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Desmopressin resistant enuresis: pathogenetic and therapeutic considerations
T Nevéus1, G Läckgren, T Tuvemo
1Department of Pediatrics, Uppsala University Children's Hospital, Swedish Agricultural University.
The Journal of Urology
|November 24, 1999
Summary
Desmopressin-resistant enuresis in children is not caused by urine production but by bladder instability. Anticholinergic medication effectively treats many children with this condition.
Area of Science:
- Pediatric Urology
- Sleep Medicine
- Pharmacology
Background:
- Nocturnal enuresis is common in children.
- Desmopressin is a standard treatment, but some children are resistant.
- The role of bladder function versus urine production in resistant enuresis is unclear.
Purpose of the Study:
- To investigate the role of bladder function in desmopressin-resistant enuresis.
- To evaluate the impact of urine production on enuretic event timing.
- To assess the response to anticholinergic medication in these children.
Main Methods:
- 33 children with desmopressin-resistant monosymptomatic nocturnal enuresis participated.
- A double-blind crossover study compared desmopressin (0.4mg, 0.8mg) and placebo.
- Enuretic event timing and response to anticholinergic treatment were documented.
Main Results:
- Desmopressin did not significantly alter the timing of voiding or enuresis.
- 5 out of 9 children responded to a higher dose (0.8mg) of desmopressin.
- 20 out of 28 children responded to anticholinergic treatment.
Conclusions:
- Antidiuresis does not explain desmopressin-resistant enuresis.
- Nocturnal bladder instability is a likely cause in these children.
- A subset of patients may benefit from higher desmopressin doses, while many respond to anticholinergics.