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A controlled trial of desmopressin and behavioral therapy for nocturnal enuresis
1Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Israel.
Insights
Behavioral therapy and desmopressin (DDAVP) show similar effectiveness for treating childhood nocturnal enuresis. However, DDAVP treatment results are less stable long-term compared to behavioral therapy alone or combined approaches.
Area of Science:
- Pediatrics
- Urology
- Behavioral Medicine
Background:
- Nocturnal enuresis is a common childhood condition impacting quality of life.
- Desmopressin (DDAVP) and behavioral therapy are established treatments, but their comparative effectiveness and long-term outcomes require further investigation.
Purpose of the Study:
- To compare the efficacy and long-term stability of desmopressin (DDAVP) combined with behavioral therapy versus each treatment modality alone for nocturnal enuresis in children.
Main Methods:
- A randomized controlled trial involving 226 children with nocturnal enuresis.
- Three treatment groups: DDAVP plus behavioral therapy, behavioral therapy plus placebo, and DDAVP alone.
- Intranasal desmopressin (20 micrograms/naris) or placebo administered for 8 weeks, with a 2-month follow-up period.
Main Results:
- All groups showed a significant reduction in wet nights per week (49% in combined, 45% in behavioral, 19% in DDAVP alone).
- No significant difference in treatment effect was observed among the groups during the trial period after controlling for confounding factors.
- Long-term follow-up revealed significantly less stable results for the desmopressin-only group (p = 0.015) compared to the other two groups.
Conclusions:
- Behavioral therapy, whether alone or combined with desmopressin, demonstrates comparable efficacy to desmopressin alone in the short term.
- Desmopressin monotherapy is associated with a higher relapse rate upon discontinuation.
- Simple discussion and behavioral interventions are beneficial for managing nocturnal enuresis, with behavioral therapy offering more stable long-term outcomes.
Abstract:
The combination of desmopressin (DDAVP) and behavioral therapy for treatment of nocturnal enuresis was compared with use of each of these modes alone. We randomly assigned 226 enuretic children being treated in primary care clinics of a major medical center in the largest health maintenance organization in Israel into 3 groups: Group A) DDAVP plus behavioral therapy (double-blind); Group B) behavioral therapy plus placebo (double-blind); and Group C) DDAVP alone (open group). DDAVP (20 micrograms/naris) and placebo were administered by intranasal spray. Both pharmacologic and behavioral therapy were initiated after a 2-week observation period and continued for 8 weeks. All patients were followed for 2 months after completion of treatment. A significant reduction in the number of wet nights/week was registered for all 3 groups: 49% in Group A, 45% in Group B, and 19% in Group C. After controlling for confounding factors, no significant difference in effect was noted among the 3 types of treatment during the trial period. However, on follow-up the results for the DDAVP patients were significantly less stable compared with the other 2 groups (p = 0.015). Minor side effects were registered, but none of the participants withdrew from the trial. To our knowledge, this is the largest randomized trial of nocturnal enuresis conducted to date. Our findings suggest that simply discussing the problem with the patient and family leads to improvement, and that behavioral therapy is also beneficial. DDAVP can help, but the relapse rate on discontinuation is high.