresis. 70 children complaining of nocturnal enuresis were enrolled in this study, half of them were given imipramine alone and the other half were given a combination of imipramine and diclofenac sodium at night before retiring to bed, and the number of wet nights per week was recorded on a calendar sheet by the parents over 4 weeks, those who showed more than 50% reduction in the number of wet nights a week were regarded as responders, who were followed after cessation of treatment over another 6 weeks to look for relapse. Of the patients treated with imipramine alone 57.14% [20/35] showed more than 50% decrease in the number of wet nights weekly compared to those treated by imipramine and diclofenac sodium who showed 84.84% [28/33] response rate [> 2.5 SE of difference between responding proportions]. The relapse rate after stopping treatment was 60% [12/20] in the first group compared to 32.1% [9/28] which exactly two times the SE of difference between relapsing proportions. The addition of diclofenac sodium to imipramine in treating patients with primary nocturnal enuresis might have caused a highly significant higher response rate and a fairly significant lower relapse rate after cessation of treatment