Abstract
Several therapeutic options have been described for children with nocturnal enuresis, but still their efficacy and outcomes are controversial. This study compares the combined Desmopressin and Tolterodine efficacy versus Desmopressin alone efficacy in the treatment of nocturnal enuresis. One hundred children 5–16 years old with nocturnal enuresis were enrolled in a randomized trial study and were assigned to two equal groups. In a double-blind manner, we used 2 mg of Tolterodine tablet plus 20 μg of nasal Desmopressin in group A and 20 μg of nasal Desmopressin plus placebo in group B. The two groups were matched for age and sex (P = 0.547, P = 0.414). The mean number of the wet nights was reduced in both groups (P < 0.001, P < 0.001). Upon ICCS scoring in the Tolterodine + Desmopressin group, 27 (54%) had full response, 17 (34%) had partial response, and 5 (10%) had an unsuccessful outcome. In the Desmopressin + placebo group, 17 (34%) had full response, 23 (46%) had partial response, and 10 (20%) had an unsuccessful outcome. The response in the Tolterodine + Desmopressin group was significantly higher (P = 0.049). Regarding the results, combined Tolterodine plus Desmopressin is slightly more effective than monotherapy.
Highlights
Primary nocturnal enuresis is intermittent nocturnal incontinence in children aged more than 5 years in the absence of structural and nervous system abnormalities
Some studies have augmented that the reduction in nocturnal functional bladder capacity is a common factor in the pathogenesis of refractory nocturnal enuresis [9, 10]. These findings suggest that the combination therapy (Desmopressin + anticholinergic) may improve treatment of nocturnal enuresis
In the group treated with Desmopressin + placebo, 17 patients (34%) had full response, 23 patients (46%) had partial response, and 10 patients (20%) had an unsuccessful outcome
Summary
Primary nocturnal enuresis is intermittent nocturnal incontinence in children aged more than 5 years in the absence of structural and nervous system abnormalities. Behavioral modification is recognized as the first step of management in enuresis. Many approached have considered behavioral modification to enuresis, by far alarm units have counted as the most effective method [2]. It is known a successful outcome depends to appropriate compliance of the child and her or his parents. Medication used for the treatment of enuresis includes Desmopressin, anticholinergic agents, and tricyclic antidepressants. Regarding the high prevalence of enuresis (15–20%) and the unsuccessful response to Desmopressin alone (25–20%) and critical side effects of tricyclic antidepressants, the need to identify a new strategy with minimal side effects and maximum effectiveness is felt.
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