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Diuretic treatment of nocturnal enuresis: preliminary results of an open pilot study
Tryggve Nevéus1, Eva Johansson, Sverker Hansson
1Uppsala University Children's Hospital, Uppsala, Sweden. tryggve.neveus@kbh.uu.se
Insights
Afternoon diuretic treatment with furosemide shows promise for treating childhood enuresis, similar to nighttime desmopressin. Further randomized trials are needed to confirm these findings for bedwetting management.
Area of Science:
- Pediatric Nephrology
- Sleep Medicine
- Pharmacology
Background:
- Nocturnal enuresis affects a significant number of children.
- Antidiuretic therapy (desmopressin) is a common treatment for enuresis.
- The potential of afternoon diuretic therapy for enuresis has not been extensively studied.
Purpose of the Study:
- To investigate the efficacy of afternoon diuretic treatment (furosemide) for monosymptomatic enuresis.
- To compare the effects of furosemide with nighttime desmopressin in children with enuresis.
- To conduct an open pilot study on novel enuresis treatment strategies.
Main Methods:
- A total of 33 children (mean age 7.6 years) with monosymptomatic enuresis participated.
- Participants underwent three 2-week periods: no medication, oral desmopressin at night, and furosemide 4-5 hours before bedtime.
- Wet and dry nights were recorded to assess treatment outcomes.
Main Results:
- Both desmopressin and furosemide significantly reduced wet nights compared to baseline (p <0.0001 and p = 0.001, respectively).
- There was no statistically significant difference between the efficacy of desmopressin and furosemide (p = 0.08).
- A small number of children achieved complete response, with some showing a better response to furosemide.
Conclusions:
- Afternoon diuretic treatment with furosemide may be a beneficial approach for managing childhood enuresis.
- The study highlights the potential of targeting fluid excretion in the afternoon for enuresis management.
- Randomized controlled trials are recommended to validate these preliminary findings and establish optimal treatment protocols.
Purpose:
Since antidiuretic treatment with desmopressin in the evening has proven effective against enuresis, it would not be surprising if diuretic treatment in the afternoon would have similar effects. We are currently testing this in an open pilot investigation.
Materials And Methods:
A total of 33 children including 12 girls with a mean age +/-SD of 7.6 +/- 2.3 years with monosymptomatic enuresis were recruited from an outpatient primary care setting. Wet and dry nights were recorded for 2 weeks without medication, 2 weeks with 0.4 mg desmopressin orally at night and 2 weeks with 1 mg/kg furosemide 4 to 5 hours before bedtime.
Results:
The mean number of wet nights +/-SD during the 3 periods was 10.2 +/- 3.0, 6.7 +/- 4.7 and 7.8 +/- 4.5, respectively. The effects of desmopressin and of furosemide were statistically significant (p <0.0001 and p = 0.001), although the 2 treatments did not differ (p = 0.08). Only 6 children had a complete response (ie greater than 90% reduction in wet nights) to desmopressin and 5 responded to furosemide. Interestingly, 2 children had a clearly better response on furosemide than on desmopressin.
Conclusions:
The treatment of enuresis with diuretic medication in the afternoon may be beneficial but needs to be tested in randomized controlled trials.
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