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Diuretic treatment of nocturnal enuresis
Tryggve Nevéus1, Eva Johansson, Kerstin Nydahl-Persson
1Uppsala University Children's Hospital, Uppsala, Sweden. tryggve.neveus@kbh.uu.se
Insights
Afternoon furosemide showed limited benefit for nocturnal enuresis compared to desmopressin. While both treatments improved outcomes over no treatment, desmopressin was more effective in reducing wet nights for children with enuresis.
Area of Science:
- Pediatrics
- Urology
- Pharmacology
Background:
- Nocturnal polyuria is a key factor in nocturnal enuresis.
- Desmopressin is a first-line treatment for nocturnal enuresis when administered at bedtime.
Purpose of the Study:
- To evaluate the therapeutic benefit of afternoon diuretic medication (furosemide) in children with primary, monosymptomatic nocturnal enuresis.
- To compare the efficacy of furosemide with desmopressin in treating nocturnal enuresis.
Main Methods:
- An open, non-randomized study involving 63 children with nocturnal enuresis.
- Children underwent a baseline period, 14 days of desmopressin (0.4 mg orally at bedtime), and 14 days of furosemide (1 mg/kg in the afternoon).
- The number of wet and dry nights was recorded for each phase.
Main Results:
- Both desmopressin and furosemide significantly reduced wet nights compared to baseline.
- Desmopressin (24% dry nights) was significantly more effective than furosemide (12% dry nights).
- Three patients unresponsive to desmopressin showed improvement with furosemide.
Conclusions:
- Afternoon furosemide has minimal therapeutic potential for nocturnal enuresis.
- Desmopressin remains a more effective treatment option for nocturnal enuresis compared to furosemide.
Objective:
Nocturnal polyuria is considered a major pathogenetic factor in nocturnal enuresis, and the antidiuretic drug desmopressin, given at bed-time, is consequently recognized as a first-line treatment alternative. The aim of this open, non-randomized study was to see whether diuretic medication, given in the afternoon, could give similar therapeutic benefit.
Material And Methods:
Sixty-three children suffering from primary, monosymptomatic, nocturnal enuresis were included in the study by their primary care paediatrician. After 14 days without any treatment and 14 days for which 0.4 mg of desmopressin was given orally at bed-time, the children were given furosemide 1 mg/kg in the afternoon for 14 consecutive days. The numbers of wet and dry nights were recorded.
Results:
The numbers of wet nights at baseline, during desmopressin treatment and during furosemide treatment were 10.2+/-3.5, 6.4+/-4.6 and 8.2+/-4.5, respectively. Both drugs were significantly better than no treatment, but only a small proportion of patients became completely dry: 24% on desmopressin and 12% on furosemide. Desmopressin was significantly better than furosemide. Three children who showed no therapeutic effect on desmopressin treatment had a favourable response to furosemide.
Conclusion:
Furosemide, given in the afternoon, has minor therapeutic potential in nocturnal enuresis.
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