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Imipramine for therapy resistant enuresis: a retrospective evaluation
Simon Gepertz1, Tryggve Nevéus
1Department of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala, Sweden.
Insights
Imipramine is effective for treating childhood enuresis, particularly in older children, when other treatments fail. Prognostic indicators include age, bladder capacity, constipation, and daytime incontinence history.
Area of Science:
- Pediatric Urology
- Pharmacology
- Clinical Medicine
Background:
- Imipramine is a tricyclic antidepressant with established efficacy in treating enuresis.
- Current clinical practice seldom utilizes imipramine for enuresis management.
- This study aimed to identify prognostic factors for imipramine treatment success in enuretic children.
Purpose of the Study:
- To review treatment outcomes of imipramine in enuretic children.
- To identify predictors of response to imipramine therapy.
- To evaluate imipramine as a salvage therapy for refractory enuresis.
Main Methods:
- Retrospective evaluation of 49 enuretic children treated with imipramine.
- Analysis of patient history, including bladder volume, urine production, and renal concentrating capacity.
- Assessment of treatment response based on enuresis frequency reduction.
Main Results:
- 64.6% of children responded to imipramine, with 22 achieving complete dryness.
- Favorable prognostic indicators included older age and lower spontaneous bladder capacity.
- Constipation and a history of daytime incontinence were associated with a poorer prognosis.
Conclusions:
- Imipramine remains a valuable treatment option for enuresis, especially for older children who have not responded to other therapies.
- Detrusor function parameters, such as bladder capacity, offer significant prognostic information.
- Imipramine treatment was generally well-tolerated, with minor side effects reported.
Purpose:
Imipramine has a proven effect in enuresis but is now seldom used. We reviewed the records of children who had been treated with imipramine to determine prognostic indicators.
Materials And Methods:
The records of all enuretic children treated with imipramine at our clinic were retrospectively evaluated, with special emphasis on history, and for most children bladder volume, renal concentrating capacity and urine production.
Results:
All 49 children included in the study had previously received desmopressin, alarm and anticholinergic treatment without success. Of the children 31 (64.6%) were responders (R), with at least 50% reduction in enuresis frequency (22 became completely dry) and 17 (35.4%) were nonresponders (NR). Older age (R 11.4 +/- 3.4, NR 8.7 +/-1.8 years, p = 0.004) and low spontaneous bladder capacity (R 2.6 +/- 0.9, NR 3.4 +/- 0.9 ml/kg body weight, p = 0.03) were prognostically favorable, whereas constipation (p = 0.02) and a history of daytime incontinence (p = 0.04) indicated poor prognosis. Ten children experienced nausea or other minor problems. Seven children with attention deficit and hyperactivity became more focused during treatment.
Conclusions:
Imipramine is a useful treatment for enuresis when everything else has failed, especially among older children. Factors related to detrusor function provide prognostic information.
