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Treatment of nocturnal enuresis in children with attention deficit hyperactivity disorder
Boris Chertin1, Dmitry Koulikov, Wael Abu-Arafeh
1Department of Urology, Shaare Zedek Medical Center, Jerusalem. bchertin@yahoo.com
Insights
Combination therapy with desmopressin and oxybutynin effectively treats nocturnal enuresis in children with attention deficit hyperactivity disorder (ADHD). This approach showed superior results compared to imipramine for improving voiding dysfunction symptoms.
Area of Science:
- Pediatric Urology
- Neurodevelopmental Disorders
- Pharmacology
Background:
- Children with attention deficit hyperactivity disorder (ADHD) frequently experience voiding dysfunction and persistent nocturnal enuresis.
- These issues stem from a combination of sphincter and detrusor overactivity, alongside nocturnal polyuria.
- Standard treatments for nocturnal enuresis often prove ineffective in this patient population.
Purpose of the Study:
- To prospectively compare the efficacy of combination therapy (desmopressin and oxybutynin) versus imipramine in treating nocturnal enuresis in children with ADHD.
- To evaluate the impact of these treatments on functional bladder symptoms.
Main Methods:
- A prospective study involving 54 patients with ADHD and nocturnal enuresis, randomly stratified into two groups.
- One group received desmopressin and oxybutynin; the other received imipramine.
- Functional bladder symptoms were assessed using the dysfunctional voiding symptoms survey (dVSS).
Main Results:
- Both treatment groups showed a significant decrease in dVSS scores post-treatment (p < 0.001).
- The combination therapy group (desmopressin and oxybutynin) exhibited significantly lower dVSS scores compared to the imipramine group (mean 6.5 vs 9.6, p < 0.001).
- A statistically significant reduction in the incidence of nocturnal enuresis was observed in the combination therapy group.
Conclusions:
- Voiding dysfunction is highly prevalent in children diagnosed with attention deficit hyperactivity disorder.
- Combination therapy with desmopressin and oxybutynin presents a safe and effective treatment option for nocturnal enuresis in this specific pediatric population.
- This therapeutic strategy offers a promising alternative for managing complex voiding issues in children with ADHD.
Purpose:
Children with attention deficit hyperactivity disorder disproportionately experience voiding dysfunction and persistent nocturnal enuresis due to a combination of sphincter and detrusor overactivity and nocturnal polyuria. The different treatment approaches to nocturnal enuresis often fail in these patients. Therefore, we performed a prospective study to compare the efficacy of combination therapy with desmopressin and oxybutynin vs the tricyclic antidepressant imipramine in patients with attention deficit hyperactivity disorder who have nocturnal enuresis.
Materials And Methods:
A total of 54 patients with attention deficit hyperactivity disorder and nocturnal enuresis were randomly stratified into 2 groups. Demographic data on patient age and gender were identical in the 2 groups. Functional bladder symptoms were judged using the dysfunctional voiding symptoms survey. The initial dysfunctional voiding symptoms survey score was similar in the 2 groups. The total survey score was compared between the 2 groups in aggregate as well as specifically regarding the incidence of nocturnal enuresis following treatment.
Results:
The first group consisted of 27 patients who received desmopressin and oxybutynin, and the second group of 27 was treated with imipramine. Of the 27 children in each group 23 (85%) received methylphenidate for attention deficit hyperactivity disorder. The mean +/- SD initial dysfunctional voiding symptoms survey score in groups 1 and 2 was 20.5 +/- 3.3 and 20.9 +/- 4.1, respectively. Following treatment the mean survey score decreased significantly in groups 1 and 2 (6.5 +/- 2.5 and 9.4 +/- 2.1, respectively, p <0.001). However, between groups analysis showed that the dysfunctional voiding symptoms survey score was significantly lower in group 1 than in group 2 (mean 6.5 +/- 0.5 vs 9.6 +/- 0.4, p <0.001). There was also a statistically significant decrease in the incidence of nocturnal enuresis in group 1 (survey question 2 score 0.9 +/- 0.2 vs 2.9 +/- 0.2).
Conclusions:
Our data show that there is a high incidence of voiding dysfunction in children with attention deficit hyperactivity disorder. Combination therapy with desmopressin and oxybutynin is a feasible, safe and effective treatment for nocturnal enuresis in these children.
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