Treatment Of Monosymptomatic Nocturnal Enuresis Research Articles

PD06-09 EFFECTS OF DESMOPRESSIN PLUS PROPIVERINE FOR THE TREATMENT OF MONOSYMPTOMATIC PRIMARY NOCTURNAL ENURESIS IN CHILDREN

You have accessJournal of UrologyCME1 Apr 2023PD06-09 EFFECTS OF DESMOPRESSIN PLUS PROPIVERINE FOR THE TREATMENT OF MONOSYMPTOMATIC PRIMARY NOCTURNAL ENURESIS IN CHILDREN Do Gyeong Lim, Jeong Hoon Oh, Jiwon Ryu, Seong Hyeon Yu, Ho Seok Chung, Eu Chang Hwang, Kyung Jin Oh, Seung Il Jung, Taek Won Kang, Kwangsung Park, Dong Deuk Kwon, and Sun-Ouck Kim Do Gyeong LimDo Gyeong Lim More articles by this author , Jeong Hoon OhJeong Hoon Oh More articles by this author , Jiwon RyuJiwon Ryu More articles by this author , Seong Hyeon YuSeong Hyeon Yu More articles by this author , Ho Seok ChungHo Seok Chung More articles by this author , Eu Chang HwangEu Chang Hwang More articles by this author , Kyung Jin OhKyung Jin Oh More articles by this author , Seung Il JungSeung Il Jung More articles by this author , Taek Won KangTaek Won Kang More articles by this author , Kwangsung ParkKwangsung Park More articles by this author , Dong Deuk KwonDong Deuk Kwon More articles by this author , and Sun-Ouck KimSun-Ouck Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003230.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We evaluated the efficacy of a combination treatment of desmopressin and propiverine for treating children with monosymptomatic primary nocturnal enuresis. METHODS: A total of 53 children aged 6 to 15 years old with monosymptomatic nocturnal enuresis prospectively were enrolled in this study. Children with a minimum of 3 wet nights weekly were included in the study. Children were randomly assigned groups and treated with desmopressin 0.2mg, or a combination of desmopressin plus propiverine 10mg. Of these patients 43 (31 boys and 12 girls, mean age 8.4±2.5 years, range 4 to 13) were followed for more than 6 months. Efficacy was measured at 1, 3 and 6 months in terms of average enuretic frequency after treatment. RESULTS: Of the 43 children finally analysed 23 received combination therapy of desmopressin and propiverine and 20 received desmopressin alone. The frequency of nocturnal enuresis at baseline in monotherapy group and combination therapy was similar (5.45±1.57 vs 5.82±1.44). However, decrease of the nocturnal enuresis was significantly pronounced in combination group after 6 months treatment than in monotherpy group (1.8±1.01 vs 1.29±0.67). Combination therapy produced better outcomes than monotherapy in terms of number of nocturnal enuresis episode. The adverse event was minimal. CONCLUSIONS: Combination therapy with desmopressin plus propiverine for the treatment of monosymptomatic nocturnal enuresis was well tolerated, and gave significantly effective results in reducing enuresis episode than single therapy of desmopressin in children. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e159 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Do Gyeong Lim More articles by this author Jeong Hoon Oh More articles by this author Jiwon Ryu More articles by this author Seong Hyeon Yu More articles by this author Ho Seok Chung More articles by this author Eu Chang Hwang More articles by this author Kyung Jin Oh More articles by this author Seung Il Jung More articles by this author Taek Won Kang More articles by this author Kwangsung Park More articles by this author Dong Deuk Kwon More articles by this author Sun-Ouck Kim More articles by this author Expand All Advertisement PDF downloadLoading ...

The Efficacy of Combined Alarm Therapy Versus Alarm Monotherapy in the Treatment of Monosymptomatic Nocturnal Enuresis: A Review of Current Literature.

Primary monosymptomatic nocturnal enuresis is a common clinical condition in childhood and affects the psychosocial development of the child. The management of this clinical condition, which includes the preschool and adolescence period, is very important for child development. Diagnostic evaluation should be performed in terms of diabetes mellitus, diabetes inspidus, neurogenic bladder, spinal anomalies, and congenital urogenital system anomalies. Treatment modalities in primary monosymptomatic nocturnal enuresis include enuretic alarm therapy, behavioral therapy, and pharmacological treatments such as desmopressin, tricyclic antidepressants, and anticholinergics. There are also experimental treatments such as percutaneous nerve stimulation, acupuncture, and manual therapy. In this study, we examined randomized controlled studies in the literature that included alarm monotherapy and combined therapy. We aimed to present the efficacy, advantages, and disadvantages of combined treatment with the results of the studies.

A prospective and randomized study comparing the use of alarms, desmopressin and imipramine in the treatment of monosymptomatic nocturnal enuresis

Monosymptomatic enuresis (MNE) results from a pathogenic triad that may include lack of vasopressin secretion during sleep, reduced functional bladder capacity and inability to wake up during sleep. The treatment of MNE can be performed through behavioral therapy, use of alarms or medications such as desmopressin and imipramine. To compare the effectiveness of different treatments of MNE. Prospective and randomized study comparing different intervention and a control group (receiving only behavior therapy) for MNE. age between 5 and 16 years old, with MNE, evaluated at the pediatric urology outpatient clinic of Hospital Infantil Menino Jesus. At first visit children were submitted to behavior therapy (urotherapy) for 3 months, children were subsequently characterized according to the ICCS as non-responders, partial responders, or full responders. Those partial responders or non-responders received a patient ID and were randomized to four groups: Alarm Group (G1), Desmopressin Group - DDAVP (G2), Imipramine Group (G3) and Control (G4). All groups were monitored monthly, for a period of 6 months. After 6 months, the children were reevaluated for MNE. 93 patients were enrolled. Mean age was 10.96 years with a standard deviation of 2.28 years, 59,1% were male. All groups had improvement in the number of dry nights (Table). Taking in account success the population full responders and partial responders: Alarm Group (G1) achieve success in 100% of cases, Desmopressin Group - DDAVP (G2) in 63.6% of cases, Imipramine Group (G3) in 73.7% of cases (Table 3). No drugs side effects were observed in both groups (G2 and G3), there was no dropout in patients who used alarms. Our data suggests that the use of alarms is the most effective treatment of ENM with superior results when compared to imipramine and DDAVP. The small number of participants is a weakness of the study, as well as the lack of a voiding diary at the end of the study. All therapeutics options utilized in the treatment of MNE are safe, effective and has a low rate of abandonment.

ODP366 Copeptin Improves Prediction of Treatment Response in Children With Monosymptomatic Nocturnal Enuresis

Abstract Background Monosymptomatic nocturnal enuresis, bedwetting of children older than 5 years, affects 10% of children, and increases psychosocial burden. Monosymptomatic nocturnal enuresiscan be treated with DDAVP, a vasopressin analogue. Not all children respond to DDAVP treatment, and no reliable treatment predictor has yet been established. We hypothesise that plasma copeptin, a surrogate marker for vasopressin, can be used to predict treatment response to DDAVP in children with monosymptomatic nocturnal enuresis. Methods In this prospective observational study, we included 28 children with monosymptomatic nocturnal enuresis. Number of wet nights were assessed prior to starting, 4 weeks, and 12 weeks following treatment with DDAVP. Plasma copeptin was measured in the morning and evening prior to starting DDAVP treatment and after 4 weeks of treatment. Initial daily dose wasDDAVP 120 mg and was increased to DDAVP 240 mg in children where treatment response was insufficient after 4 weeks. Treatment response was defined as >50% reduction in wet nights and divided into partial treatment response (50-99% reduction of wet nights per week) and complete treatment response (100% reduction of wet nights). The primary endpoint was prediction of treatment response following 12 weeks of treatment with DDAVP using plasma copeptin ratio (evening/morning copeptin) at baseline. Results Median [IQR] age of children with monosymptomatic nocturnal enuresis was 10 years [8. 0, 11.2], 75% were male. Median [IQR] number of wet nights at baseline was 5. 0 [2.8, 7. 0]. 18 children responded to DDAVP treatment at 12 weeks (partial treatment response 10 children, complete treatment response 8 children). To predict overall treatment response, the best copeptin ratio cut-off was 1.34 (sensitivity 55.56%, specificity 94.12%, AUC 70.6%). To predict partial treatment response, the best copeptin cut-off was 1.3 (sensitivity 55.56%, specificity 100%, AUC 73. 0%). To predict complete treatment response, the best copeptin cut-off was 1.34 (sensitivity 31.25%, specificity 90%, AUC 54.1%). In contrast, neither number of wet nights at baseline, age, BMI, or serum sodium alone or in combination with plasma copeptin improved outcome prediction. Discussion Our results indicate that plasma copeptin ratio is the best predictor for treatment response in children withmonosymptomatic nocturnal enuresis. Plasma copeptin ratio could thus be useful to identify children with the highest benefit of DDAVP treatment and improve individualized treatment of monosymptomatic nocturnal enuresis. Presentation: No date and time listed

Immunoterapia orale per arachide, da piccoli è meglio. I risultati di un RCT

Monosymptomatic primary nocturnal enuresis and daily urotherapy: an unnecessary intervention? Although evidence of their effectiveness is lacking, basic bladder function indications (urotherapy, BBA), according to old international guidelines have been the first step in treating nocturnal enuresis in children. Sixty-two children aged 6-11 were randomized into 3 groups (standard urotherapy, enuresis alarm, no treatment) and followed for 8 weeks; response to therapy was measured, defined as a reduction in the number of wet nights during the last 2 weeks of treatment (or no treatment), compared with 2 weeks before the intervention. The difference in reduction in frequency of enuresis between groups was highly significant (p=0.002) in favor of the alarm group, while no difference was found between BBA and controls. The small number of participants, the brevity of follow-up, and the lack of follow-up on compliance, do not allow the results to be generalized. It is reported that urotherapy is no longer planned in the treatment of monosymptomatic nocturnal enuresis according to the 2020 ICCS guideline update. Surprisingly, although the authors cited this update regarding the usefulness of the micturition chart in the initial evaluation of all children with enuresis, they made no mention of urotherapy being surpassed as the first level of treatment in monosymptomatic nocturnal enuresis.

The Desmopressin melt therapy in children with non-monosymptomatic nocturnal enuresis: a prospective study

Objective: The negative consequences of enuresis in children can be far reaching and an understanding of the impact of these is essential for effective treatment by the clinician. Enuresis can be categorized into monosymptomatic nocturnal enuresis (MNE) and non-monosymptomatic nocturnal enuresis (NMNE). There have been several studies in treatment of MNE with lyophilizate desmopressin melt but very limited research into the efficacy of desmopressin melt in treating NMME. The objectives of this study were to measure the efficacy and side effects of desmopressin melt in treating children with NMNE. Materials and Methods: Children aged 6 to 18 years with NMNE who visited the outpatient department of pediatric urology were included in this prospective study. Any underlying diseases and lower urinary tract symptoms were corrected then their enuresis was treated with 120-240 mcg of desmopressin melt for 6-8 weeks. Outcomes were defined as complete response, partial response, and no-response as defined by the International Children’s Continence Society guidelines. Results: A total of 25 children with NMNE were included in the study. The results showed 44% complete response, 20% partial response, and 36% no-response. The mean volume of nocturnal enuresis decreased from 159.96 to 115.30 ml in the pre and post treatment periods, respectively (p = 0.012). The mean frequency of enuresis decreased from 4.36 to 2.84 days per week in pre and post treatment periods, respectively (p < 0.001). The mean whole night urine volume decreased from 373.39 to 292.37 ml in pre and post treatment periods (p = 0.061). There were no major side effects in the study. Conclusion: Desmopressin melt is effective and safe in treating NMNE in children. However, to add weight to the findings of this study further research with a larger number of patients should be considered in the near future.

Pediatric Tuina (massage) for primary monosymptomatic nocturnal enuresis: A protocol for systematic review and meta-analysis.

Background:Primary monosymptomatic nocturnal enuresis is one of the common diseases of preschool and school-age children and it will cause adverse effects on the healthy growth. Pediatric Tuina (massage) has been widely used in the treatment of monosymptomatic nocturnal enuresis in China. The study is conducted to summarize the current evidence on the effects and safety of Pediatric Tuina (massage) therapy for the treatment of primary monosymptomatic nocturnal enuresis in children.Methods:The following electronic databases will be searched from establishment to December, 2019: Cochrane Library, MEDLINE, EMBASE, Web of Science, World Health Organization International Clinical Trials Registry Platform (ICTRP), China National Knowledge Infrastructure (CNKI), Wan-fang database, Chinese Scientific Journal Database (VIP), Chinese Biomedical Literature Databases (CBM), and other databases, without any language restrictions. Randomized controlled trials about this theme will be retrieved. Independent reviewers will operate literature retrieval, duplication removing, screening, quality evaluation, data analyses by EndNote (X9), and Review Manager (5.3). Meta-analysis, subgroup analysis, and/or descriptive analysis will be performed based on the included data form.Results:High-quality synthesis and/or descriptive analysis of current evidence will be provided from improvement of nocturia frequency, improvement of sleep wakefulness disorder, and total efficiency.Conclusion:This review will provide evidence of whether Pediatric Tuina (massage) is an effective and safe intervention for primary monosymptomatic nocturnal enuresis in children.Trail registration number:This protocol of systematic review has been registered on PROSPERO website (No. CRD42020165107).

Comparison of the efficacy of desmopressin fast-melting formulation and enuretic alarm in the treatment of monosymptomatic nocturnal enuresis

Primary monosymptomatic nocturnal enuresis (MNE) is a common pediatric condition and there are two firstline, evidence-based treatments available; desmopressin and the enuresis alarm. Although there are many studies comparing enuresis alarm and desmopressin treatments in the literature, most were conducted using old formulations of desmopressin. To compare the efficacy of desmopressin MELT formulation and enuresis alarm therapy in patients with MNE. A total of 130 patients who had primary MNE were included in the study. The patients were divided into two groups using simple randomization; desmopressin MELT (Group 1, n=66) and enuresis alarm (Group 2, n=64). The patients were invited for a follow-up visit at the fourth, 12th and 24th weeks of treatment. Treatment response and compliance were evaluated using bed-wetting diary and ICSS criteria. The mean age of the patients Group 1 and 2 was 11.2+3.3 and 10.2+3.4 years, respectively (p=0.104). Complete response rate was similar at 4th week (53% vs. 37.3%, p=0.162) and at 12th week (68.4% vs. 68.2%, p=0.257). The relapse rate was significantly higher in the desmopressin MELT group than in the enuresis alarm group (48.9% vs 20.5%, p=0.007). At the end of the study ten patients were excluded from the study because of loss to follow-up and/or side effects. The overall complete response rate was significantly higher in the enuresis alarm group than in the desmopressin MELT group at the end of the study (41.3% vs 64.9%, p=0.035). When the intention to treat analysis population was considered, similarly the complete response rate was significantly higher in the enuresis alarm group than in the desmopressin MELT group (40.9% vs 64.1%, p=0.027). With regard to the management of children with MNE, our study revealed that desmopressin MELT and enuresis alarm both have high efficacy rates in primary MNE treatment both at 4th and 12th week. However, overall complete response rate was better in enuresis alarm treatment at 24th week. In addition, enuresis alarm treatment also presents as a more favorable relapse rate. Enuresis alarm presented a more permanent treatment response and a lower relapse rate than desmopressin MELT formulation.

Understanding of and misconceptions around monosymptomatic nocturnal enuresis: findings from patient and physician surveys

Monosymptomatic nocturnal enuresis (MNE) is a common paediatric condition, caused by the interaction of multiple physiological mechanisms. The condition can lead to psychiatric comorbidities that are detrimental to quality of lifebut is under-recognised and misunderstood by society and healthcare providers. The objective of this study was to gather information from non-specialist physicianson their understanding of enuresis in selected European countries and from patients about the prevalence of MNE, its relationship with comorbiditiesand the burden of the condition. Between June 2016 and March 2017, physicians and patients in Alpe-Adria, Italy, Romania, Russia, Serbia and Slovakia were asked to complete different surveys on their understanding of the medical condition, its impact on the lives of patientsand the prevalence of comorbidities. Surveys were translated into local languages. Surveyresponses were collated, and data were presented descriptively. Overall, 261 physicians (paediatricians comprising nearly two-thirds) and 340 patients (approximately two-thirds were male) completed their respective surveys. Most physicians (67%) believed MNE to be caused by circadian variation of antidiuretic hormonebut also mentioned psychological factors as a cause (48%). The most common explanation for MNE given by patients was psychological factors (26%), but 17% gave no explanation. For patients, difficulties related to enuresis were often behavioural (77%), including difficulties at school (61%) and with sleeping (40%). Physicians perceived low self-esteem (32%), anxiety (24%) and embarrassment (17%) as having the greatest impact on patients. There was disagreement among physicians about which discipline is best placed to treat MNE. Favoured treatments were not necessarily consistent with evidence-based guidelines, with lifestyle changes and pharmacological interventions cited most frequently. The findings of these complementary surveys illustrate that the causes and best treatment of MNE are subject to misconceptions on the part of both the physician and the patient's caregiver. Overall, MNE is perceived as a psychological condition, rather than having a multifactorial pathophysiological basis with a substantial psychological impact. Educational initiatives for healthcare practitioners and the public should help to optimise the understanding of MNE and care of patients.

Evaluation of Urinary Aquaporin 2 and Plasma Copeptin as Biomarkers of Effectiveness of Desmopressin Acetate for the Treatment of Monosymptomatic Nocturnal Enuresis

Desmopressin is a synthetic V2 specific analogue of antidiuretic hormone (arginine vasopressin) that is widely used as first line treatment for monosymptomatic nocturnal enuresis. However, no biomarkers to predict desmopressin effectiveness have yet been established. Because arginine vasopressin is unstable, we prospectively measured the major urine concentration factor aquaporin 2 and serum copeptin (as a surrogate marker for vasopressin) in patients with monosymptomatic nocturnal enuresis, and evaluated whether they are useful for predicting desmopressin treatment outcome. The study included 32 children 6 to 11 years old with monosymptomatic nocturnal enuresis and nocturnal polyuria. Exclusion criteria were daytime urinary symptoms and underlying diseases causing nocturnal enuresis. Subjects were treated with 120 μg or 240 μg desmopressin oral disintegrating tablet and were divided into responders (at 120 or 240 μg) and nonresponders (at 240 μg). Day/night ratios of plasma copeptin and urinary aquaporin 2 were measured during desmopressin treatment. There was no significant difference in baseline day/night ratio of urinary aquaporin 2 between desmopressin responders and nonresponders. After 8 weeks of treatment there was a significant correlation between day/night ratio of aquaporin 2 and percentage of wet nights. In responders (but not nonresponders) there was a significant difference in the change in aquaporin 2 day/night ratio from before treatment to complete remission (p = 0.0004). For plasma copeptin the baseline day/night ratio for responders at 120 μg was significantly lower than in the 240 μg nonresponder group (p = 0.02). Urinary aquaporin 2 appears to be a biomarker of desmopressin treatment effectiveness during therapy, while plasma copeptin levels before treatment are predictive of desmopressin response.

Additional Use of Alarm Systems in Wakefulness in the Treatment of Mono-Symptomatic Nocturnal Enuresis

Introduction: There are many factors associated with nocturnal enuresis in children and can be very challenging as regards its management. Consequently, misunderstanding could arise explaining the state when a child for years urinates in bed. The aim of this study was to investigate possibilities of increase of efficiency of alarm systems and decrease of time of result achievement in case of usage of such modernized therapy algorithm.Materials and methods: 452 children (307 boys and 145 girls) took part in the study. All patients were randomly divided into two groups prior to alarm systems therapy. Group А patients (206) were offered to use alarm system (Wet Stop/ BYE-WET by PALCO LABS, Inc (USA) in normal mode. Group В patients (246) were using alarm system in wakefulness – urinated on device catching sensor. Alarm intervention was carried out within 12 weeks, total period of observation over the patients– 5 months.Results: We found out that number of patients with urination in sleep after 3 months of therapy was reliably less in this group than in control (23.5 against 40.3 percent, p < 0.05).Conclusion: Usage of alarm systems in patient’s wakefulness in addition to standard treatment regimen was improved the efficiency of Alarm-therapy up to 76.5 percent. Day training with the usage of alarm systems reliably increased the number of dry nights and self-wakening in case of desire to urinate. Usage of alarm systems in wakefulness was safe and did not result in additional refusal from treatment.J Nepal Paediatr Soc 2016;36(1):8-13

Effective treatment of monosymptomatic nocturnal enuresis results in improved neuropsychological functioning and sleep

Objective There is a high comorbidity between nocturnal enuresis, sleep disorders and psychological problems. This study investigates whether a decrease in nocturnal diuresis volume not only improves enuresis, but also ameliorates the major comorbidities : disrupted sleep and (neuro)psychological dysfunction. Study design In this open-label, prospective phase IV study, 30 children with monosymptomatic nocturnal enuresis underwent standardized video-polysomnographic testing and multi-informant (neuro)psychological testing at baseline and six months after the start of desmopressin treatment in the University Hospital Ghent, Belgium. Primary endpoints were the effect on sleep and (neuro)psychological functioning. The secondary endpoint was the change in the first undisturbed sleep period or the time to the first void. Results Thirty children between six and 16 years (mean 10.43, SD 3.08) completed the study. The study demonstrated a significant decrease in periodic limb movements during sleep (F[1,26] = 122.50, P P Conclusion The study demonstrates that the degree of comorbidity symptoms is at least aggravated by the enuresis (and/or high nocturnal diuresis-rate), since sleep and (neuro)psychological functioning were significantly ameliorated by successful treatment of enuresis. Although the results should be confirmed in a larger patient group, the findings suggest that monosymptomatic nocturnal enuresis is not such a benign condition as has previously been assumed. Trial registration Clinical Trials.gov NCT01645475

The pathophysiology of monosymptomatic nocturnal enuresis with special emphasis on the circadian rhythm of renal physiology.

Nocturnal polyuria in monosymptomatic nocturnal enuresis (MNE) has so far mainly been attributed to a disturbed circadian rhythm of renal water handling. Low vasopressin levels overnight correlate with absent maximal concentrating activity, resulting in an increased nocturnal diuresis with low urinary osmolality. Therefore, treatment with desmopressin is a rational choice. Unfortunately, 20 to 60% of children with monosymptomatic enuresis are desmopressin-resistant. There is increasing evidence that other disturbed circadian rhythms might play a role in nocturnal polyuria. This review focuses on renal aspects in the pathophysiology of nocturnal polyuria in MNE, with special emphasis on circadian rhythms. Articles related to renal circadian rhythms and enuresis were searched through the PubMed library with the goal of providing a concise review. Nocturnal polyuria can only partially be explained by blunted circadian rhythm of vasopressin secretion. Other alterations in the intrinsic renal circadian clock system also seem to be involved, especially in desmopressin-resistant enuresis. • Disturbance in the circadian rhythm of arginine vasopressin secretion is related to nocturnal polyuria in children with enuresis. • Desmopressin is recommended as a treatment for monosymptomatic nocturnal enuresis, working as a vasopressin analogue acting on V2 receptors in the collecting ducts of the kidney. What is New: • Other renal circadian rhythms might play a role in nocturnal polyuria, especially in desmopressin-resistant case.

A double-blind randomized clinical trial on the efficacy of magnetic sacral root stimulation for the treatment of Monosymptomatic Nocturnal Enuresis.

Purpose: Purpose of this study was to evaluate the long term efficacy of repetitive sacral root magnetic stimulation (rSMS) in patients with monosymptomatic nocturnal enuresis (MNE). Methods: Forty four patients were randomized to receive either sham or real repetitive sacral root magnetic stimulation (rSMS; 15 Hz with a total of 1500 pulses/session) for 10 sessions. Evaluation was performed before starting treatment, immediately after the 5th and 10th treatment session, and 1 month later, using frequency of enuresis/week, visual analogue scale (VAS) and quality of life as outcome measures. Resting and active motor thresholds of gastrocnemius muscles were measured before and after the end of sessions. Results: Both treatment and control groups were comparable for baseline measures of frequency of enuresis, and VAS. The mean number of wet nights/week was significantly reduced in patients who received real rSMS. This improvement was maintained 1 month after the end of treatment. Patients receiving real-rSMS also reported an improvement in VAS ratings and quality of life. A significant reduction of resting motor threshold was recorded after rSMS in the real group while no such changes were observed in the sham group. Conclusion: These findings suggest that rSMS has potential as an adjuvant treatment for MNE and deserves further study.

Role of urine osmolality as a predictor of the effectiveness of combined imipramine and desmopressin in the treatment of monosymptomatic nocturnal enuresis

Background: We examined the usefulness of urine osmolality, as a predictive factor in the treatment of monosymptomatic nocturnal enuresis (NE) with combination therapy of imipramine and desmopressin. Methods: From May 2014 to April 2015, 59 monosymptomatic NE patients participated in this study. Early morning urine osmolality was measured at 1 week and 1 day before combination therapy of imipramine and desmopressin, and at 1 week and 2 weeks after therapy. The response to combination therapy was evaluated at 3 months after treatment. The mean period of combination therapy was 6.4± 4.2 weeks. Therapeutic response was classified as complete (0-1 wet night/week), partial (over 50% reduction of night) and non-responders (less than 50% reduction of night). Results: The cumulative rate of the complete and partial responders was 76.3%. Among the 3 groups, the statistically lowest value of pre-treatment urine osmolality was observed in the complete responder group (p<0.001). Urine osmolality increased in all groups after treatment, however, statistically the greatest difference between pre and post-treatment urine osmolality was observed in the complete responder group (p=0.024). No serious side effects were observed. Conclusion: Early morning urine osmolality and change of urine osmolality between pre and post-treatment have predictive values in the response to combined imipramine and desmopressin for treatment of monosymptomatic NE.

Family compliance with the use of alarm devices in the treatment of monosymptomatic nocturnal enuresis.

In the treatment of monosymptomatic nocturnal enuresis (MNE), enuretic alarm devices (EADs) are the first recommended treatment option. This study aimed to evaluate parental and child compliance with EAD treatment. Fifty patients for whom EAD therapy was recommended were included in this study. The mean age of the patients was 10.4 years (5-16). All the patients were nursery or school children. Patients who did not return for their follow-up visits were called by phone, and verbal information were gathered about the use and performance success of the device. We documented the patients who used, and did not use the EAD with their reasons. Nineteen (36%) patients were able to use the EAD without any problems. Eight of the remaining 31 patients didn't return for control, and they could not be get in touch with, either. Of the 23 (46%) families whom we could get a contact, 4 families did not purchase EAD due to a decrease in the number of wet nights, 4 families due to compensatory payment, and 3 families due to reluctance of one of the parents. One family reported that they gave up the EAD treatment because of the disturbing loud volume of the device. Four families reported that their children refused to use the EAD. Four families said that they could not use the EAD regularly because the device frequently did not work properly. In this study, we could not keep in touch with 16% of the patients, and 46% of the patients stopped using or did not receive this therapy. Although EAD has been the priorly recommended alternative with its relatively higher success, and lower recurrence rates, our study demonstrated that the compliance of families with this treatment is below the expected level.

Re: Family compliance with the use of alarm devices in the treatment of monosymptomatic nocturnal enuresis.

Childhood enuresis is one of the most distressing medical and social conditions that could a child and his/her parents can face. The prevalence of nocturnal enuresis was suggested to be between 15–22% of boys and 7–15% of girls at 7 years of age.[1,2] Moreover, 7 out of 100 children wetting bed at age 7 will take this condition into adulthood. It is extremely important to remember that treatment is unnecessary in younger childen in whom spontaneously cure is likely.3 Initial conservative therapeutic approaches should be considered first. Explaining the situation and treatment options to the child and parents are important. A strong motivation is a must and success depends not only to child’s compliance but also the parents should have a high compliance. EAU guideline suggests alarm treatment to be the best option for arousal disorder (LE:1, GR:A).[3] However, family compliance problems were suggested to be the most important issue and a limitation of this modality.[3] In this article, Oguz et al, [4] pointed to an important aspect of alarm treatment in monosymptomatic nocturnal enuresis. This effort should be congragulated since they examined the family compliance with alarm device in the treatment of this condition. The results revealed that almost a quarter of parents who were suggested to use the device declined to start treatment with this option. Moreover, 46% of families never purchased the device, and only 19 families were eligible for evaluation. Enuretics who did not use the device were reported the limitations as follows: decreased bedwetting episodes, unable to pay additionally, had negative feedback from neighbours, disturbing noise, child rejection and very frequent breakdown of the device. The reluctancy of the parent which is the crucial factor examining family compliance was present in only 3 parents. Thus, it limits the interpretation of results. Similarly, authors did also acknowledged that the study is in retrospective nature and they could include only 19 families since majority of the parents did not comply with the treatment which restricted the number of participants. It would have been more informative and guide better if the authors examined social background of the families, compliance with respect to age, the literal status of parents, school year of child, house environment and some other demographic parameters. These need to be clarified in large scale prospective studies. Nevertheless, as authors stated this is the first study in Turkey that will guide physicians in choosing proper treatment alternatives according to the child’s and parents’ compliances to the alarm device.

A Two Years Follow-Up Study of Children with Monosymptomatic Enuresis Treated with Enuresis Alarm

Objective: Nocturnal enuresis is a common problem among children. This multifactorial disease is a source of stress of the families. Therefore, it is important how to approach the disorder, plan the treatment in order to provide a satisfactory cure rate. The aim of this study was to evaluate the long term results of alarm therapy after an initial response. Materials Methods: The study consisted of 36 of 50 patients with nocturnal enuresis, that were responded alarm therapy after three months treatment. At the end of the second year, detailed interviews with the parents of the children were recorded. Results: It was found that only 6 (16.7%) patients achieved complete dryness with the alarm device and no different treatment modalities were needed after the initial success. The remaining 30 (83.3%) patients had recurrence in the subsequent period and 25 (%83.3) of them tried retreatment. Conclusions: In long term follow up recurrence rates are high and families may seek different treatment approaches. Recurrence probabilities should be emphasized to the families at the beginning of the alarm treatment for monosymptomatic nocturnal enuresis.

Oral desmopressin lyophilisate (MELT) for monosymptomatic enuresis: Structured versus abrupt withdrawal

ObjectiveTo investigate whether a structured withdrawal program from a sublingual formulation of fast-melting oral desmopressin lyophilisate (MELT) is superior to a sudden withdrawal from this formulation in the treatment of monosymptomatic nocturnal enuresis. Materials and methodsOne hundred and three children presented to our pediatric nephrology outpatient clinic for bedwetting. Eighty-one children, aged between 5½ and 14 years (mean age 8.64 years), were treated with MELT at a dosage of 120 mcg a day. Responders were randomized to been withdrawn from therapy, after 3 months, abruptly or in a structured withdrawal program (60 mcg/day for 15 days and then 60 mcg every second evening for another 15 days).Main outcome parameter was relapse rate 1 month after the end of treatment. Relapse was defined as bedwetting occurring more than 2 nights per month after the 1-month treatment-free period. ResultsRelapse rate at 1 month after the end of treatment was 47.83% in the group on a structured program versus 45.83% in the abrupt termination group (p = 0.89). ConclusionOur study suggests that a structured withdrawal program from MELT therapy doesn't offer advantages compared to an abrupt termination in children with monosymptomatic nocturnal enuresis.

193 EFFECTS OF DESMOPRESSIN PLUS PROPIVERINE FOR THE TREATMENT OF MONOSYMPTOMATIC PRIMARY NOCTURNAL EENURESIS IN CHILDREN

INTRODUCTION AND OBJECTIVES: We evaluated the efficacy of a combination treatment of desmopressin and propiverine for treating children with monosymptomatic primary nocturnal enuresis. METHODS: A total of 53 children aged 6 to 15 years old with monosymptomatic nocturnal enuresis were enrolled in this prospective study. Children with a minimum of 3 wet nights weekly were included. Children were randomly assigned groups and treated with desmopressin 0.2mg, or a combination of desmopressin plus propiverine 10mg. Of these patients 43 (31 boys and 12 girls, mean age 8.4 2.5 years, range 4 to 13) were followed for more than 6 months. Efficacy was measured at 1, 3 and 6 months in terms of average enuretic frequency after treatment. RESULTS: Of the 43 children finally analyzed, 23 received combination therapy of desmopressin and propiverine and 20 received desmopressin alone. The frequency of nocturnal enuresis at baseline in the monotherapy group and combination therapy group was similar (5.45 1.57 vs 5.82 1.44). However, a decrease of the nocturnal enuresis was significantly pronounced in the combination group after 6 months treatment than in monotherpy group (2.2 1.01 vs 1.29 0.67). Combination therapy produced better outcomes than monotherapy in terms of the number of nocturnal enuresis episodes (p 0.017). Adverse events were minimal. CONCLUSIONS: Combination therapy with desmopressin plus propiverine for the treatment of monosymptomatic nocturnal enuresis was well tolerated, and gave effective results in reducing enuresis episodes rather than a single therapy of desmopressin in children.