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Desmopressin for bed wetting: length of treatment, vasopressin secretion, and response
1Department of Paediatrics and Child Health, St James's University Hospital, Leeds.
Insights
A one-month intranasal desmopressin course is as effective as a three-month course for treating childhood nocturnal enuresis. While many children improve during treatment, few achieve complete dryness, and most relapse after stopping desmopressin.
Area of Science:
- Pediatric Nephrology
- Sleep Medicine
- Pharmacology
Background:
- Nocturnal enuresis affects a significant number of children.
- Intranasal desmopressin is a common treatment, but optimal duration is debated.
Purpose of the Study:
- To compare the efficacy of one-month versus three-month intranasal desmopressin courses for nocturnal enuresis.
- To investigate the association between nocturnal polyuria and desmopressin response.
Main Methods:
- A controlled trial involving 55 children with nocturnal enuresis.
- Comparison of treatment outcomes between one-month and three-month desmopressin groups.
- Measurement of nocturnal urine volume, osmolality, and vasopressin in different patient groups.
Main Results:
- No significant difference in efficacy between one-month and three-month desmopressin courses.
- 36% of children improved by at least two dry nights/week during treatment.
- Only a small percentage achieved complete dryness, with most relapsing post-treatment.
- No significant differences in nocturnal urine parameters between responsive, non-responsive, and control groups.
Conclusions:
- A three-month course of intranasal desmopressin offers no advantage over a one-month course for nocturnal enuresis.
- Desmopressin provides temporary improvement for many children, but long-term dryness is uncommon.
- Nocturnal polyuria characteristics did not predict therapeutic response to desmopressin.
Abstract:
Fifty five children with nocturnal enuresis referred to a hospital enuresis clinic entered a controlled trial to compare the efficacy of one month and three month courses of intranasal desmopressin (Desmospray). There was no significant difference in outcome between the two groups. Overall 36% improved by at least two dry nights/week during treatment, but only five children (18%) in the one month group and three (11%) in the three month group became completely dry and only one in each group remained dry after treatment. To determine whether nocturnal polyuria was associated with a therapeutic response to desmopressin, the nocturnal urine volume, osmolality, and vasopressin concentration were measured in desmopressin responsive enuretics, desmopressin non-responders, and non-enuretic control children. There were no significant differences between the three groups. A three month course of desmopressin is no more effective than a one month course. Although many children will improve during treatment, only a small number become dry and most will relapse when treatment is stopped.