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Nocturnal enuresis and the use of desmopressin: is it helpful?
1Southern Derbyshire Community Trust and Derbyshire Children's Hospital, Derby, UK.
Insights
For children with nocturnal enuresis, an enuretic alarm is more effective long-term than desmopressin. Continued alarm use with dry bed training offers better outcomes for persistent bedwetting cases.
Area of Science:
- Pediatrics
- Urology
Background:
- Nocturnal enuresis (bedwetting) affects many children.
- Treatment options include enuretic alarms and desmopressin, but resistance can occur.
Purpose of the Study:
- To assess the effectiveness of enuretic alarms and desmopressin for childhood nocturnal enuresis.
- To investigate reasons for desmopressin resistance.
Main Methods:
- Children received a 4-month enuretic alarm course if new to it.
- Desmopressin was given to those who failed alarms or were poorly motivated.
- Persistent enuretic children received further alarm training, some with dry bed training.
Main Results:
- 57% of new alarm users became dry; 38% of desmopressin users became dry.
- Only 7% of desmopressin responders remained dry after withdrawal.
- 15 of 27 children achieved dryness with continued alarm use and dry bed training.
- Desmopressin-resistant children had small bladder capacities and concentrated urine.
Conclusions:
- Enuretic alarms are more effective than desmopressin for persistent nocturnal enuresis.
- Continue alarm use and consider dry bed training if initial alarm treatment fails.
- Small nocturnal bladder capacity is a likely primary cause of nocturnal enuresis.
Abstract:
We assessed the outcome of the use of an enuretic alarm and desmopressin according to conventional guidelines and investigated the reasons for resistance to desmopressin. Children were given a 4 month course using an enuretic alarm if they had not previously used one; 12 out of 21 were dry (57%) after 4 months and one relapsed 1 month later. Those who had previously failed with an alarm or were considered poorly motivated to use it, were given a 4 month course of intranasal desmopressin. Of these 26 children, 10 (38%) were dry at the end of 4 months but only two (7%) remained dry after this was withdrawn. After the initial treatment with alarm or desmopressin, 27 children were still enuretic and attending the clinic. They were shown how to use the alarm and eight also used the dry bed training technique: 15 had become dry after a further 6 months. Of the 12 children who made no response to intranasal desmopressin, nine were given this medication under supervision in hospital; seven of these children still wet the bed despite producing small amounts of concentrated urine overnight. They also had small measured diurnal bladder capacities. We conclude that if a 4 month course with an enuretic alarm is unsuccessful, rather than using desmopressin, the alarm should be continued with relearning and consideration given to additional use of the dry bed training technique. The major factor causing nocturnal enuresis in children is likely to be a small nocturnal bladder capacity.