deamino-arginine-vasopressin and oxybutynin

This study aimed to estimate the cost-utility of effective interventions for enuresis treatment in children and adolescents and to calculate the incremental cost-utility ratio from the perspective of the Brazilian Unified Health System in a 1-year time horizon.. The economic analysis is in 7 stages: (1) survey of evidence of treatments for enuresis, (2) performing the network meta-analysis, (3) estimation of the probability of cure, (4) cost-utility analysis, (5) model sensitivity analysis, (6) analysis of acceptability of interventions by acceptability curve, and (7) monitoring the technological horizon.. The association between desmopressin and oxybutynin is the therapeutic strategy with the highest probability of success in the treatment of enuresis in children and adolescents compared with placebo (relative risk [RR] 2.88; 95% confidence interval [CI] 1.65-5.04), followed by the combination therapy between desmopressin and tolterodine (RR 2.13; 95% CI 1.13-4.02), alarm (RR 1.59; 95% CI 1.14-2.23), and neurostimulation (RR 1.43; 95% CI 1.04-1.96). Combination therapy between desmopressin and tolterodine was the only 1 considered not to be cost-effective. Neurostimulation, alarm therapy, and therapy had the respective incremental cost-utility ratio values: R$5931.68, R$7982.92, and R$29 050.56/quality-adjusted life-years.. Among the therapies that are on the borderline of efficiency, the combined therapy between desmopressin and oxybutynin presents the greatest incremental benefit at an incremental cost that is still feasible, given that it does not exceed the reference value of the cost-effectiveness threshold established in Brazil.

Topics: Adolescent; Brazil; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Tolterodine Tartrate

To conduct an overview of Cochrane systematic reviews about treatment alternatives for children and/or adolescents with enuresis.. An overview of Cochrane systematic reviews about interventions for enuresis in children/adolescents was developed between September/2021 and December/2021. The protocol was registered on PROSPERO and the search was conducted only in the Cochrane Library database without any restriction. Reviews involving any type of intervention for the treatment of enuresis in children/adolescents were included. The risk of bias was assessed using Risk of Bias in Systematic Reviews (ROBIS) and the quality of reviews was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR-2).. Seven systematic reviews were identified. Based on the ROBIS assessment, all reviews were classified as low risk of bias. According to the AMSTAR-2 assessment, the three oldest systematic reviews were rated as critically low quality, one review was moderate quality, and the three most recent systematic reviews were rated as high quality. No difference was shown between alarm and desmopressin for a complete response to therapy after treatment (RR = 1.30; 95%CI: 0.92 to 1.84), but alarm use is related to a lower risk of adverse events (RR = 0.38; 95%CI: 0.20 to 0.71). There is a moderate certainty that the association between imipramine and oxybutynin is better than placebo to reduce the risk of children who do not achieve 14 consecutive dry nights after treatment (RR = 0.43; 95%CI: 0.23 to 0.78).. There is no difference between alarm and desmopressin for enuresis treatment. However, alarm therapy had fewer adverse events than desmopressin. Moreover, combination therapy between imipramine and oxybutynin is better than placebo.

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Imipramine; Nocturnal Enuresis; Systematic Reviews as Topic; Urinary Incontinence

Nocturnal enuresis, or bedwetting, is the most common cause of urinary incontinence in children. It is known to have a significant psychosocial impact on the child as well as the family. Nocturnal enuresis typically presents as failure to become dry at night after successful daytime toilet training. It can be primary or secondary (developing after being successfully dry at night for at least 6 months). Children with nocturnal enuresis may have excessive nocturnal urine production, poor sleep arousal and/or reduced bladder capacity. Alarm therapy is the recommended first-line therapy, with treatment choices being influenced by the presence or absence of the abnormalities mentioned above. Children with nocturnal enuresis may also have daytime urinary urgency, frequency or incontinence of urine. This group (non-monosymptomatic nocturnal enuresis) requires a different clinical approach, with a focus on treating daytime bladder symptoms, which commonly involves pharmacotherapy with anticholinergic medications and urotherapy (including addressing bowel problems). This review discusses the current management of nocturnal enuresis using the terminologies recommended by the International Children's Continence Society.

Topics: Algorithms; Anti-Inflammatory Agents, Non-Steroidal; Antidepressive Agents, Tricyclic; Antidiuretic Agents; Behavior Therapy; Child; Child, Preschool; Cholinergic Antagonists; Deamino Arginine Vasopressin; Humans; Imipramine; Mandelic Acids; Neurophysins; Nocturnal Enuresis; Protein Precursors; Risk Factors; Vasopressins

Monosymptomatic nocturnal enuresis, a heterogeneous condition, is frequently treated in children aged >5 years. Of the various treatment options, enuresis alarm has been widely advocated as being effective for treating nocturnal enuresis, while extracorporeal pelvic floor magnetic stimulation for overactive bladder, urge incontinence and urgency-frequency syndrome has not yet been confirmed by controlled studies as primary treatment for monosymptomatic nocturnal enuresis. Desmopressin, an antidiuretic hormone (ADH) analog, or arginine vasopressin (AVP), can resolve primary nocturnal enuresis by decreasing night-time urine production. Enuretic children requiring either desmopressin or desmopressin plus oxybutynin to achieve dryness have polyuria. Tricyclic antidepressants (i.e. imipramine) are used successfully in enuretic children. Although tricyclics and desmopressin are effective in reducing the number of wet nights, most children relapse after discontinuation of active treatment. Combined therapy (enuresis alarm, bladder training, motivational therapy and pelvic floor muscle training) is more effective than each component alone or than pharmacotherapy. Furthermore, desmopressin combined with alarm therapy has a positive effect on enuresis. Pharmacotherapy can provide early relief of enuresis, while behavioral intervention may lead to greater long-term benefits. The positive effect of achieving dry nights with pharmacotherapy can encourage the child to sustain behavioral therapy.

Topics: Antidiuretic Agents; Arginine Vasopressin; Behavior Therapy; Child; Child, Preschool; Deamino Arginine Vasopressin; Drug Therapy, Combination; Exercise Therapy; Humans; Mandelic Acids; Motivation; Nocturnal Enuresis; Parasympatholytics; Toilet Training; Treatment Outcome; Urodynamics

Bedwetting (nocturnal enuresis) is not uncommon in childhood but it can have a profound effect on children and their families. Parents sometimes avoid seeking help due to feelings of shame or embarrassment, or because they believe that nothing can be done and they must wait for their child to "grow out of it". For some children this may take many years and one in 50-100 will reach their teens without becoming dry. There is evidence that effective intervention can reduce the duration of the problem and help to improve the lives of children and their families. An individual assessment is the key to successful treatment, as well as practical suggestions to help families to manage the situation and therefore reduce the stress it may cause. The primary health care professional is ideally placed to offer this support and to encourage families to come forward to discuss the problem. This article gives an overview of current treatment practice and outlines the information and support that health professionals can give to parents and carers.

Topics: Antidiuretic Agents; Causality; Child; Deamino Arginine Vasopressin; Health Education; Humans; Mandelic Acids; Muscarinic Antagonists; Nocturnal Enuresis; Nurse's Role; Nursing Assessment; Parents; Patient Selection; Pediatric Nursing; Primary Health Care; Referral and Consultation; Social Support; Toilet Training; United Kingdom

Nocturnal enuresis is a problem that affects many children and their families. The etiology seems to be multifactorial and may include a combination of genetic factors,abnormal urodynamics, alterations in vasopressin secretion, sleep factors, psychologic factors, organic disease, and maturational delay. Generally, a complete history and physical examination, with a specific focus on the genitourinary, gastrointestinal, and neurologic systems, is all is that is needed in the evaluation of a patient with enuresis.Currently, the mainstays of medical therapy are DDAVP, imipramine, and oxybutynin. Medications can help to control the symptoms of enuresis, but they generally do not provide a cure; therefore, behavioral therapy is often recommended in conjunction with pharmacotherapy.

Topics: Antidepressive Agents, Tricyclic; Deamino Arginine Vasopressin; Enuresis; Humans; Imipramine; Mandelic Acids; Physical Examination; Renal Agents; Urodynamics

Primary nocturnal enuresis is one of the most frequent complaints in paediatric and urologic practice. Physicians face the dilemma of whether or not to treat primary nocturnal enuresis since the trend towards spontaneous remission is countered by social disadvantages and reduced self esteem of the children affected and their families. We reviewed randomised, controlled trials investigating efficacy and adverse effects of current medical treatment for primary nocturnal enuresis. Only desmopressin and imipramine displayed significant effects in reducing wet nights: when compared with baseline bedwetting or placebo controls, 30-70% of the studied children achieved therapeutic success. For drugs such as indometacin or oxybutynin, convincing studies displaying a significant positive effect are still needed. However, considering the adverse effects profiles of desmopressin and imipramine it can be seen that imipramine is associated with about twice as many unwanted reactions. More importantly, a serious adverse effect of imipramine is sudden cardiac arrest. In general, adverse effects with desmopressin are rare and mild, but there have been a number of case reports of hyponatraemic hypervolaemia associated with coma and seizures. Of these, many cases were attributed to excess water intake before taking the drug and all children recovered fully. In summary, if medical treatment is considered, preference should be given to desmopressin.

Topics: Antidepressive Agents, Tricyclic; Carbamazepine; Child; Cyclooxygenase Inhibitors; Deamino Arginine Vasopressin; Enuresis; Humans; Mandelic Acids; Randomized Controlled Trials as Topic; Renal Agents

Adequate sleep is a basic requirement for good health. Adults generally require 7 to 8 hours of sleep per night. Sleep deprivation is associated with a decreased ability to perform tasks controlled by the frontal lobe, such as planning, concentration, motor performance, and high-level intellectual skills. Constant poor-quality sleep can also cause excessive daytime sleepiness, depression, and immune function compromise. In addition, continued sleep disruption has been associated with an increased risk for mortality.

Topics: Behavior Therapy; Deamino Arginine Vasopressin; Female; Humans; Male; Mandelic Acids; Quality of Life; Renal Agents; Rest; Sleep; Sleep Wake Disorders; Urination Disorders; Urine

Topics: Adolescent; Antidepressive Agents, Tricyclic; Behavior Therapy; Child; Child, Preschool; Cholinergic Antagonists; Deamino Arginine Vasopressin; Enuresis; Humans; Imipramine; Mandelic Acids; Renal Agents

Topics: Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Drug Therapy, Combination; Enuresis; Female; Humans; Male; Mandelic Acids; Parasympatholytics; Prognosis; Renal Agents; Sleep Arousal Disorders

Topics: Behavior Therapy; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Mandelic Acids; Patient Acceptance of Health Care; Secondary Prevention; Self-Help Devices; Treatment Outcome

Topics: Antidepressive Agents, Tricyclic; Child; Cholinergic Antagonists; Deamino Arginine Vasopressin; Dicyclomine; Enuresis; Humans; Imipramine; Male; Mandelic Acids; Renal Agents; Self-Help Devices

Nocturnal enuresis (NE) is a multifactorial condition of childhood affecting both children and their parents. NE may result from a vasopressin deficiency, bladder instability or lack of arousal from sleep to bladder sensations. The development of the three-systems model offers increased understanding of the multifactorial aetiology of NE and may aid the development of a tailored treatment regimen for the individual child. For decades, treatment of NE has focused on pharmacological, behavioural and combination therapies, and many studies provide supporting evidence for each of these treatment approaches. However, many of these studies were performed on unselected patient populations. without assessment of the cause of the patients' enuresis, and therefore both the methodologies and results of these studies are questionable. This paper reviews the efficacy of combined treatment interventions and assesses when such interventions may be of most benefit to the patient.

Topics: Antidepressive Agents, Tricyclic; Cholinergic Antagonists; Combined Modality Therapy; Deamino Arginine Vasopressin; Enuresis; Humans; Imipramine; Mandelic Acids; Multivariate Analysis; Randomized Controlled Trials as Topic; Renal Agents; Time Factors; Wakefulness

The objective of this study was to review the published literature on aetiology and treatment of nocturnal enuresis, with the aim of providing a treatment strategy which is easy for the patient and their family to follow. Results from European studies conducted over the last 15 y were included in this review. It can be concluded from the results of these studies that enuresis is the cause and not the result of a psychiatric disorder. However, there is still considerable variation in success rates, from 28 to 90%. It is of vital importance that a caring approach from the doctor and a positive family and patient attitude are present for successful treatment. The first choice of treatment should be the one most acceptable to the family, e.g. alarm, desmopressin and combination treatment.

Topics: Age Factors; Antidepressive Agents, Tricyclic; Behavior Therapy; Cholinergic Antagonists; Circadian Rhythm; Combined Modality Therapy; Deamino Arginine Vasopressin; Enuresis; Europe; Guidelines as Topic; Humans; Mandelic Acids; Osmolar Concentration; Prognosis; Renal Agents; Urine

Nocturnal enuresis in children is not a psychogenic disorder. It is caused by a hereditary delay in maturation of the somatic mechanisms (reduction of nocturnal urine production and a normal arousal to a full bladder) which prevent the child from wetting the bed. Traditionally, doctors treating bedwetting children have used an expectant attitude, because nocturnal enuresis has been looked upon as self-limiting and harmless. According to recent research this is not true. More than 5% of children and 0.5% of the adult population report nocturnal enuresis, meaning that 10% of enuretic children will remain bedwetters for life if left untreated, and nocturnal enuresis is perceived as a shameful condition, giving a significant impairment of self-esteem at an age when an intact self-image is extremely important for an optimal development of the child's personality. Treatment should be given when the enuretic child wants to sleep dry.

Topics: Adolescent; Adult; Arousal; Child; Child, Preschool; Combined Modality Therapy; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Mandelic Acids; Parasympatholytics; Polyuria; Renal Agents; Self Concept; Shame; Urinary Bladder; Urodynamics

Topics: Adrenergic Uptake Inhibitors; Animals; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Imipramine; Mandelic Acids; Parasympatholytics; Renal Agents

Bedwetting is present in 5 to 7% of children aged 7 to 8 years. The history of the disorder and the examination of the child are of main importance. This is usually the first step to identify nocturnal enuresis, bladder or urethral instability and other voiding dysfunctions. Therapeutic failure is often related to an inadequate analysis of the disorder. For nocturnal enuresis, the best results are obtained with alarms and/or desmopressine; bladder instability usually requires oxybutinine chlorydrate and urethral instability can be treated with biofeedback therapy. The management of other voiding dysfunctions depends on urodynamic assessment.

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Mandelic Acids; Urination Disorders

Nocturnal enuresis is a common problem occurring in 15% of children at 5 years of age. Although usually self-limiting, justification for early treatment is founded in the psychological impact on the child. The physician's role in treating enuresis is first to rule out structural causes for enuresis. After this has been done, the physician can tailor an enuresis treatment program for the child and family.

Topics: Age Factors; Behavior Therapy; Child; Circadian Rhythm; Clinical Protocols; Deamino Arginine Vasopressin; Enuresis; Humans; Imipramine; Mandelic Acids; Medical History Taking; Parasympatholytics; Physical Examination; Physician's Role; Recurrence; Treatment Outcome

Since the early 1960s, a number of pharmacologic agents have been used to treat children with enuresis. Success has been reported with tricyclic antidepressants (imipramine), anticholinergics (oxybutynin), and desmopressin acetate (DDAVP). Sedatives, stimulants, or sympathomimetic agents have not proved beneficial. Because treatment with medication may be effective even in children with an organic problem such as infection or neuropathy, patients should always be evaluated carefully before drug therapy is started. Of the tricyclic antidepressants, imipramine has been investigated and used the most extensively. Oxybutynin is beneficial for children with small bladder capacity and daytime enuresis. DDAVP, introduced in the 1990s, has response rates similar to those of imipramine but with fewer side effects.

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Imipramine; Mandelic Acids; Parasympatholytics

Bed-wetting is a common and disturbing problem for children and their families. Underlying causes are rarely found and should be suspected from the history rather than from investigations. Children older than 7 years can usually be cured if they are motivated enough to use an alarm conditioning device. Intranasal desmopressin acetate, the current drug of choice, will produce only temporary relief.

Topics: Administration, Intranasal; Age Factors; Causality; Child; Deamino Arginine Vasopressin; Diagnosis, Differential; Enuresis; Family Practice; Humans; Imipramine; Mandelic Acids; Medical History Taking; Monitoring, Physiologic; Motivation; Parasympatholytics; Sleep; Time Factors; Treatment Failure

To compare the frequency of spina bifida occulta (SBO) detected in patients with nocturnal enuresis (NE) and to investigate its clinical significance.. Patients aged 6 to 15 years who were admitted to the urology clinic with NE were included in this prospective study. The control group consisted of patients who were admitted with a complaint of abdominal or lateral pain. The patients who had lower urinary tract symptoms (LUTS) were classified as nonmonosymptomatic NE (NMNE). Those with monosymptomatic NE were treated with desmopressine. In patients with NMNE, treatment with oxybutynin was added if an overactive bladder or uninhibited contraction was detected by urodynamics.. A total of 184 NE and 180 control patients were included in the study. SBO was detected in 71 (19.5%) patients and LUTS in 100 (27.4%). When the groups with and without NE were compared, the number of patients with SBO (26% vs 17%, P = .044) and those with LUTS (36% vs 17.5%, P < .001) were significantly higher in the NE group. The overall rate of dryness (67.4% vs 83.6%, P = .024) and response to LUTS treatment (65% vs 97%, P < .01) were significantly lower in those with SBO than in those without SBO.. SBO is more common in NE patients than in non-NE patients. Response to NE treatment is lower in SBO patients with severe LUTS; for this population, advanced treatment options may be considered earlier.

Topics: Antidiuretic Agents; Child; Deamino Arginine Vasopressin; Female; Humans; Lower Urinary Tract Symptoms; Male; Mandelic Acids; Nocturnal Enuresis; Prospective Studies; Spina Bifida Occulta; Treatment Outcome; Urodynamics; Urological Agents

To assess the efficacy of desmopressin plus oxybutynin and compare two starting dosages of desmopressin (120 and 240 µg) in a randomized, double-blinded, placebo-controlled trial for children with monosymptomatic nocturnal enuresis (MNE) resistant to desmopressin. The predictive factors of children with MNE responsive to desmopressin and combination therapy were also evaluated.. Our sample included 206 patients aged between 6 and 13 (mean age 10.6 ± 2.9 years), 117 males. All patients were required to have MNE. The patients were randomly divided into two groups: the first group was given oral melt 120 µg and the second group 240 µg, for 2 weeks. All patients who had experienced failure of treatment with sublingually administered desmopressin alone were given either desmopressin plus 5 mg oxybutynin or desmopressin plus placebo in a randomized, double-blinded trial for 4 weeks. As predictive factors, bladder volume and wall thickness index, nocturnal polyuria and voiding latency were considered.. There was no significant difference between the 120 µg and 240 µg patients in terms of response. The oxybutynin group showed a higher rate of full and partial responses (45% success) compared with the placebo group (17% success), P < 0.01. The responders to combined oxybutynin and desmopressin had significantly lower bladder volume and wall thickness index than the other patients.. Our findings highlight that anticholinergic agents may play an important role for a subset of children with enuresis who have a restricted bladder capacity and thickened bladder wall. Ultrasonography-measured bladder variables can provide useful predictive clues for MNE. Predictive factors can help to differentiate treatment subtypes and guide clinical management in primary nocturnal enuresis.

Topics: Adolescent; Antidiuretic Agents; Child; Deamino Arginine Vasopressin; Double-Blind Method; Female; Humans; Male; Mandelic Acids; Nocturnal Enuresis

To evaluate the response rate of various modalities of therapy in primary nocturnal enuretic children according to the ultrasound bladder volume and wall thickness index (BVWI) measurements.. From February 2006 to November 2007, a total of 31 children, aged 6-12 years old were enrolled in a clinical trial. Based on BVWI they were divided into 3 groups as follows: Group 1 (BVWI <70%) was treated with oral desmopressin and oxybutynin; Group 2 (BVWI 70% to <130%) was treated with oral desmopressin. Group 3 (BVWI >130%) was treated with oral desmopressin accompanied by double-voiding technique and scheduled voiding. All of them were treated for 3 months.. Significant reductions in mean bed-wetting frequency before and after first treatment cycle were observed in all groups (p<0.05). The complete response rate was 70% in Group 1, 25% in Group 2, and 20% in Group 3. Overall, the complete and partial response rate was 9/10 (90%) children in Group 1, 13/16 (81%) in Group 2, and 3/5 (60%) in Group 3. Bedwetting frequency significantly decreased at the first and second treatment cycles in Group 2 (p<0.05) for each pair wise comparison.. The proposed treatment representation according to ultrasound BVWI measurements achieves favorable response rates in children with PNE. We suggest that this treatment should be used to develop the management of enuresis in children.

Topics: Antidiuretic Agents; Child; Clinical Protocols; Combined Modality Therapy; Deamino Arginine Vasopressin; Drug Therapy, Combination; Female; Humans; Male; Mandelic Acids; Muscarinic Antagonists; Nocturnal Enuresis; Organ Size; Ultrasonography; Urinary Bladder

Children with attention deficit hyperactivity disorder disproportionately experience voiding dysfunction and persistent nocturnal enuresis due to a combination of sphincter and detrusor overactivity and nocturnal polyuria. The different treatment approaches to nocturnal enuresis often fail in these patients. Therefore, we performed a prospective study to compare the efficacy of combination therapy with desmopressin and oxybutynin vs the tricyclic antidepressant imipramine in patients with attention deficit hyperactivity disorder who have nocturnal enuresis.. A total of 54 patients with attention deficit hyperactivity disorder and nocturnal enuresis were randomly stratified into 2 groups. Demographic data on patient age and gender were identical in the 2 groups. Functional bladder symptoms were judged using the dysfunctional voiding symptoms survey. The initial dysfunctional voiding symptoms survey score was similar in the 2 groups. The total survey score was compared between the 2 groups in aggregate as well as specifically regarding the incidence of nocturnal enuresis following treatment.. The first group consisted of 27 patients who received desmopressin and oxybutynin, and the second group of 27 was treated with imipramine. Of the 27 children in each group 23 (85%) received methylphenidate for attention deficit hyperactivity disorder. The mean +/- SD initial dysfunctional voiding symptoms survey score in groups 1 and 2 was 20.5 +/- 3.3 and 20.9 +/- 4.1, respectively. Following treatment the mean survey score decreased significantly in groups 1 and 2 (6.5 +/- 2.5 and 9.4 +/- 2.1, respectively, p <0.001). However, between groups analysis showed that the dysfunctional voiding symptoms survey score was significantly lower in group 1 than in group 2 (mean 6.5 +/- 0.5 vs 9.6 +/- 0.4, p <0.001). There was also a statistically significant decrease in the incidence of nocturnal enuresis in group 1 (survey question 2 score 0.9 +/- 0.2 vs 2.9 +/- 0.2).. Our data show that there is a high incidence of voiding dysfunction in children with attention deficit hyperactivity disorder. Combination therapy with desmopressin and oxybutynin is a feasible, safe and effective treatment for nocturnal enuresis in these children.

Topics: Antidepressive Agents, Tricyclic; Antidiuretic Agents; Attention Deficit Disorder with Hyperactivity; Child; Deamino Arginine Vasopressin; Drug Therapy, Combination; Enuresis; Female; Humans; Imipramine; Male; Mandelic Acids; Parasympatholytics; Prospective Studies; Treatment Outcome

We prospectively evaluated the efficacy of a combination of desmopressin and oxybutynin for treating children with nocturnal enuresis, compared to the single drugs imipramine and desmopressin.. We enrolled 158 patients from 2003 to 2004. Children were randomly assigned to 1 of 3 groups and treated with desmopressin, imipramine or a combination of desmopressin plus oxybutynin. Of these patients 145 (100 boys and 45 girls, mean age 7.8 +/- 2.5 years, range 5 to 15) were followed for more than 6 months. Efficacy was measured at 1, 3 and 6 months in terms of average enuretic frequency, 5-scale response based on change in nocturnal enuretic frequency after treatment and posttreatment enuretic frequency as a percentage of pretreatment baseline frequency. The latter efficacy was classified according to daytime voiding symptoms. Statistical evaluation was performed using chi-square tests and ANOVA.. Of the 145 children followed 48 received combination therapy, 49 received desmopressin and 48 received imipramine. A total of 68 patients (47%) had monosymptomatic enuresis and 77 (53%) had polysymptomatic enuresis. Combination therapy produced the best and most rapid results regardless of whether the children had monosymptomatic or polysymptomatic enuresis.. Combination therapy with desmopressin plus oxybutynin for the treatment of pediatric nocturnal enuresis was well tolerated, and gave significantly faster and more cost-effective results than single drug therapy using either desmopressin or imipramine.

Topics: Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Drug Therapy, Combination; Enuresis; Female; Humans; Imipramine; Male; Mandelic Acids; Prognosis; Prospective Studies; Treatment Outcome; Urodynamics

There are many therapeutic options against enuresis.. To evaluate several therapies introduced progressively to treat monosymptomatic nocturnal enuresis.. Eighty-four patients, aged 6 to 14 years old, were studied. The 67 year olds were treated with desmopressin and oxybutynin was added in nonresponders. If enuresis persisted, Alarm was given. Children over 7 years of age were randomly divided and treated with Alarm or Alarm plus desmopressin. Nonresponders were treated with desmopressin alone.. In children aged 6-7 years the cumulative response was 72%. Those who wetted themselves less responded to desmopressin. In children over 7 years of age, response to Alarm was 73.3% and response to Alarm plus desmopressin was 58.6%. In nonresponders the cumulative response after desmopressin treatment increased to 80% and 62% respectively.. In the group of 6 to 7 year-olds desmopressin was indicated as first line therapy. Treatment efficacy was increased by adding oxybutynin especially in the children who wetted themselves the most. In children over 7 years of age Alarm was the most effective treatment and relapses were fewer. No advantages were observed with the combination of Alarm and desmopressin in our protocol.

Topics: Adolescent; Child; Combined Modality Therapy; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Mandelic Acids; Renal Agents

A review of the scarce literature concerning oxybutynin treatment for nocturnal enuresis reveals that its success is greatest when enuresis is combined with daytime incontinence. The renal and bladder related characteristics of children with monosymptomatic enuresis responsive to oxybutynin were evaluated.. Renal concentrating capacity and functional bladder capacity were compared between 55 dry children who served as controls, and children with monosymptomatic enuresis who responded to desmopressin only (group 1, 27), oxybutynin only (group 2, 11), combination desmopressin and oxybutynin (group 3, 7) or were resistant to all treatment alternatives (group 4, 23).. Renal concentrating capacity was lowest in groups 1 and 3 (939 +/- 147 mOsm./kg. controls, 856 +/- 158 group 1, 1,073 +/- 71 group 2, 762 +/- 119 group 3 and 970 +/- 146 group 4; p <0.01), whereas they had high urinary output (15.4 +/- 73.4 ml./kg. per hour controls, 22.2 +/- 10.2 group 1, 13.5 +/- 4.3 group 2, 21.5 +/- 11.2 group 3 and 15.0 +/- 6.9 group 4; p <0.01). Forced functional bladder capacity of that expected for age was lowest in groups 2 to 4 (107 +/- 43% controls, 88 +/- 43 group 1, 71 +/- 25 group 2, 68 +/- 22 group 3 and 59 +/- 22 group 4; p <0.01).. Children responding to oxybutynin have small bladders and probably hyperactive detrusors, whereas those responding to desmopressin or who need both drugs to achieve dryness have polyuria.

Topics: Child; Cholinergic Antagonists; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Mandelic Acids; Renal Agents

Different etiopathological mechanisms of enuresis are today under study, and different therapies and drugs have been proposed. The Italian Multicentric Trial was undertaken in twelve pediatric and urological centers in order to assess the efficacy of two of the most popular drugs, desmopressin (DDAVP) and oxybutynin.. 114 enuretic patients were enrolled in the study. After a 2-week observation period, 66 patients with primary monosymptomatic enuresis were treated with DDAVP, 30 micrograms/day intranasally, for 6 weeks, 48 patients with enuresis and voiding dysfunction were randomly assigned to a protocol with oxybutynin alone or oxybutynin plus DDAVP. The efficacy of the two drugs was measured in terms of reduction of wet nights per week during the 6-week treatment period and a 2-week follow-up period. Children with 0-3 dry nights/week were considered as nonresponders.. Patients with monosymptomatic enuresis treated with DDAVP reported a significantly lower number of wet night during treatment than during the baseline period, with 79% showing a 'good' (6-7 dry nights/week) or 'intermediate' response (4-5 dry nights/week). Of the patients with diurnal voiding disturbances and enuresis, those treated with oxybutynin alone had a 54% success rate. The patients treated with both oxybutynin and DDAVP showed a better response, with a 71% rate of success.. The efficacy of the two drugs is confirmed in patients carefully selected on the clinical basis of voiding disturbances. In patients with enuresis and voiding dysfunction, the reduced urinary output and the lower bladder filling rate due to DDAVP can reduce uninhibited bladder contractions, thus enhancing the oxybutynin action.

Topics: Administration, Intranasal; Adolescent; Adult; Analysis of Variance; Child; Child, Preschool; Circadian Rhythm; Deamino Arginine Vasopressin; Drug Therapy, Combination; Enuresis; Female; Follow-Up Studies; Humans; Male; Mandelic Acids; Middle Aged; Parasympatholytics; Renal Agents; Treatment Outcome

Combination therapy (CT) (desmopressin plus oxybutynin) has been considered for the treatment of monosymptomatic nocturnal enuresis (MNE). We designed our study with the aim to evaluate the response rate to CT compared with desmopressin alone (primary outcome) and to identify factors associated with the response to CT (secondary outcome). We prospectively enrolled children with MNE with absent/partial response after 3 months of evening treatment with 240 mcg of desmopressin. We defined the response rate to CT compared with desmopressin alone according to the standardization of terminology document of the International Children's Continence Society: no-response, < 50% reduction; partial response, 50 to 99% reduction; and complete response, 100% reduction of wet nights. Both partial response and complete response to CT were clustered for the analyses of this manuscript. The enrolled children treated with 240 mcg/evening of desmopressin had also an additional evening administration of 0.3 mg/kg oxybutynin. A follow-up was scheduled at 3 and 6 months after the beginning of CT. At 3 months, oxybutynin dose was augmented to 0.5 mg/kg in case of absent/partial response to CT. Nocturnal diuresis was measured in 5 wet nights prior the beginning of therapy with desmopressin. Nocturnal polyuria (NP) was defined as nocturnal urine production > 130% of the expected bladder capacity. All patients with constipation were treated with macrogol. We enrolled 81 children (35.8% females) with a mean age of 8.4 ± 2.3 years. Seventy-eight patients completed the follow-up. After the CT, 59/78 (75.6%) patients showed an improvement of the response with CT compared with desmopressin alone. At multivariate analysis, both NP in more than 1 night (OR = 8.5; 95% CI, 1.4-51.6; p = 0.02) and absence of constipation (OR = 7.1; 95% CI, 1.6-31.0; p = 0.009) resulted significant after Bonferroni correction.. CT determines an improvement of response compared to therapy with desmopressin alone in 75.6% of patients. Significant predictive factors of response to CT were presence of NP and absence of constipation.. • Combination therapy (CT) (desmopressin plus anticholinergic drug) has been described as a therapeutic option for patients with monosymptomatic nocturnal enuresis (MNE) not responding to desmopressin alone as first-line treatment. • Variable protocols and variable combination of drugs have been described with a response rate ranging from 44 to 76%.. • We found that 59 patients (75.6%) treated with evening administration of 240 mcg of sublingual desmopressin plus 0.3-0.5 mg/kg of oxybutynin had an improvement of response compared to treatment with desmopressin alone. • We add evidence that presence of frequently recurring nocturnal polyuria and absence of constipation are predictors of response to CT.

Topics: Child; Constipation; Deamino Arginine Vasopressin; Female; Humans; Male; Nocturnal Enuresis; Polyuria

Enuresis is identified as voluntary or involuntary leakage of urine for at least three consecutive months in the daytime and/or nighttime on clothes for children older than five. Monosymptomatic nocturnal enuresis (MNE) describes nighttime wetting without daytime leakage of urine in children with no pathology in the urinary system and it is 80% more common than enuresis. Desmopressin is the most common medical treatment for MNE. The aim of this study is to retrospectively compare the effectiveness of desmopressin as monotherapy and desmopressin + oxybutynin as a combination therapy in the treatment of nocturnal enuresis.. This study retrospectively evaluated 183 patients who applied to pediatrics, pediatrics surgery and urology clinics with the complaint of nocturnal enuresis and diagnosed with primary monosymptomatic nocturnal enuresis between January 2014 and December 2019. The patients were divided into two groups (91 patients) who only received desmopressin therapy (Group 1), and those (92 patients) who received desmopressin and oxybutynin combination therapy (Group 2). Response to treatment, compliance and recurrence ratios were determined in the evaluation. Complete response was accepted as 90-100% decrease in the number of nighttime wetting, partial response was accepted as 50-90% decrease in the number of nighttime wetting and those below 50% were regarded as non-response. The 1st, 3rd, and 6th months of control data of treatment effectiveness of both groups were evaluated and their responses to treatment and the side effects of drugs were examined.. The mean age 183 patients of whom 103 were male and 80 were female was 10 (6-16) year. In the first month of control of Group 1, 71.4% had a complete cure, 8.8% had a partial cure and 19.8% had no response to treatment. In the third month of control of Group 1, 74.73% gave a complete response and were cured, 5.5% gave a partial response and 19.78% had no response. In the sixth month of Group 1, 70 patients were evaluated as complete response (79.5%), and 5 patients were evaluated as partial response (5.6%). In the first month of control of Group 2, 75% gave a complete response, 10.9% gave a partial response, 14.1% had no response to treatment. In the third month of control of Group 2, 86.9% gave a complete response, 6.52% gave a partial response, and 6.52% had no response. In the sixth month of the control of Group 2, the number of patients who did not come for control and could not be reached was 2, 83 patients out of 90 patients were evaluated as complete response (92.2%), 6 patients were evaluated as partial response (6.6%).. Desmopressin is the only FDA approved pharmacologic treatment for nocturnal enuresis. Desmopressin reduces urine production and the anticholinergic agent allows the bladder to store more urine. Therefore, combined therapy can be recommended in the MNE treatment for specially selected cases.

Topics: Antidiuretic Agents; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Mandelic Acids; Nocturnal Enuresis; Retrospective Studies; Treatment Outcome

Desmopressin was approved by the Food and Drug Administration (FDA) in 1978 for use in diabetes insipidus and bleeding disorders, but it is also prescribed off-label for patients with nocturia. Quantifying the potential risks facing adult patients taking desmopressin has taken on added importance because a new intranasal formulation of desmopressin was approved by the FDA in 2017. Like the old formulation, the main active ingredient is desmopressin acetate, but the new formulation also contains an excipient designed to enhance absorption. Our objective was to quantify the rate of hyponatremia in routine clinical care for patients prescribed the older formulation of desmopressin.. We conducted a population-based new-user cohort study from 1 February 2006 to 1 February 2017 using a nationwide commercial health plan database. Patients newly prescribed the older formulation of desmopressin were propensity-score (PS)-matched to patients newly prescribed oxybutynin. As a sensitivity analysis, tamsulosin was used as the comparator rather than oxybutynin. The primary outcome was a primary position diagnosis of hyponatremia. Proportional hazard models after 1:1 PS matching were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI). We identified 3,137 adults who were newly prescribed desmopressin and matched them to 3,137 adults who were newly prescribed oxybutynin. Mean age was 70, 55% were male, 13% filled a prescription for a diuretic during the baseline time period, and the mean baseline sodium prior to receiving either study drug was 140 mmol/L (normal: 135-145). The rate of hyponatremia was 146 per 1,000 person-years for adults prescribed desmopressin compared to 11 per 1,000 person-years for adults prescribed oxybutynin, corresponding to a 13-fold higher rate (HR 13.19; 95% CI 6.69, 26.01; p < 0.01). When follow-up was truncated at 30 days, a similar increased rate was observed (HR 19.41; 95% CI 7.11, 52.99; p < 0.01). A higher rate of hyponatremia was also observed with desmopressin when tamsulosin was the comparator (HR 12.10; 95% CI 6.54, 22.37; p < 0.01). Important limitations of our study include unmeasured confounding (for example, over-the-counter medication use, dietary intake), missing data (i.e., only 20% of patients had a baseline serum sodium), and a lack of data on the newer formulation of desmopressin.. Use of an older formulation of desmopressin was associated with a marked increased rate of subsequent hyponatremia compared to use of other medications indicated for lower urinary tract symptoms. Such risks should be clearly communicated to patients prescribed this formulation of desmopressin.

Topics: Administration, Intranasal; Aged; Aged, 80 and over; Cohort Studies; Deamino Arginine Vasopressin; Female; Hemostatics; Humans; Hyponatremia; Male; Mandelic Acids; Middle Aged; Nocturia; Propensity Score; Proportional Hazards Models; Risk Factors; Tamsulosin; Treatment Outcome

Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Enuresis; Humans; Mandelic Acids; Nocturnal Enuresis; Renal Agents

Nocturnal enuresis is a common pediatric condition with limited treatment options. In older children, pharmacologic therapy is often the preferred treatment. Pharmacologic therapies including desmopressin (DDAVP) or imipramine are effective in 40-50% of children. However, imipramine has serious safety concerns. Desmopressin in combination with a fixed dose anticholinergic has been shown to be useful in individuals who fail desmopressin monotherapy, but still fails to achieve success rates greater than 60%.. The goal was to explore the efficacy and safety of using combination therapy desmopressin plus oxybutynin with increasing dose of oxybutynin in patients refractory to standard combination therapy.. This was a single institution, IRB-approved, retrospective chart review of 61 patients (ages 7-18 years) including those with monosymptomatic primary nocturnal enuresis and non-monosymptomatic enuresis with controlled daytime voiding symptoms (CDVS) treated initially with desmopressin. All patients who failed initial therapy with desmopressin were started on combination therapy desmopressin (0.6 mg) plus standard dose (5 mg) oxybutynin. In patients who failed standard combination therapy, the dose of oxybutynin was titrated upwards until a response or the maximum dose of 10 mg was achieved. Demographic and medical history data were evaluated to determine predictive factors associated with response/failure to different therapy groups.. The use of escalating doses of oxybutynin in combination with desmopressin achieved an overall response rate of 96.7% defined as a 2-week period without any enuretic events following initiation of treatment. Low-dose combination therapy (LDCT) (0.6 mg of desmopressin+5 mg of oxybutynin) had a response rate of 68% (Table). Advanced dose combination therapy (ADCT) (0.6 mg of desmopressin+7.5-10 mg of oxybutynin) had a response rate of 75.0%. A statistically significant relationship was found correlating both attention deficit disorder/attention-deficit hyperactivity disorder(ADD/ADHD) and CDVS with failure on monotherapy. No patients in the study reported any adverse events or side effects from the medications.. The overall success rate of 96.7% with titrated doses of oxybutynin in combination with desmopressin is considerably higher than the response rates on fixed dose combination therapy quoted in the literature and supports the need for further evaluation in larger studies. Additionally, we found a statistically significant association between monotherapy failure and children with either ADD/ADHD or controlled daytime voiding symptoms. Our study is limited by small numbers and larger studies are needed to confirm these results.. Our results suggest that ADCT is a safe and effective treatment option for primary nocturnal enuresis refractory to standard and low-dose combination therapy.

Topics: Adolescent; Antidiuretic Agents; Attention Deficit Disorder with Hyperactivity; Child; Deamino Arginine Vasopressin; Drug Therapy, Combination; Female; Humans; Male; Mandelic Acids; Muscarinic Antagonists; Nocturnal Enuresis; Retrospective Studies

To investigate the relevance of enuresis subtyping for selection of treatment modality and for long-term outcome in a large consecutive patient cohort.. We included all patients referred for urinary incontinence during a 5-year period but excluding recurrent urinary tract infections (UTI). Type and severity of incontinence, prior history, results of examinations performed, number of visits, and effect of all treatments provided, were included in a clinical database.. Seven hundred twenty children aged 4-16 years (mean 8.5 ± 2.2 years, 239 girls) were included in the analysis (42% with monosymptomatic (MNE), 55% with non-MNE, and 3% with isolated daytime incontinence). Initial evaluation revealed only few underlying causes (one neurological and eight anatomical). Investigations showed significant differences between MNE and non-MNE patients as both maximal voided volume and nocturnal urine volume was lower in non-MNE patients (P < 0.001). Follow-up for average 1,587 days (3.4 years) was performed in 660 (92%) patients. A higher number of visits and a longer treatment period were needed for non-MNE patients (on average 4.7 ± 2.8 visits) than MNE patients (3.1 ± 1.6 visits, P < 0.001). The most common treatment regimen that resulted in dryness in both MNE (40%) and non-MNE (36%) was the alarm system. Interestingly, of the 539 patients who initially were referred due to desmopressin resistance 177 (33%) of these were dry on desmopressin monotherapy.. The study indicated that MNE and non-MNE are two distinct disease entities with different optimal treatments and showed that the latter patients are more difficult and time-consuming to manage.

Topics: Adolescent; Adrenergic Uptake Inhibitors; Antidiuretic Agents; Biofeedback, Psychology; Child; Child, Preschool; Cohort Studies; Deamino Arginine Vasopressin; Diurnal Enuresis; Enuresis; Female; Follow-Up Studies; Humans; Imipramine; Male; Mandelic Acids; Nocturnal Enuresis; Urinary Bladder, Overactive; Urological Agents

Dilutional hyponatremia, although not uncommon, is an underestimated problem in the pediatric population. In most cases, it results from excessive hydration or water retention, also described as the so-called water intoxication. One of the most known causes is the use of desmopressin in enuretic children. This drug enhances the free water reabsorption in the renal collecting ducts. The addition of the anticholinergic agent oxybutynin aggravated the condition by causing a dry mouth with excessive thirst and water intake in our first case. Dietary water overconsumption, either voluntary or involuntary, is a phenomenon seen in formula-fed babies. But in our second case, a game involving forced ingestion of large amounts of water had serious consequences including hyponatremia-related coma. An effort should therefore be made to inform caretakers about the risks of these games. These cases, provoked by rather unusual and peculiar causes, illustrate again that electrolytes and especially serum [Na(+)] are key points to be determined in a child with diminished consciousness. Moreover, an accurate history including the intake of medication and dietary information should be made.

Topics: Antidiuretic Agents; Child; Cholinergic Antagonists; Deamino Arginine Vasopressin; Drug Therapy, Combination; Electrocardiography; Female; Humans; Hyponatremia; Male; Mandelic Acids; Nocturnal Enuresis; Water Intoxication

This study examined the sustainability of remission of primary nocturnal enuresis (PNE) using an algorithm-based multimodal treatment plan, Try for Dry. Remission of PNE using the Try for Dry treatment method was retained longer and more often than using a non-Try for Dry plan.

Topics: Adolescent; Algorithms; Antidiuretic Agents; Child; Combined Modality Therapy; Constipation; Deamino Arginine Vasopressin; Drug Administration Schedule; Drug Therapy, Combination; Equipment Failure; Humans; Incidence; Kaplan-Meier Estimate; Mandelic Acids; Muscarinic Antagonists; Nocturnal Enuresis; Nursing Evaluation Research; Patient Care Planning; Remission Induction; Retrospective Studies; Surveys and Questionnaires; Toilet Training; Treatment Outcome; Urodynamics

Topics: Adrenergic Uptake Inhibitors; Analysis of Variance; Antidiuretic Agents; Chi-Square Distribution; Child; Child, Preschool; Deamino Arginine Vasopressin; Drug Therapy, Combination; Enuresis; Female; Humans; Imipramine; Male; Mandelic Acids; Muscarinic Antagonists; Parasympatholytics; Patient Compliance; Time Factors; Treatment Outcome

We compared the remission of pediatric primary nocturnal enuresis in groups of children who used a physician advised practice plan vs a parent chosen alternative.. Between January 2004 and January 2006 there were 119 patients with primary nocturnal enuresis enrolled in this prospective, nonrandomized study. For this study primary nocturnal enuresis was defined as wetting at night during sleep during any 6-month interval without any known causative problem. A total of 76 children received the physician advised treatment plan and used an alarm, oxybutynin, desmopressin, an elimination diet and a bowel program, as indicated. A total of 43 children received a parent chosen alternative treatment plan, which consisted of any single or combination of treatments involving an alarm, oxybutynin, desmopressin and an elimination diet or bowel program. Parents from each group completed an intake survey that measured functional bladder capacity using a 3-day home diary and they identified demographic variables. Followup occurred at 2 weeks and then monthly for 12 weeks to study end.. We found that the probability of remission by the end of the study for the physician advised treatment group was significantly higher than that of the parent choice group (88% vs 29%, Kaplan-Meier curve p <0.0001).. The group of children who followed physician advised treatment for primary nocturnal enuresis showed significantly earlier remission of primary nocturnal enuresis than children who followed the parent choice treatment (25th percentile 2 vs 10 weeks).

Topics: Adolescent; Adult; Antidiuretic Agents; Child; Child, Preschool; Choice Behavior; Combined Modality Therapy; Constipation; Deamino Arginine Vasopressin; Diet; Enuresis; Female; Humans; Male; Mandelic Acids; Monitoring, Physiologic; Parasympatholytics; Parents; Patient Selection; Prospective Studies; Treatment Outcome

We evaluated combination treatment with desmopressin and oxybutynin in patients with enuresis who did not respond to desmopressin monotherapy. Furthermore, we compared 2 methods of estimating bladder capacity and evaluated the ability of these methods to predict the response to desmopressin and oxybutynin.. A total of 60 children with a mean age +/- SD of 10.6 +/- 3.0 years who had monosymptomatic nocturnal enuresis completed the study. After a 2-week observation period maximal voided volume during free access to fluid intake was determined by a 2-day frequency-volume chart and maximal voided volume after water load was determined on a separate day. Patients then received 20 mug desmopressin intranasally at bedtime during 2 weeks. In nonresponders to desmopressin with less than a 50% decrease in wet nights 5 mg oxybutynin twice daily was added for another 2 weeks.. Of the patients 41 (68%) showed more than 50% decrease in wet nights during the 2-week desmopressin treatment period (4.6 +/- 1.6 to 0.7 +/- 0.8, p <0.001). In desmopressin nonresponders combined treatment with desmopressin and oxybutynin resulted in a further decrease in wet nights (4.0 +/- 1.2 to 1.7 +/- 1.4, p <0.001). Maximal voided volume during free access to fluid intake was significantly higher in desmopressin responders than in nonresponders (244 +/- 111 vs 160 +/- 65 ml, p <0.001). In contrast, maximal voided volume after water load was not significantly different between desmopressin responders and nonresponders.. The study indicates a role for oxybutynin in combination with desmopressin in children who are not responding to desmopressin monotherapy. Maximal voided volume during free access to fluid intake is a clinically useful predictor of the response to desmopressin but not to oxybutynin.

Topics: Antidiuretic Agents; Child; Deamino Arginine Vasopressin; Drug Therapy, Combination; Enuresis; Humans; Mandelic Acids; Muscarinic Antagonists; Urinary Bladder

We present our experience in the treatment of enuresis at the Pediatric Urology Outpatient Office over a period of four years. We report pertinent epidemiological data, diagnostic workup, as well as routine treatment protocol.. Between April 1998 and May 2002, 142 healthy children, aged between 6.5 and 18 years (mean: 9 +/- 0.5 years), were referred to us for bedwetting. Ninety three of them were boys and 49--girls. Eight of them had also concurrent daytime enuresis. According to our protocol, the type of enuresis was identified (primary or secondary) and then we administered the respective treatment. Sixteen children underwent behavioural therapy only. Fifteen children with detrusor instability received oxybutinine or tolterodine. Twenty children with diurnal and nocturnal enuresis were given desmopressin and oxybutinine or desmopressin and tolterodine. The remaining 91 children received monotherapy with desmopressin (individualized dose). The initial follow up ranged from 3 to 6 months.. Out of 111 children receiving desmopressin, 66 stopped wetting, but 28 relapsed in two weeks and treatment continued for 3 more months. Nine children became dry. In the other groups there was almost complete response to treatment.. Enuresis continues to be a suppressed problem for both children and parents; however, effective treatment is possible.

Topics: Adolescent; Antidiuretic Agents; Behavior Therapy; Benzhydryl Compounds; Chi-Square Distribution; Child; Combined Modality Therapy; Cresols; Deamino Arginine Vasopressin; Drug Therapy, Combination; Enuresis; Female; Greece; Humans; Male; Mandelic Acids; Phenylpropanolamine; Tolterodine Tartrate; Treatment Outcome

Topics: Adrenergic Uptake Inhibitors; Behavior Therapy; Benzhydryl Compounds; Benzilates; Biofeedback, Psychology; Cholinergic Antagonists; Contraindications; Cresols; Deamino Arginine Vasopressin; Electric Stimulation Therapy; Female; Humans; Imipramine; Male; Mandelic Acids; Muscarinic Antagonists; Nortropanes; Parasympatholytics; Phenylpropanolamine; Physical Therapy Modalities; Renal Agents; Tolterodine Tartrate; Urinary Incontinence; Urinary Incontinence, Stress

We assume that desmopressin decreases nocturnal urine output of the enuretic child. The aim of this study is to evaluate the efficacy of desmopressin plus oxybutynin and to define urodynamic pattern in children with bladder hyperactivity partially-responders to oxybutynin alone (in which nocturnal enuresis persists in spite of bladder stability).. 48 enuretic patients with urodynamically confirmed bladder hyperactivity were enrolled in the prospective study. All patients were treated with oxybutynin, 0.3-05 mg/Kg/day orally, and bladder therapy, for six months. At the end of this period, patients with excellent response (cessation of nocturnal and diurnal symptoms) was designed as group I (28 children, 58%); patients with partial response (persistence of nocturnal enuresis) as group II (19 children, 40%); and patients non-responders as group III (1 patient, excluded because of no completion of treatment). After six months patients were assessed by standardized urodynamic study. Group II patients were treated with combined therapy, desmopressin-20 mcg/day-plus oxybutynin, for six months. Group I patients served as controls.. The differences between mean bladder accommodation and mean voiding pressure in patients with excellent response and partially response to oxybutynin were statistically significant. After combined therapy 18 of 19 patients (95%) of group II became group I.. The efficacy of desmopressin plus oxybutynin is confirmed in patients with low final accommodation (< 3 ml/cm H2O) and high voiding pressure (> 70 cm H2O). Combined therapy can be a good choice of treatment in children with bladder hyperactivity with partial response to oxybutynin alone.

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Drug Therapy, Combination; Female; Humans; Male; Mandelic Acids; Muscarinic Antagonists; Prospective Studies; Renal Agents; Urinary Bladder Diseases

Topics: Adrenergic alpha-Antagonists; Antidepressive Agents, Tricyclic; Benzhydryl Compounds; Cholinergic Antagonists; Cresols; Deamino Arginine Vasopressin; Humans; Imipramine; Mandelic Acids; Muscarinic Antagonists; Phenylpropanolamine; Renal Agents; Tolterodine Tartrate; Urinary Incontinence

Topics: Antidepressive Agents, Tricyclic; Child; Combined Modality Therapy; Deamino Arginine Vasopressin; Enuresis; Humans; Imipramine; Male; Mandelic Acids; Renal Agents

The objective of this study was to determine the effectiveness of various treatments for nocturnal enuresis in a large, diverse population of children. A retrospective cohort review of patients with nocturnal enuresis was undertaken. All patients selected treatment after a single visit that included a history, examination, and demonstration of treatments. Families were contacted 1 year later to determine what treatment they chose and whether their child still wet. Families primarily chose an alarm (31%), followed by desmopressin acetate (22%) and oxybutynin (9%). Some preferred no treatment (23%). Fifty-six percent of patients using the alarm were completely dry compared to 18% using desmopressin acetate (p<0.0001), 16% using oxybutynin, and 28% receiving no treatment. In a heterogeneous population 1 year after a single visit, children whose parents chose the nocturnal enuresis alarm were most likely to be completely dry.

Topics: Adolescent; Biofeedback, Psychology; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Mandelic Acids; Parasympatholytics; Renal Agents; Retrospective Studies; Treatment Outcome

To determine the effect of long-term desmopressin therapy in enuretic patients on the levels of antidiuretic hormone (ADH) during and after the end of therapy.. The study comprised 25 outpatients (18 boys and seven girls) aged 8-12 years at the start of therapy and 12-16 years at the end. The morning (08.00 hours) plasma ADH level was determined before treatment (T0) with desmopressin and 2 years after (T1) ending the therapy. Seven of the 25 patients evaluated had monosymptomatic (simple enuresis, SE) and 18 had other symptoms (complex enuresis, CE).. In the patients with SE, the mean (SD) duration of therapy was 305 (183) days and they were reevaluated 2.5 (0.67) years later. Of 18 patients with CE, eight were treated only with desmopressin for 204 (117) days. In 10 with an incomplete response after 30 days with only desmopressin, oxybutynin (5 mg twice daily) was added; the duration of their therapy was 255 (152) days and they were re-evaluated 3.9 (0.6) years later. The mean (SD) ADH level in those with SE and CE was 2.14 (0.93) ng/L and 2.53 (1.16) ng/L), respectively, both significantly lower (P < 0.001) than in controls, at 5.1 (1.6) ng/L. On re-evaluation at T1, there was a significant (P < 0.001) increase in ADH levels over those at T0 in both groups, at 5.2 (0.8) and 5.3 (1.9) ng/L, respectively.. These results seem to confirm the role played by ADH in the pathophysiology of enuresis.

Topics: Adolescent; Child; Cholinergic Antagonists; Deamino Arginine Vasopressin; Drug Therapy, Combination; Enuresis; Female; Humans; Long-Term Care; Male; Mandelic Acids; Renal Agents; Vasopressins

Topics: Administration, Intranasal; Adult; Ambulatory Care; Clozapine; Deamino Arginine Vasopressin; Female; Humans; Male; Mandelic Acids; Treatment Outcome; Urinary Incontinence

Topics: Adult; Clozapine; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Mandelic Acids; Parasympatholytics; Prevalence; Psychotic Disorders; Urination Disorders