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[Drug therapy of enuresis: sense/nonsense]
1Abteilung für Kinderurologie, Krankenhauses der Barmherzigen Schwestern, Linz. marcus.riccabona@bhs.at
Insights
Nocturnal enuresis, or bedwetting, is common in children. Desmopressin medication, alongside behavioral therapy, effectively treats it in up to 80% of cases when bladder capacity is exceeded.
Area of Science:
- Pediatric Urology
- Endocrinology
- Sleep Medicine
Context:
- Nocturnal enuresis is a prevalent childhood disorder.
- Comprehensive evaluation is crucial for effective management.
- Understanding underlying causes like genetics and ADH secretion is key.
Purpose:
- To outline the diagnostic and therapeutic strategies for nocturnal enuresis.
- To highlight the role of pharmacotherapy, specifically desmopressin.
- To present desmopressin as a primary treatment option for specific cases.
Summary:
- Diagnosis involves patient history, physical exam, ultrasounds, and urine analysis.
- Key causes include genetic factors and reduced nocturnal antidiuretic hormone (ADH) secretion.
- Desmopressin is indicated when nocturnal urine volume surpasses bladder capacity, with an 80% success rate.
Impact:
- Provides a clear treatment pathway for pediatric nocturnal enuresis.
- Emphasizes the efficacy of desmopressin when used appropriately.
- Aims to improve treatment outcomes and reduce the disorder's prevalence.
Abstract:
Nocturnal enuresis is a very common disorder in childhood. Classification and evaluation through patient history, physical examination, ultrasound of the kidneys and bladder including residual volume, dipstix and urine output protocol are necessary for successful treatment. Genetic, family-associated factors and a lowered nocturnal ADH-secretion are the main causes considered today. Next to behavioral therapy and conditioning, pharmacotherapy form the mainstay of therapy. Desmopressin is indicated when the nocturnal urinary volume exceeds the actual bladder capacity. Together with the right indication and optimal dosage, the therapy should be given for at least 4 to 6 weeks before step-by-step reduction, resulting in a success rate of up to 80%.