Desmopressin versus indomethacin treatment in primary nocturnal enuresis and the role of prostaglandins

Abstract

Objectives. To compare the efficacy of desmopressin and indomethacin and also determine the prostaglandin E 2 (PGE 2) concentrations in the patient and control groups. Methods. Eighty-five children with primary nocturnal enuresis were followed up for a baseline period of 4 weeks, during which they recorded wet and dry nights. After this period, the patients were divided into three groups that used desmopressin, indomethacin, or placebo for 4 weeks. The dosage of desmopressin (group A, n = 31) was 20 μg/day and the dosage of indomethacin (group B, n = 29) was 100 mg/day. The placebo group (group C) consisted of 25 patients. We determined the serum PGE 2 and urine PGE 2 concentrations before and after treatment in the three groups and in a control group. Results. Treatment with desmopressin and indomethacin resulted in significantly more dry nights during the 4 weeks of observation than did placebo ( P <0.005). The number of dry nights was also significantly different in the desmopressin group than in the indomethacin group ( P <0.01). In the total patient group, the mean serum and urine PGE 2 concentrations were significantly different from the control group’s serum and urine PGE 2 concentrations ( P <0.001). There was a significant decrease in the serum and urine PGE 2 concentrations in group A and group B after the treatment period ( P <0.01). Conclusions. Desmopressin and indomethacin were found to be more effective than placebo. We conclude that prostaglandins have an important role in the pathophysiology of primary nocturnal enuresis.