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Treatment of primary monosymptomatic nocturnal enuresis with desmopressin: predictive factors
S Kruse1, A L Hellström, E Hanson
1The Urotherapeutic Unit, The Queen Silvia Children's Hospital, Department of Nursing, Göteborg University, Sweden. sonia_kruse@vgregion.se
Insights
Older children with fewer wet nights are more likely to achieve dryness with desmopressin (1-desamino-8-D-arginine vasopressin) treatment for primary monosymptomatic nocturnal enuresis. Frequent wetting and high desmopressin doses were less predictive of success.
Area of Science:
- Pediatrics
- Urology
- Pharmacology
Background:
- Primary monosymptomatic nocturnal enuresis (PMNE) affects many children.
- Desmopressin is a common treatment for PMNE.
- Predicting treatment success is crucial for effective management.
Purpose of the Study:
- To identify factors predicting successful desmopressin treatment in children with PMNE.
- To understand characteristics associated with positive treatment outcomes.
Main Methods:
- Analysis of data from a large, open, multicenter study of 399 children with PMNE.
- Inclusion of a 4-week observation period before treatment and a 6-week dose-titration phase with desmopressin.
- Classification of children into response groups based on enuresis reduction.
Main Results:
- Older age, fewer nocturnal wet episodes, and single nighttime voids (post-midnight) predicted positive response to desmopressin.
- Many successful responders achieved dryness without requiring the maximum desmopressin dose.
- No hereditary factors were identified as influencing desmopressin response.
Conclusions:
- Older children responding to 20 mcg desmopressin with infrequent wetting are most likely to achieve permanent dryness.
- Predictive factors can guide treatment decisions for PMNE.
- Desmopressin efficacy in PMNE is linked to specific patient characteristics.
Objective:
To investigate predictive factors for the outcome of treatment of primary monosymptomatic nocturnal enuresis (PMNE) with desmopressin.
Patients And Methods:
Data from a large open multicentre study were analysed. The study comprised 399 children with PMNE who were recruited for long-term desmopressin treatment. Before treatment a history was taken and the children observed for 4 weeks. After a 6-week dose-titration period with desmopressin, the children were classified into four groups depending on the response rate.
Results:
The children who improved during desmopressin treatment were older, had fewer wet nights during the observation period and had only one wet episode during the night, mostly after midnight. Many of them did not require the maximum dose of desmopressin to become dry. No hereditary factor for the response to desmopressin was found.
Conclusion:
Those most likely to be permanently dry with desmopressin treatment are older children who respond to 20 microg desmopressin and who do not wet frequently.
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