Efficacy Of Desmopressin Research Articles

Safety and efficacy of desmopressin (DDAVP) in preventing hematoma expansion in intracranial hemorrhage associated with antiplatelet drugs use: A systematic review and metaanalysis.

One of the most serious complications associated with antiplatelet agents is antiplatelet-associated intracranial hemorrhage (AA-ICH). Desmopressin is a synthetic antidiuretic hormone (ADH) analog. It has been linked to improving patient outcomes in antiplatelet-induced intracranial hemorrhage. The secondary outcomes included the incidence of thrombotic complications and neurological outcomes. A systematic search was conducted on three databases (PubMed, Cochrane, and ClinicalTrials.gov) to find eligible literature that compares desmopressin (DDAVP) versus controls in patients with AA-ICH. The Mantel-Haenszel statistic was used to determine an overall effect estimate for each outcome by calculating the risk ratios and 95% confidence intervals (CI). Heterogeneity was measured using the I2 test. The risk of bias in studies was calculated using the New Castle Ottowa Scale. Five studies were included in the analysis with a total of 598 patients. DDAVP was associated with a nonsignificant decrease in the risk of hematoma expansion (RR=.8, 95% CI,.51-1.24; p=.31, I2=44%). It was also associated with a non-significant decrease in the risk of thrombotic events (RR,.83; 95% CI,.25-2.76; p=.76, I2=30%). However, patients in the DDAVP group demonstrated a significant increase in the risk of poor neurological outcomes (RR, 1.31; 95% CI, 1.07-1.61; p=.01, I2=0%). The risk of bias assessment showed a moderate to low level of risk. DDAVP was associated with a nonsignificant decrease in hematoma expansion and thrombotic events. However, it was also associated with a significantly poor neurological outcome in the patients. Thus, until more robust clinical trials are conducted, the use of DDAVP should be considered on a case-to-case basis.

Efficacy and safety of desmopressin in nocturia and nocturnal polyuria control of neurological patients: A systematic review and meta-analysis.

Evidence on the efficacy of desmopressin in nocturia in patients with neurological diseases is still very limited except for multiple sclerosis (MS). Our aim was to evaluate the efficacy and safety of desmopressin treatment on nocturia in patients with underlying neurological diseases. Studies were identified by electronic search of PubMed, Embase, Cochrane, CINAHL, and Google Scholar databases. Studies were considered if they provided information on the effectiveness and safety of desmopressin (1-desamino-8-d-arginine vasopressin, or DDAVP) in the treatment of nocturia and their participants had acquired neurological pathology. Two researchers independently extracted the articles using specified datasets, such as quality-of-study indicators. Statistical meta-analysis was carried out using Review Manager (RevMan) 5.4 statistical software (Cochrane Collaboration). Of a total of 1042 articles in the initial search, 14 studies were included. Most of the published papers were related to MS (n = 7), two were on spinal cord injury,and other conditions were neural tube defect,myelodysplasia, Parkinson's disease, stroke, and multiple system atrophy. Overall, a total of 200 patients (mostly females) were enrolled. Thirteen studies evaluated the intranasal formulation of desmopressin and one study evaluated oral desmopressin. A significant decrease in nocturia episodes was reported in seven studies evaluating this topic. An increase in the maximum hours of uninterrupted sleep was reported in the three studies in which this outcome was assessed. A significant reduction in the volume of nocturnal incontinence was found in one study. Three studies were eligible to include in the meta-analysis. The results showed that desmopressin compared to placebo, significantly reduced nighttime urination (mean difference: -0.75, 95% CI: -1.10 to-0.41; p < 0.00001). The rate of adverse events ranged from 0% to 68.42%. The critical appraisal results for all trials showed that most of the studies had low or moderate quality. Our results emphasized desmopressin's safety and efficacy in reducing nocturia episodes, with transient adverse effects on neurological patients. However, the data were achieved from low or medium-quality trials, and further well-designed randomized controlled trials are needed.

The Safety and Efficacy of Desmopressin in Patients With Intracranial Hemorrhage and a History of Alcohol Use.

Patients with a history of alcohol use disorder are at an increased risk of hematoma expansion following intracranial hemorrhage (ICH) due to the effects of alcohol on platelet aggregation. Desmopressin (DDAVP) improves platelet aggregation and may decrease hematoma expansion in patients with ICH. However, DDAVP may also increase the risk of hyponatremia and thrombotic events. Evidence is limited regarding the safety and efficacy of DDAVP in alcohol use (AU)-associated ICH. This was a retrospective chart review of adult patients with radiographic evidence of ICH and a confirmed or suspected history of alcohol use upon admission. Patients were categorized into groups based on DDAVP administration. Safety outcomes included hyponatremia (serum sodium <135 mEq/L or decrease in serum sodium of ≥ 5 mEq/L for patients with baseline sodium <135 mEq/L) within 24 hours of ICH and thrombotic events within 7 days of ICH. The primary efficacy outcome was the incidence of hematoma expansion, defined as any expansion of the hemorrhage noted on repeat imaging within 32 hours. In total, 52 patients were included in the safety analysis (27 DDAVP and 25 non-DDAVP). Although hyponatremia was numerically higher in the DDAVP group, there was no significant difference between groups (19.2% vs 4.2%, P = 0.192). Thrombotic complications were similar between the DDAVP and non-DDAVP groups (11.1% vs. 8%, P = 1.0). Thirty-nine patients met criteria for hemostatic efficacy analysis. There was no difference in hematoma expansion between the DDAVP and non-DDAVP groups (23.1% vs 34.6%, P = 0.71) and these findings were consistent after adjusting for differences in baseline characteristics (OR 0.63, 95% CI 0.1-3.3). The administration of DDAVP was not associated with adverse safety events, but did not significantly reduce the incidence of hematoma expansion in patients with AU-associated ICH.

Desmopressin acetate the first sublingual tablet to treat nocturia due to nocturnal polyuria

ABSTRACT Introduction: Desmopressin was widely used to treat nocturnal polyuria in adults under the age of 65 due to the well-established risk of hyponatremia. Since the prevalence of nocturia increases with age, and with an aging population, those most affected were excluded from treatment. Recently, a new lower dose sublingual tablet formulation that optimizes the balance between efficacy and tolerability has been licensed for symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults of any age, with the caveat of regular serum monitoring for those over 65. This newer formulation aims to achieve the same clinical outcomes as previous formulations while reducing the risk of hyponatremia. Areas covered: This review will look at the pharmacology of the newly formulated desmopressin and examine the results of the clinical trials that would support its treatment of adult nocturia with idiopathic nocturnal polyuria. Expert opinion: When reporting on the clinical efficacy of desmopressin on nocturia, it is important for clinical trials to publish their complete data on nocturnal and 24-hour urine voided volumes. Further research examining the physiological reasoning behind this gender-specific dosing for desmopressin and the optimal recommended treatment duration of desmopressin for those over 65 is needed.

Constipation in nocturnal enuresis may interfere desmopressin management success

Previous studies indicated that the prevalence of constipation in enuretic patients is higher than that in the general population. Several studies have revealed that successful treatment of constipation may be helpful in resolving enuresis. However, constipation affecting the efficacy of desmopressin in treating enuresis remains to be clarified. This study aimed to determine whether the presence of constipation is associated with the efficacy of desmopressin in treating enuresis. Patients diagnosed with nocturnal enuresis (NE) were studied prospectively. Treatment responses in different stratified groups of patients with NE were compared by Chi-squared tests or Wilcoxon rank sum test. A logistic regression model was performed to investigate the relationship between the possible factors and the effectiveness of desmopressin. In children with severe enuresis, patients with constipation had significantly lower complete response rate compared with patients without constipation. The presence of constipation was always related to the effectiveness of desmopressin whether in monosymptomatic NE or non-monosymptomatic patients with NE. With stratification for dose of desmopressin, non-constipated patients who received 0.2mg of desmopressin had significantly higher complete response rate than patients with constipation. However, in subgroups of mild to moderate NE and 0.4mg desmopressin, constipation was not associated with treatment response of enuresis. Logistic regression analysis revealed that constipation was significantly related to the effectiveness of desmopressin. This study confirmed the negative effects of constipation in response to desmopressin in patients with NE. To the best of authors knowledge, this work is the first study to evaluate the relationship of constipation in enuretic patients and the efficacy of desmopressin. The presence of constipation negatively affects the response to desmopressin in patients with NE, especially in patients with severe enuresis and in patients prescribed with low dose of desmopressin.

Do independent geriatric outpatients with nocturnal polyuria profit from desmopressin?

To compare the efficacy of desmopressin and placebo in independent geriatric outpatients with nocturnal polyuria (NP). A prospective, randomized, single-center, national, double blind, placebo-controlled, fixed-dose, parallel group comparative trial was carried out. The study included 110 geriatric outpatients, 55patients per treatment group using desmopressin acetate nasal spray (strength: 0.1 mg/ml) once daily of 10 μg/spray blast or placebo. The NP positive geriatric outpatients with >33% nocturnal urine output volume, antidiuretic hormone (ADH) positive or negative were treated over 10days with intranasal spray in the evening time (7p.m.), drug or placebo. On day1 voiding frequency, voiding volumes day and night, serum osmolarity and arginine-vasopressin (AVP) were measured at 7p.m. On days2, 5 and 10 creatinine, blood urea nitrogen (bun), blood count and C‑reactive protein (CrP), vena cava diameter and bioimpedance were measured and astructured interview was implemented (voiding frequency, sleeping behavior and subjective and cognitive behavior). The NP patients showed amean night voiding volume of 50.60%, 39.21% (n = 102) showed alow AVP level at baseline with no correlation to sodium concentration or voiding frequencies. The primary efficacy criterion, a decrease of the nocturnal voiding frequency during the course of the clinical trial as change from baseline at day10 (visit4) was 50% versus 41.40% in the verum versus placebo group, respectively but the differences were not significant. The U‑test showed superiority of AVP-positive NP patients to a positive reaction on desmopressin. Sleeping time hours increased in both groups without significant differences. In this 10-day clinical trial desmopressin was not proven to be therapeutically superior to placebo with respect to micturition frequency or sleeping hours. Independent geriatric outpatients with decreased ADH levels seemed to respond and benefit from active treatment with desmopressin. The unexpected results in the placebo group may be due to the effect of intensive outpatient care and information on NP outpatients with normal AVP levels.

Comparing the efficacy of desmopressin and oxybutynin combination therapy and desmopressin monotherapy in children with primary nocturnal enuresis; a randomized clinical trial

Introduction: Nocturnal enuresis is known as the most common developmental problems of childhood which has often a familial basis. It is usually benign and gradually disappears with age. Objectives: This study was conducted on children with primary nocturnal enuresis to compare the efficacy of desmopressin and oxybutynin combination therapy with desmopressin monotherapy. Patients and Methods: This clinical trial was conducted on 59 patients (age range; 5 to 15 years) with primary nocturnal enuresis who had referred to our center in Tabriz in 2012. The participants were divided into two groups as group 1 (30 participants) and group 2 (29 subjects). For three months, one group received desmopressin and oxybutynin and the other group received desmopressin alone. Descriptive statistics (mean ± SD and frequency) and chi-square test was conducted. Results: In the group treated only with desmopressin, 72.4% of the participants were completely cured in 1 month and 44.8% in 3 months. In the group treated with combination of desmopressin and oxybutynin, 83.34% were cured in 1 month and 86.7% in 3 months. Conclusion: Desmopressin and oxybutynin combination therapy is more effective than desmopressin monotherapy for treating children with enuresis.

The efficacy of desmopressin in the treatment of central diabetes insipidus after resection of chiasmo-sellar region tumors

to study the efficacy and safety of desmopressin in CDI patients after resection of chiasmatic-sellar region (CSR) tumors. Examination and treatment of patients were performed at a hospital for 7-14 days after surgery and then were continued after discharge. During treatment, the following tests were performed: a daily fluid intake and excretion volume, serum levels of sodium, potassium, and glucose twice a day, morning urine specific gravity, and Zimnitsky's test. Twenty-three patients with CSR tumors (11 craniopharyngiomas, 10 pituitary adenomas, 1 skull base chordoma, and 1 CSR meningioma) and CDI after neurosurgical treatment received desmopressin. On treatment, a thirst decrease, a reduced rate of diuresis, a reduced amount of excreted urine, and normalization of the sodium level were observed in all patients. In 12 patients (with pituitary adenoma, skull base chordoma, and meningioma) with transient CDI, desmopressin therapy was discontinued upon regression of symptoms 7-30 days after surgery. Eleven patients with permanent CDI continued to receive the drug at a dose of 1 to 4 doses per day. All patients well tolerated the drug without significant adverse effects. Therapy with desmopressin in the form of a nasal spray (vazomirin) in patients with transient and permanent CDI after resection CSR tumors of various histological nature (craniopharyngiomas, pituitary adenomas, meningiomas, and chordomas) was effective and safe in the early postoperative and long-term postoperative periods.

Melatonin's Effect on the Efficacy of Desmopressin in the Treatment of Enuresis.

PurposeThis study aims to evaluate and compare the efficacy of exogenous melatonin associated with desmopressin (dDAVP) and dietary recommendations.MethodsA total of 189 patients were enrolled from the Service of Pediatrics, Campus Bio-Medico University Hospital of Rome, from January 2013 to June 2015. Of the 189 original patients, 153 children, aged between 5 and 14 years (mean age, 8.7 years) were included in the study. After clinical evaluation and a 3-month period of observation without treatment, children were assigned to receive treatment in one of 3 groups: group 1, dDAVP at a dose of 120 mcg a day (Minirin); group 2, dDAVP at a dose of 120 mcg and dietary recommendations; or group 3, dDAVP at a dose of 120 mcg, dietary recommendations, and melatonin at a dose of 1 mg a day (Melamil plus). Each patient was treated for 3 months.ResultsAfter the 3 months of therapy, a desiderable response was achieved in 30 of 51 patients (58.82%) treated with dDAVP, 35 of 53 patients (66.04%) treated with dDAVP and dietary recommendations, and 35 of 49 patients (71.43%) treated with dDAVP, dietary recommendations, and melatonin.ConclusionsAlthough not statistically significant, the results show that the association between dDAVP treatment with dietary recommendations and melatonin could be considered a safe and effective treatment of NE. Considering that the statistically insignificant results might be due to the small sample size, the study will be continued to increase the number of subjects.

Safety and efficacy of desmopressin for the treatment of nocturia in elderly patients: a cohort study

Desmopressin is used widely to treat nocturnal polyuria (NP), but there is concern of hyponatremia especially in elderly patients. This study aimed to evaluate the safety and efficacy of long-term desmopressin treatment in elderly patients with NP. Patients who were ≥65 years old with NP were analyzed. All patients were started on 0.1 mg desmopressin, and the dose was escalated to 0.2 mg depending on patient symptoms. All patients were educated the mechanism of desmopressin. The voiding diary and serum sodium levels were evaluated at baseline, 3-7 days after starting treatment and every 3-6 months. Safety was evaluated by hyponatremia, hyponatremic symptoms and other adverse drug events. The mean changes in number of nocturia and nocturnal urine volume (NUV) were evaluated for efficacy. A total of 68 patients were included. The mean age was 72.6 (66-85) years. The mean night-time frequency was 3.0 ± 1.8 day, and the mean serum sodium level was 141.2 ± 2.1 mEq/L at baseline. The mean follow-up period was 27.9 months. The mean decrease in serum sodium level was 1.3 ± 3.4 mEq/L at the last follow-up (p = 0.003). Hyponatremia incidence was 4.4 %, and all patients recovered by stopping medication. Severe adverse events were not observed. The mean night-time frequency had decreased by 2.1, and the NUV had decreased by 374.2 ± 261.3 mL at the last follow-up (p < 0.001). Desmopressin at doses below 0.2 mg is safe and effective in elderly patients with NP if patients are well informed and are closely followed up.

Desmopressin for the treatment of female storage lower urinary tract symptoms

Female storage lower urinary tract symptoms are prevalent and bothersome. They are usually attributed to an overactive bladder and treated with antimuscarinics. Nevertheless, failure of conventional treatment to alleviate nocturia in particular and epidemiological data suggesting that nocturnal polyuria is the only or a contributing factor to nocturia, has attracted interest in decreasing nighttime urine production as a method of managing nocturia. A reduction in urine production could also, at least temporarily, delay daytime storage symptoms by delaying bladder filling. Therefore, desmopressin, the synthetic analogue or naturally occurring antidiuretic hormone, could have a role in the management of female frequency, urgency and urgency incontinence. This work aims to review data on the use of desmopressin in females with storage symptoms. Available evidence indicates that desmopressin is effi cacious in reducing nighttime urine production and episodes of nocturia, resulting in fewer sleep interruptions. This translates into improved quality of life. Desmopressin is also effective in postponing micturition, urgency and incontinence for several hours after being taken on demand. The tolerability profile of desmopressin is good and significantly improved compared to historical figures due to the introduction of new oral formulations, tailoring the dose according to gender and age and adhering to instructions for fluid restriction before administration. The incidence of hyponatremia, desmopressin’s most important side-effect, is less than 3% in recent trials. The efficacy of desmopressin, combined with its improved safety profile, makes it an interesting method for treating female storage lower urinary tract symptoms.

Transcutaneous Parasacral Electrical Neural Stimulation in Children with Primary Monosymptomatic Enuresis: A Prospective Randomized Clinical Trial

Parasacral transcutaneous electrical neural stimulation is widely used to treat hyperactive bladder in children and adults. Its use in nonmonosymptomatic enuresis has demonstrated improvement in number of dry nights. We assessed the effectiveness of parasacral transcutaneous electrical neural stimulation in the treatment of monosymptomatic primary enuresis. This prospective randomized clinical trial included 29 girls and 16 boys older than 6 years with primary monosymptomatic enuresis. Children were randomly divided into 2 groups consisting of controls, who were treated with behavioral therapy, and an experimental group, who were treated with behavioral therapy plus 10 sessions of parasacral transcutaneous electrical neural stimulation. Neural stimulation was performed with the electrodes placed in the sacral region (S2/S3). Sessions always followed the same pattern, with duration of 20 minutes, frequency of 10 Hz, a generated pulse of 700 μs and intensity determined by the sensitivity threshold of the child. Sessions were done 3 times weekly on alternate days. Patients in both groups were followed at 2-week intervals for the first month and then monthly for 6 consecutive months. Rate of wet nights was 77% in controls and 78.3% in the experimental group at onset of treatment (p = 0.82), and 49.5% and 31.2%, respectively, at the end of treatment (p = 0.02). Analyzing the average rate of improvement, there was a significantly greater increase in dry nights in the group undergoing neural stimulation (61.8%) compared to controls (37.3%, p = 0.0038). At the end of treatment percent improvement in children undergoing electrical stimulation had no relation to gender (p = 0.391) or age (p = 0.911). Treatment of primary monosymptomatic enuresis with 10 sessions of parasacral transcutaneous electrical neural stimulation plus behavioral therapy proved to be effective. However, no patient had complete resolution of symptoms.

Efficacy and Safety of Low Dose Desmopressin Orally Disintegrating Tablet in Women with Nocturia: Results of a Multicenter, Randomized, Double-Blind, Placebo Controlled, Parallel Group Study

Previous studies suggest a lower dose of desmopressin orally disintegrating tablet may be effective in females compared to males with nocturia. We confirm the efficacy and safety of 25 μg desmopressin orally disintegrating tablet compared to placebo in female patients. In this 3-month, randomized, double-blind, parallel group study 25 μg desmopressin once daily was compared to placebo in women with nocturia (2 or more nocturnal voids). The co-primary efficacy end points were change from baseline in mean number of nocturnal voids and proportion of patients achieving at least a 33% reduction from baseline in the mean number of nocturnal voids (33% responders). The full analysis set comprised 261 patients (age range 19 to 87 years). Desmopressin significantly reduced the mean number of nocturnal voids and increased the odds of a 33% or greater response compared to placebo during 3 months, assessed by longitudinal analysis (-0.22, p = 0.028 and OR 1.85, p = 0.006, respectively). Desmopressin increased the mean time to first nocturnal void by 49 minutes compared to placebo at 3 months (p = 0.003). The response to desmopressin was seen by week 1 of treatment and was sustained throughout the trial. Significant increases in health related quality of life and sleep quality were observed compared to placebo. Desmopressin was well tolerated. Serum sodium levels remained greater than 125 mmol/L throughout the trial and 3 transient decreases to less than 130 mmol/L were recorded. At a dose of 25 μg, desmopressin orally disintegrating tablet is an effective and well tolerated treatment for women with nocturia. Treatment provides rapid and sustained improvement in nocturia and quality of life.

Desmopressin Add-On Therapy for Refractory Nocturia in Men Receiving α-Blockers for Lower Urinary Tract Symptoms

Alpha-blockers improve lower urinary tract symptoms associated with benign prostatic obstruction. Nocturia, a storage symptom, is a common complaint in men. However, it does not fully respond to α-blocker therapy, likely due to its multifactorial pathophysiology. We evaluated the efficacy and safety of desmopressin as add-on therapy for refractory nocturia in men previously treated with an α-blocker for lower urinary tract symptoms. Eligible patients were men 50 years old or older with lower urinary tract symptoms and persistent nocturia despite α-blocker treatment for a minimum of 4 weeks. The optimum dose of oral desmopressin was determined during a 4-week dose titration period and this dose was maintained for 24 weeks. Flow volume charts, International Prostate Symptom Score total and subscores, uroflowmetry and post-void residual urine volume were assessed. A total of 216 patients were enrolled in the study. Of these patients there were 158 (76%) with nocturnal polyuria, 15 (7.2%) with decreased nocturnal bladder capacity and 35 (16.8%) with nocturia due to both causes. The number of nocturnal voids significantly decreased from a baseline mean of 7.0 to 5.7 episodes for 3 days at the 24-week visit. The average International Prostate Symptom Score total and subscore significantly decreased by 4 weeks and were maintained at 24 weeks. In patients younger than 65 years, International Prostate Symptom Score voiding subscores were significantly improved at 24 weeks compared to those age 65 years or older. Desmopressin add-on therapy for refractory nocturia in men previously treated with an α-blocker for lower urinary tract symptoms improved voiding symptoms as well as nocturia, storage symptoms.

The Effect of Maximum Voided Volume on Response to Desmopressin Therapy in Children with Enuresis

This study was aimed to determine the effect of maximum voided volume (MVV) on the efficacy of desmopressin, which is commonly used to treat primary monosymptomatic nocturnal enuresis (PMNE) in children and adolescents. Bladder capacity was measured with different methods in 52 patients with PMNE, and the effect of bladder capacity on desmopressin therapy was investigated. Patients with PMNE in whom MVV was 70% or less of estimated bladder capacity were found to be unresponsive to desmopressin therapy. The MVV can be measured before desmopressin therapy in patients with PMNE as a marker to predict treatment success. Our results suggest that desmopressin should not be used in patients with low MVV.

UP-02.181 Efficacy of Desmopressin and Celecoxib in Treatment of Nocturia Caused by Benign Prostatic Hyperplasia: Comparative Study

BPH treatment has relative response to alpha-1 blockers and 5-alpha reductase inhibitors (25-39%). In spite of these treatments, many patients complain of nocturia. Desmopressin and celecoxib have been used in BPH for treatment of nocturia, but there are no studies that compare the effectiveness of these two drugs for nocturia.

A retrospective observational study of enuresis, daytime voiding symptoms, and response to medical therapy in children with attention deficit hyperactivity disorder and autism spectrum disorder

IntroductionChildren with attention deficit hyperactivity disorder (ADHD) show an increased prevalence of enuresis and other daytime voiding symptoms (DVS). There is also some evidence toward an increased prevalence of enuresis among children with autism spectrum disorder (ASD), but with no data available with respect to DVS or response to medical treatment. The aim of this study was to assess enuresis and DVS, along with treatment outcomes, in children with ASD, to aid urological management. MethodsA retrospective observational study on the incidence of enuresis and other DVS in 671 children with/without ADHD/ASD was performed. Symptomatic improvement ≥50% was required to be considered positive. Complete resolution of symptoms for 3 months after cessation of treatment was considered cure. ResultsSymptomatic improvement with desmopressin or anticholinergic treatment was seen in 76% of patients without ADHD/ASD, 85% of patients with ADHD, and 100% of patients with ASD. Cure was seen in 61% of patients without ADHD/ASD, 48% of patients with ADHD, and 50% patients with ASD. Mean time to cure was 9 months in those without ADHD/ASD (N = 319), 10 months in those with ADHD (N = 62), and 8 months in those with ASD (N = 10) (P = 0.69). ConclusionDespite the small sample size of patients with ASD, our data show a favorable trend toward efficacy of desmopressin and anticholinergic therapy in these children with enuresis and DVS.

UP-2.13: Characteristics of lower urinary tract symptoms and efficacy of treatment with desmopressin in female patients

Nocturia is one of the important lower urinary tract symptoms to cause a decline in quality of life and about 15% of females experience more than 2 voids per night. However, there are few studies about nocturia in females. Therefore we studied, retrospectively, the cause of nocturia, the efficacy of desmopressin and the relation with other lower urinary tract symptoms in female patient.

Efficacy of Desmopressin and Enuretic Alarm as the First and Second-Line Treatment for Monosymptomatic Nocturnal Enuresis; A Prospective, Randomized, Cross-Over Study

Purpose To compare the efficacy of desmopressin (DESM) and enuretic alarm (EA) for the treatment of monosymptomatic nocturnal enuresis (MNE). Material and Methods Children with MNE were randomly assigned to either oral DESM or EA group. After 3 months of the treatment, result was assessed by 1-month wetting diary; full response (FR): reduction rate in the wetting episode of ≥90% or mean wetting episode of ≤ 1/month, partial response (PR): reduction rate of 50∼89%, no response (NR): reduction rate of 1/month. Children with PR or NR were switched to the alternative treatment and the result was evaluated after 3-month of the treatment. Results Of the total of 97 children (74 boys, 23 girls), 51 were assigned to DESM and 46 to EA. Mean age was 8.4±2.1 years, and mean baseline wetting episode was 5.6±1.9/week. After the first-line treatment, 39.2% of DESM and 54.3% of EA obtained FR (p=0.302). And 82.3% of DESM and 89.1% of EA achieved successful result. Of the children with FR, 33% of DESM and 12% of EA experienced relapse (p=0.095). After the second-line treatment, 55.5% of EA-DESM and 50.0% of DESM-EA obtained FR (p=0.572). And 83.3% of EA-DESM and 75.0% of DESM-EA achieved successful result. Conclusions Treatment efficacy and relapse rate were comparable between DESM and EA in the children with MNE. Switch to the alternative treatment gave an additional benefit.

Characteristics of a Tertiary Center Enuresis Population, With Special Emphasis on the Relation Among Nocturnal Diuresis, Functional Bladder Capacity and Desmopressin Response

We evaluated pretreatment values of circadian rhythm of urine production and urine osmolality in children with different subtypes of monosymptomatic nocturnal enuresis, and investigated their predictive value for desmopressin response. We assessed 125 consecutive patients with monosymptomatic nocturnal enuresis, nocturnal polyuria and normal functional bladder capacity who were treated with desmopressin for a median of 17 months (range 3 to 100). Patients were characterized according to the desmopressin response as full responders or nonfull responders. Baseline parameters were obtained from a 2-week home recording diary. Results were compared with 125 consecutive children with monosymptomatic nocturnal enuresis and reduced functional bladder capacity. No differences in pretreatment values of functional bladder capacity, circadian rhythm of urine production or urine osmolality were found between desmopressin full responders and nonfull responders. Patients with nocturnal polyuria had a significantly higher 24-hour diuresis volume compared to children with reduced functional bladder capacity. Some children with reduced functional bladder capacity also had nocturnal polyuria. Our findings show that the characteristics of nocturnal polyuria in patients with monosymptomatic nocturnal enuresis and normal functional bladder capacity do not predict desmopressin response. The wide overlap among the different subgroups suggests that dividing patients with monosymptomatic nocturnal enuresis into those with reduced functional bladder capacity and those with desmopressin responsive nocturnal polyuria might be insufficient. Patients with nocturnal polyuria and normal functional bladder capacity have a significantly higher daytime and nighttime diuresis volume compared to children with reduced functional bladder capacity, suggesting a direct correlation between daytime fluid intake and nocturnal diuresis rate. Some children with reduced functional bladder capacity also have nocturnal polyuria.