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Daytime functional bladder capacity as a predictor of response to desmopressin in monosymptomatic nocturnal enuresis
D A Eller1, P F Austin, S Tanguay
1Division of Pediatric Urology, Tampa General Hospital Children's Medical Center, University of South Florida, USA.
Insights
Daytime functional bladder capacity and age predict response to desmopressin (DDAVP) in children with nocturnal enuresis. Larger bladder capacity and older age indicate a higher likelihood of successful treatment with DDAVP.
Area of Science:
- Pediatric Nephrology
- Urology
- Pharmacology
Background:
- Monosymptomatic nocturnal enuresis (MNE) affects many children.
- Desmopressin (DDAVP) is a common treatment for MNE.
- Predicting DDAVP response can optimize treatment and reduce costs.
Purpose of the Study:
- To identify a cost-effective method for predicting therapeutic response to desmopressin (DDAVP).
- To correlate daytime functional bladder capacity, age, and urine osmolalities with DDAVP response in children with MNE.
Main Methods:
- Study included 35 children with MNE.
- Maximal daytime functional bladder capacity was measured over 2 days.
- Urine samples were collected at home for osmolality.
- Intranasal DDAVP was administered, with doses titrated over 2 weeks.
Main Results:
- 27 out of 35 children (77%) showed a complete response to DDAVP.
- Higher daytime functional bladder capacity significantly predicted a positive response (p = 0.006).
- Older age was also a significant predictor of good response (p = 0.008).
- Urine osmolalities did not predict DDAVP response (p > 0.1).
Conclusions:
- Daytime functional bladder capacity is a reliable predictor of desmopressin efficacy in MNE.
- Older children tend to respond better to DDAVP treatment.
- Home-collected spot urine osmolality is not a useful predictor of DDAVP response.
Objective:
The objective of this study was to identify a cost-effective method of predicting a therapeutic response to desmopressin (DDAVP) by correlating daytime functional bladder capacity, age and urine osmolalities in patients with monosymptomatic nocturnal enuresis.
Materials And Methods:
Thirty-five children out of 51 who initially presented to our institutions were included in the study. The remainder was excluded for lack of complete data. Constipation was actively addressed and was managed by administration of evening enemas for 3 consecutive days and dietary adjustment prior to initiating the study. Each micturition as measured throughout the day and the maximal daytime functional bladder capacity was determined as the largest void over a 2-day period. Urine samples were collected at home at 08:00, 16:00 and 22:00 (times that would best reflect the fluctuations in plasma vasopressin levels). Intranasal DDAVP was then administered, titrating the dose over a 2-week period. The initial dose was 10 micrograms and the dose was increased 10 micrograms every 3 days.
Results:
The response to DDAVP was then evaluated and of the 35 children, 27 demonstrated a complete response to DDAVP (all at doses between 10 and 30 micrograms). These were then related to the possible predictive factors. There was a significant correlation between a high maximum daytime functional bladder capacity and response to DDAVP (p = 0.006). Similarly, age was also predictive of a good response to DDAVP treatment (p = 0.008). However, spot urine osmolalities were not predictive of a response to DDAVP (p > 0.1).
Conclusions:
Functional bladder capacity is a reliable predictor of response to desmopressin; children with larger capacities are more likely to exhibit a successful response. Older children have a better response rate than younger ones. Spot urine osmolality measured on specimens collected in the home setting is not predictive of response to desmopressin.