deamino-arginine-vasopressin and Enuresis

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

Desmopressin is a synthetic analogue of the natural antidiuretic hormone arginine vasopressin. Over the years, it has been clinically used to manage nocturnal polyuria in children with enuresis. Various pharmaceutical formulations of desmopressin have been commercialized for this indication-nasal spray, nasal drops, oral tablet and oral lyophilizate. Despite the fact that desmopressin is a frequently prescribed drug in children, its use and posology is based on limited pediatric data. This review provides an overview of the current pediatric pharmacological data related to the different desmopressin formulations, including their pharmacokinetics, pharmacodynamics and adverse events. Regarding the pharmacokinetics, a profound food effect on the oral bioavailability was demonstrated as well as different plasma concentration-time profiles (double absorption peak) of the desmopressin lyophilizate between adults and children. Literature about maturational differences in distribution, metabolism and excretion of desmopressin is rather limited. Regarding the pharmacodynamics, formulation/dose/food effect and predictors of response were evaluated. The lyophilizate is the preferred formulation, but the claimed bioequivalence in adults (200 µg tablet and 120 µg lyophilizate), could not be readily extrapolated to children. Prescribing the standard flat-dose regimen to the entire pediatric population might be insufficient to attain response to desmopressin treatment, whereby dosing schemes based on age and weight were proposed. Moreover, response to desmopressin is variable, whereby complete-, partial- and non-responders are reported. Different reasons were enumerated that might explain the difference in response rate to desmopressin observed: different pathophysiological mechanisms, bladder capacity and other predictive factors (i.e. breast feeding, familial history, compliance, sex, etc.). Also, the relapse rate of desmopressin treatment was high, rendering it necessary to use a pragmatic approach for the treatment of enuresis, whereby careful consideration of the position of desmopressin within this treatment is required. Regarding the safety of the different desmopressin formulations, the use of desmopressin was generally considered safe, but additional measures should be taken to prevent severe hyponatremia. To conclude the review, to date, major knowledge gaps in pediatric pharmacological aspects of the different desmopressin formulations still remain. Addition

Topics: Antidiuretic Agents; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Tablets

Enuresis constitutes a frequently encountered problem area for children that may adversely affect social and emotional adjustment. This type of incontinence has been of concern to the human family for centuries. A brief history of enuresis is presented followed by current conceptualizations, diagnostic criteria, prevalence rates and psychiatric comorbidities. Historic notions of causation together with ineffective, sometimes barbaric treatments are then discussed, ending with a presentation of evidence-based treatment modalities, with the urine alarm being an essential element of effective treatment. An intervention termed dry bed training combines the urine alarm with a series of procedures designed in part to reduce relapse potential and should be a primary consideration for implementation by treatment professionals. Finally, a brief case study is presented illustrating special etiological and treatment considerations with juvenile psychiatric patients.

Topics: Behavior Therapy; Deamino Arginine Vasopressin; Enuresis; Humans

Enuresis is a common and possibly underestimated condition. While 5-10% of school-aged children suffer from the condition, a lack of background knowledge may impede timely child-adapted and successful therapy.. To provide a comprehensive overview of the pathophysiology, diagnosis, and treatment of enuresis.. Guideline and position papers from the European Society of Pediatric Urology, the European Association of Urology, and the International Children's Continence Society were acquired. PubMed was searched for literature on enuresis, and all papers published in the last 5 yr were considered. The most relevant information from the papers with the highest level of evidence was extracted and incorporated into the review.. An altered antidiuretic hormone profile, arousal failure, and delayed bladder maturation are the main pathophysiological factors in primary enuresis. Coexisting constipation, obstructive airway disease, attention deficit hyperactivity disorder, obesity, and genetic preconditions influence its prevalence. Diagnosis relies on history-taking and simple noninvasive examinations to differentiate monosymptomatic enuresis and patients with daytime symptoms. It is essential to exclude daytime voiding symptoms, overactive bladder, dysfunctional voiding, and urinary tract infections. Further imaging is indicated in complex cases with a suspicion of underlying congenital malformations or systemic or endocrine diseases and in children refractory to initial therapy. In secondary enuresis, psychological causes should also be taken into consideration. While desmopressin melt tablets and alarm systems constitute the mainstays of treatment in monosymptomatic enuresis, anticholinergics and urotherapy play an additional role in nonmonosymptomatic enuresis. For therapy-refractory cases, after a thorough re-investigation to identify any missed comorbidities and anatomical or functional causes of enuresis, combination therapy and stationary urotherapy might be promising options.. While enuresis seems to be an often underestimated condition in terms of the suffering that children and their families, there are efficacious therapy options once a correct and full diagnosis is made.. This article reviews primary and secondary nocturnal enuresis, which is the medical term for the condition whereby children wet their beds regularly after their first birthday. We describe the background of enuresis,including its complex underlying mechanisms, as well as diagnosis and treatment in the light of current scientific publications. We conclude that while enuresis seems to be an often underestimated condition in terms of the suffering that children and their families may undergo, there are efficacious therapy options once a correct and full diagnosis is made.

Topics: Antidiuretic Agents; Biofeedback, Psychology; Child; Cholinergic Antagonists; Deamino Arginine Vasopressin; Enuresis; Humans

Enuresis was historically viewed as a primarily psychiatric disorder, but this understanding has changed dramatically since the end of the last century, when it became clear that somatic factors, such as nocturnal polyuria as a result of vasopressin deficiency, nocturnal detrusor overactivity and high arousal thresholds, all play a crucial role in enuresis pathogenesis. It has also become clear that enuresis is inherited in the majority of cases, although the correlation between genotype and enuretic phenotype is not straightforward. The standard view of enuresis as being the result of either (i) nocturnal polyuria and high arousal thresholds; or (ii) nocturnal detrusor overactivity and high arousal thresholds has become well-established, but further research now complicates the picture. First, psychological/psychiatric problems are overrepresented in enuresis, and might in a minority of cases have a causal or aggravating role. Second, nocturnal polyuria is not always linked to vasopressin deficiency. Third, nocturnal detrusor overactivity is in itself pathogenetically heterogeneous, and could be linked to constipation. Fourth, the sleep of enuretic children might be "deep," but possibly also disturbed (by obstructed airways or a distended or contracting bladder). These children might have high arousal thresholds because of the enuresis instead of the other way around. The same might possibly be said about nocturnal polyuria. Taking these new insights into account, a new model of enuresis pathogenesis is presented, which is more complicated but hopefully also more true than the standard consensus.

Topics: Adult; Antidiuretic Agents; Arousal; Central Nervous System; Child; Constipation; Deamino Arginine Vasopressin; Enuresis; Humans; Polyuria; Sleep; Urinary Bladder, Overactive; Vasopressins

Several studies have proposed the combination of desmopressin and anticholinergic as a treatment regimen to address the pathophysiology of polyuria and bladder dysfunction in pediatric enuresis. However, the available literature is inconsistent with regards to the immediate 1-month efficiency of the combination therapy in the treatment for pediatric enuresis.. The aim was to assess the immediate 1-month efficacy and safety of desmopressin and anticholinergic agent combination therapy versus desmopressin monotherapy in the treatment of pediatric enuresis using meta-analysis of randomized controlled trials (RCTs).. Systematic literature acquisition was carried out on electronic medical databases up to April 2015. RCTs relevant to the topic were critically appraised. Dichotomous data of the 1-month post-treatment response rate (defined as ≥90% reduction of wet nights) were extracted for calculation of the risk ratio (RR) and 95% confidence interval (CI). The Mantel-Haenszel method with the random effects model was used to pool effect estimates. Inter-study heterogeneity and publication bias were assessed. Subgroup analysis was done for the desmopressin treatment-naive versus treatment-resistant groups: PROSPERO (CRD42015017922).. Four RCTs of good methodological quality without heterogeneity were included for meta-analysis. The pooled effect estimates showed that combination therapy was associated with a significantly better immediate 1-month response rate than desmopressin monotherapy. Subgroup analysis showed a greater immediate 1-month response rate among desmopressin-resistant patients than treatment-naive patients. No severe adverse events were noted among combination therapy treated groups.. The limitation of the current meta-analyses is the small sample size, albeit with high-quality studies pooled for effect estimation. Despite the limitation, the study results were able to consistently illustrate a large treatment effect of combination therapy among desmopressin treatment-resistant patients. It was consistent with the literature review of retrospective and non-comparative studies by Alloussi et al. (2011), who summarized a similar impressive treatment outcome. However, due to the low level of evidence available at the time of their study, only a grade B-C recommendation was given to combination therapy as an approach for second-line treatment. This study also summarized that combination therapy was well tolerated and similar to desmopressin monotherapy.. This study was able to summarize the immediate 1-month efficacy of combination therapy compared with desmopressin monotherapy in the treatment of pediatric enuresis. For both treatment-naive and desmopressin-resistant pediatric enuresis, combination therapy of desmopressin with an anticholinergic agent is well tolerated and resulted in a significantly better immediate 1-month response rate than desmopressin monotherapy.

Topics: Child; Child, Preschool; Cholinergic Antagonists; Deamino Arginine Vasopressin; Drug Therapy, Combination; Enuresis; Humans; Randomized Controlled Trials as Topic; Time Factors; Treatment Outcome

A high relapse rate after discontinuation of desmopressin treatment of pediatric enuresis is consistently reported. Structured withdrawal strategies have been used to prevent relapse.. To assess the efficacy of a structured withdrawal strategy of desmopressin on the relapse-free rate for desmopressin responder pediatric enuresis.. Systematic literature search up to November 2015 on Medline, Embase, Ovid, Science Direct, Google Scholar, Wiley Online Library databases, and related references without language restriction.. Related clinical trials were summarized for systematic review. Randomized controlled trials on the efficacy of structured versus abrupt withdrawal of desmopressin in sustaining relapse-free status in pediatric enuresis were included for meta-analysis.. Eligible studies were evaluated according to Cochrane Collaboration recommendations. Relapse-free rate was extracted for relative risk (RR) and 95% confidence interval (CI). Effect estimates were pooled via the Mantel-Haenszel method with random effect model.. Six hundred one abstracts were reviewed. Four randomized controlled trials (total 500 subjects) of adequate methodological quality were included for meta-analysis. Pooled effect estimates compared with the abrupt withdrawal, structured withdrawal results to a significantly better relapse-free rate (pooled RR: 1.38; 95% CI, 1.17-1.63; P = .0001). Subgroup analysis for a dose-dependent structured withdrawal regimen showed a significantly better relapse-free rate (pooled RR: 1.48; 95% CI, 1.21-1.80; P = .0001).. The small number of studies included in meta-analysis represents a major limitation.. Structured withdrawal of desmopressin results in better relapse-free rates. Specifically, the dose-dependent structured withdrawal regimen showed significantly better outcomes.

Topics: Antidiuretic Agents; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Recurrence; Withholding Treatment

Dilutional hyponatremia is a serious adverse effect of desmopressin, a vasopressin analog that is widely prescribed to manage monosymptomatic enuresis. The presentation of hyponatremia, largely related to cerebral dysfunction, can include severe signs like altered mental status and seizures.. We reviewed the literature dealing with altered mental status or seizures in enuretic subjects on desmopressin. The retained publications included patients who were described individually, revealing data on mode of administration, further identifiable factors predisposing to hyponatremia, presentation and clinical course.. We found 54 cases of hyponatremia secondary to desmopressin treatment presenting with altered mental status or seizures. In most cases the complication developed 14 days or less after starting desmopressin. An intranasal formulation had been used in 47 patients. Excess fluid intake was documented as a contributing factor in at least 22 cases. In 6 cases severe signs of hyponatremia developed in the context of intercurrent illnesses.. Altered mental status or seizures are very rare but recognized complications of desmopressin in enuresis. This complication mostly develops in subjects managed with the intranasal formulation 14 days or less after starting the medication, following excess fluid intake and during intercurrent illnesses.

Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Enuresis; Humans; Hyponatremia; Lethargy; Seizures; Severity of Illness Index

Nocturnal enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15% to 20% of five year olds and up to 2% of adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs can be great. Behavioural interventions for treating bedwetting are defined as interventions that require a behaviour or action by the child which promotes night dryness and includes strategies which reward that behaviour. Behavioural interventions are further divided into:(a) simple behavioural interventions - behaviours or actions that can be achieved by the child without great effort; and(b) complex behavioural interventions - multiple behavioural interventions which require greater effort by the child and parents to achieve, including enuresis alarm therapy.This review focuses on simple behavioural interventions.Simple behavioural interventions are often used as a first attempt to improve nocturnal enuresis and include reward systems such as star charts given for dry nights, lifting or waking the children at night to urinate, retention control training to enlarge bladder capacity (bladder training) and fluid restriction. Other treatments such as medications, complementary and miscellaneous interventions such as acupuncture, complex behavioural interventions and enuresis alarm therapy are considered elsewhere.. To determine the effects of simple behavioural interventions in children with nocturnal enuresis.The following comparisons were made:1. simple behavioural interventions versus no active treatment;2. any single type of simple behavioural intervention versus another behavioural method (another simple behavioural intervention, enuresis alarm therapy or complex behavioural interventions);3. simple behavioural interventions versus drug treatment alone (including placebo drugs) or drug treatment in combination with other interventions.. We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, and handsearching of journals and conference proceedings (searched 15 December 2011). The reference lists of relevant articles were also searched.. All randomised or quasi-randomised trials of simple behavioural interventions for treating nocturnal enuresis in children up to the age of 16. Studies which included children with daytime urinary incontinence or children with organic conditions were also included in this review if the focus of the study was on nocturnal enuresis. Trials focused solely on daytime wetting and trials of adults with nocturnal enuresis were excluded.. Two reviewers independently assessed the quality of the eligible trials and extracted data. Differences between reviewers were settled by discussion with a third reviewer.. Sixteen trials met the inclusion criteria, involving 1643 children of whom 865 received a simple behavioural intervention. Within each comparison, outcomes were mostly addressed by single trials, precluding meta-analysis. The only exception was bladder training versus enuresis alarm therapy which included two studies and demonstrated that alarm therapy was superior to bladder training.In single small trials, rewards, lifting and waking and bladder training were each associated with significantly fewer wet nights, higher full response rates and lower relapse rates compared to controls. Simple behavioural interventions appeared to be less effective when compared with other known effective interventions (such as enuresis alarm therapy and drug therapies with imipramine and amitriptyline). However, the effect was not sustained at follow-up after completion of treatment for the drug therapies. Based on one small trial, cognitive therapy also appeared to be more effective than rewards. When one simple behavioural therapy was compared with another, there did not appear to be one therapy that was more effective than another.. Simple behavioural methods may be superior to no active treatment but appear to be inferior to enuresis alarm therapy and some drug therapy (such as imipramine and amitriptyline). Simple behavioural therapies could be tried as first line treatment before considering enuresis alarm therapy or drug therapy, which may be more demanding and have adverse effects, although evidence supporting their efficacy is lacking.

Topics: Adolescent; Antidepressive Agents, Tricyclic; Child; Child, Preschool; Clinical Alarms; Cognitive Behavioral Therapy; Deamino Arginine Vasopressin; Enuresis; Humans; Randomized Controlled Trials as Topic; Renal Agents; Reward

In voiding disorders in childhood, after a precise diagnosis, treatment can be provided. Aspecific hygienic and dietetic measures are the basis of care in all micturating disorders and frequently must be established to allow a precise diagnosis. In case of enuresis, restriction of beverage and diuretic foods is recommended in the evening. Other treatments for enuresis should be proposed to motivated children. In the polyuric form of enuresis, the treatment is desmopressin (DDAVP) and in the form with low bladder capacity, alarms or a combination of these 2 treatments. In dysfunctional voiding, after caring for the secondary causes, and depending on the characteristics of the disorder, the first-step treatment is pelvic floor rehabilitation with or without anticholinergic therapy. Other medical treatments are used in a second step. Isolated urethral instability remains controversial.

Topics: Behavior Therapy; Child; Child, Preschool; Combined Modality Therapy; Conditioning, Classical; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Infant; Male; Pelvic Floor Disorders; Referral and Consultation; Surveys and Questionnaires; Urination Disorders; Water Deprivation

To evaluate outcomes of desmopressin treatment in monosymptomatic enuresis (ME) and nonmonosymptomatic enuresis (NME).. PubMed was searched for all studies investigating enuresis, up to July 2009, in which desmopressin was administered alone or combined with other treatments. Each study was graded according to its respective level of evidence.. Altogether, 99 studies enrolling 7422 patients were identified as fulfilling the inclusion criteria. In 76 studies, desmopressin was administered as monotherapy; in 29 it was combined with other treatments such as antimuscarinics and enuresis alarm.. Studies incorporating a minor invasive versus a non-invasive diagnostic approach seem to achieve superior long-term success rates. Primary efficacy outcomes following desmopressin treatment are more favourable in ME than NME. Desmopressin administered with adjunct measures achieves superior outcomes compared to monotherapy, especially in NME. Compared to sudden withdrawal, the structured withdrawal programs show better long-term success and lower relapse rates. So far, no superiority has been shown for either time- or dose-dependent structured withdrawal programs. Most studies incorporated only small case series; only 25 studies with level of evidence 1 or 2 have been conducted. The broad range of mono- and adjunct treatments were evaluated according to the evidence based criteria recommended by the European Association of Urology.

Topics: Administration, Intranasal; Administration, Oral; Antidiuretic Agents; Clinical Alarms; Deamino Arginine Vasopressin; Drug Administration Schedule; Drug Therapy, Combination; Enuresis; Humans; Muscarinic Antagonists; Recurrence

Topics: Adolescent; Antidiuretic Agents; Behavior Therapy; Child; Child, Preschool; Clinical Alarms; Deamino Arginine Vasopressin; Enuresis; Evidence-Based Medicine; Guidelines as Topic; Humans; Patient Care Team

DDAVP is a drug that should be used with caution for each patient individually. Particular care is needed to avoid fluid overload and rapid fluctuations in sodium concentration. Not only families but physicians as well should be educated and aware of the adverse effects of DDAVP, especially in high risk patients. Extreme caution is needed in children with severe neurological and developmental problems who cannot control their fluid intake themselves. Similarly, caution is needed in patients with hypodipsia and DI who have difficulty in balancing water intake and DDAVP dose. The treatment of DI is water; however, DDAVP is given to avoid a large fluid intake which can result in medullary washout. Frequent home monitoring of body weight and regular determinations of serum sodium may help to disclose the early phase of over-hydration or dehydration. DDAVP therapy should be temporarily interrupted during acute illness, febrile episodes, hot days and other conditions with increased water intake. It should be used with considerable caution in patients with cystic fibrosis, or renal or cardiovascular diseases. In patients with enuresis, it is recommended that DDAVP medication should not be continued for longer than 3 months without stopping for 1 week for full reassessment. Fluid intake should be limited 1 hour before and 8 hours after the dose. Generally, undertreatment with vasopressin analogue is safer than overtreatment. A simple measure to avoid overtreatment is to miss one dose once a week; a rapid onset diuresis ('washout' effect) provides considerable reassurance.

Topics: Adolescent; Antidiuretic Agents; Brain Edema; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Drinking; Enuresis; Hemostatics; Humans; Hyponatremia; Myelinolysis, Central Pontine; Sodium; Water Intoxication

Topics: Antidiuretic Agents; Behavior Therapy; Child; Cost of Illness; Deamino Arginine Vasopressin; Drug Costs; Enuresis; Equipment Failure; Humans; Nurse's Role; Patient Acceptance of Health Care; Patient Education as Topic; Patient Selection; Social Support; United States

Bedwetting (nocturnal enuresis) is common. It occurs in up to 20% of 5 year olds and 10% of 10 year olds, with a spontaneous remission rate of 14% per year. Weekly daytime wetting occurs in 5% of children, most of whom (80%) also wet the bed. Bedwetting can have a considerable impact on children and families, affecting a child's self-esteem and interpersonal relationships, and his or her performance at school. Primary nocturnal enuresis (never consistently dry at night) should be distinguished from secondary nocturnal enuresis (previously dry for at least 6 months). Important risk factors for primary nocturnal enuresis include family history, nocturnal polyuria, impaired sleep arousal and bladder dysfunction. Secondary nocturnal enuresis is more likely to be caused by factors such as urinary tract infections, diabetes mellitus and emotional stress. The treatment for monosymptomatic nocturnal enuresis (bedwetting with no daytime symptoms) is an alarm device, with desmopressin as second-line therapy. Treatment for non-monosymptomatic nocturnal enuresis (bedwetting with daytime symptoms--urgency and frequency, with or without incontinence) should initially focus on the daytime symptoms.Bedwetting without daytime symptoms, the most common toileting problem, can be effectively treated with an alarm device.

Topics: Absorbent Pads; Antidiuretic Agents; Behavior Therapy; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Humans; Risk Factors

Enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15 to 20% of five year olds, and up to 2% of young adults.. To assess the effects of alarm interventions on nocturnal enuresis in children, and to compare alarms with other interventions.. We searched the Cochrane Incontinence Group specialised trials register (searched 22 November 2004) and the reference lists of relevant articles.. All randomised or quasi-randomised trials of alarm interventions for nocturnal enuresis in children were included, except those focused solely on daytime wetting. Comparison interventions included no treatment, simple and complex behavioural methods, desmopressin, tricyclics, and miscellaneous other methods.. Two reviewers independently assessed the quality of the eligible trials, and extracted data.. Fifty five trials met the inclusion criteria, involving 3152 children of whom 2345 used an alarm. The quality of many trials was poor, and evidence for many comparisons was inadequate. Most alarms used audio methods. Compared to no treatment, about two thirds of children became dry during alarm use (RR for failure 0.38, 95% CI 0.33 to 0.45). Nearly half who persisted with alarm use remained dry after treatment finished, compared to almost none after no treatment (RR of failure or relapse 45/81 (55%) vs 80/81 (99%), RR 0.56, 95% CI 0.46 to 0.68). There was insufficient evidence to draw conclusions about different types of alarm, or about how alarms compare to other behavioural interventions. Relapse rates were lower when overlearning was added to alarm treatment (RR 1.92, 95% CI 1.27 to 2.92) or if dry bed training was used as well (RR 2.0, 95% CI 1.25 to 3.20). Penalties for wet beds appeared to be counter-productive. Alarms using electric shocks were unacceptable to children or their parents. Although desmopressin may have a more immediate effect, alarms appear more effective by the end of a course of treatment (RR 0.71, 95% CI 0.50 to 0.99) and there was limited evidence of greater long-term success (4/22 (18%) vs 16/24 (67%), RR 0.27, 95% CI 0.11 to 0.69). Evidence about the benefit of supplementing alarm treatment with desmopressin was conflicting. Alarms were better than tricyclics during treatment (RR 0.73, 95% CI 0.61 to 0.88) and afterwards (7/12 (58%) vs 12/12 (100%), RR 0.58, 95% CI 0.36 to 0.94).. Alarm interventions are an effective treatment for nocturnal bedwetting in children. Alarms appear more effective than desmopressin or tricyclics by the end of treatment, and subsequently. Overlearning (giving extra fluids at bedtime after successfully becoming dry using an alarm), dry bed training and avoiding penalties may further reduce the relapse rate. Better quality research comparing alarms with other treatments is needed, including follow-up to determine relapse rates.

Topics: Absorbent Pads; Case-Control Studies; Child; Child, Preschool; Deamino Arginine Vasopressin; Electrodes; Enuresis; Humans; Nephrology; Randomized Controlled Trials as Topic; Renal Agents

Nocturnal enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15 to 20% of five year olds, and up to 2% of young adults.. To assess the effects of complementary interventions and others such as surgery or diet on nocturnal enuresis in children, and to compare them with other interventions.. We searched the Cochrane Incontinence Group Specialised Register (searched 22 November 2004), the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS) (January 1984 to June 2004) and the reference lists of relevant articles.. All randomised or quasi-randomised trials of complementary and other miscellaneous interventions for nocturnal enuresis in children were included except those focused solely on daytime wetting. Comparison interventions could include no treatment, placebo or sham treatment, alarms, simple behavioural treatment, desmopressin, imipramine and miscellaneous other drugs and interventions.. Two reviewers independently assessed the quality of the eligible trials, and extracted data.. In 15 randomised controlled trials, 1389 children were studied, of whom 703 received a complementary intervention. The quality of the trials was poor: four trials were quasi-randomised, five showed differences at baseline and ten lacked follow up data. The outcome was better after hypnosis than imipramine in one trial (relative risk (RR) for failure or relapse after stopping treatment 0.42, 95% confidence interval (CI) 0.23 to 0.78). Psychotherapy appeared to be better in terms of fewer children failing or relapsing than both alarm (RR 0.28, 95% CI 0.09 to 0.85) and rewards (0.29, 95% 0.09 to 0.90) but this depended on data from only one trial. Acupuncture had better results than sham control acupuncture (RR for failure or relapse after stopping treatment 0.67, 95% CI 0.48 to 0.94) in a further trial. Active chiropractic adjustment had better results than sham adjustment (RR for failure or relapse after stopping treatment 0.74, 95% CI 0.60 to 0.91). However, each of these findings came from small single trials, and need to be verified in further trials. The findings for diet and faradization were unreliable, and there were no trials including homeopathy or surgery.. There was weak evidence to support the use of hypnosis, psychotherapy, acupuncture and chiropractic but it was provided in each case by single small trials, some of dubious methodological rigour. Robust randomised trials are required with efficacy, cost-effectiveness and adverse effects carefully monitored.

Topics: Acupuncture Therapy; Child; Complementary Therapies; Counseling; Deamino Arginine Vasopressin; Electric Stimulation Therapy; Enuresis; Homeopathy; Humans; Hypnosis; Manipulation, Chiropractic; Psychotherapy; Randomized Controlled Trials as Topic; Renal Agents

For children with primary nocturnal enuresis, treatment with enuresis alarms reduced the number of wet nights by almost 4 per week, with almost half of patients remaining dry for 3 months after treatment (strength of recommendation [SOR]: A, based on a systematic review of homogeneous randomized control trials [RCTs]). Desmopressin (DDAVP) and tricyclic drugs reduce the number of wet nights by 1 to 2 per week during treatment, although the effect is not sustained after treatment is finished (SOR: A, based on a SR of homogeneous RCTs). Dry bed training with an alarm results in an additional reduction of wet nights over alarms alone (SOR: A, based on a systematic review of homogeneous RCTs.).

Topics: Behavior Therapy; Child; Clinical Trials as Topic; Deamino Arginine Vasopressin; Enuresis; Evidence-Based Medicine; Humans; Renal Agents

Nocturnal enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15-20% of five year olds, and up to 2% of young adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs can be great. Simple behavioural methods of treating bedwetting include reward systems such as star charts given for dry nights, lifting or waking the children at night to urinate, retention control training to enlarge bladder capacity (bladder training) and fluid restriction.. To assess the effects of simple behavioural interventions on nocturnal enuresis in children, and to compare these with other interventions.. We searched the Cochrane Incontinence Group trials register (searched 18 September 2003). The reference list of a previous version of this review was also searched.. All randomised or quasi-randomised trials of simple behavioural interventions for nocturnal enuresis in children up to the age of 16. Trials focused solely on daytime wetting were excluded.. Two reviewers independently assessed the quality of the eligible trials and extracted data.. Thirteen trials met the inclusion criteria, involving 702 children of whom 387 received a simple behavioural intervention. However, within each comparison each outcome was addressed by single trials only, precluding meta-analysis. In single small trials, reward systems (e.g. star charts), lifting and waking were each associated with significantly fewer wet nights, higher cure rates and lower relapse rates compared to controls. There was not enough evidence to evaluate retention control training (bladder training), whether compared with controls or dry bed training, or used as a supplement to alarms, or versus desmopressin. Cognitive therapy may have lower failure and relapse rates than star charts, but this finding was based on one small trial only. One small trial of poor quality suggested that star charts were initially less successful than amitriptyline but this difference did not persist after the treatments stopped. Another suggested that imipramine was better than fluid deprivation and avoidance of punishment.. Simple behavioural methods may be effective for some children, but further trials are needed, in particular in comparison with treatments known to be effective, such as desmopressin, tricyclic drugs and alarms. However, simple methods could be tried as first line therapy before considering alarms or drugs, because these alternative treatments may be more demanding and may have adverse effects.

Topics: Adolescent; Antidepressive Agents, Tricyclic; Child; Child, Preschool; Cognitive Behavioral Therapy; Deamino Arginine Vasopressin; Enuresis; Humans; Randomized Controlled Trials as Topic; Renal Agents; Reward

Bedwetting (nocturnal enuresis) is common among school-aged children, with around one in six 5-year-olds, and at least one in fifty 7-year-old boys and one in a hundred 7-year-old girls, wetting the bed more than once a week. Moreover, in some children, the problem can persist, with around 0.8% of girls and 1.6% of boys aged 15-16 years wetting at least once every 3 months. The condition can affect the child's self-esteem, and may lead to teasing or bullying, reduced social interactions and behavioural problems. The frequent changing and washing of bedding and night-clothes can place an additional workload and financial burden on the family. Parents may become intolerant of the situation, and this may even lead to physical punishment of the child. Here we review the primary-care management of children with bedwetting.

Topics: Acoustic Stimulation; Behavior Therapy; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Humans; Renal Agents

Topics: Behavior Therapy; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Renal Agents; Treatment Outcome

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

Nocturnal enuresis is a common problem. Physiologic and environmental factors are thought to have a role in the etiology and treatment of this condition. This article discusses the association between enuresis and behavioral or emotional problems. Common behavioral treatments are described, and evidence for their efficacy is reviewed. A brief discussion of hypnosis and acupuncture is included.

Topics: Deamino Arginine Vasopressin; Drinking; Enuresis; Humans; Hypnosis; Renal Agents

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

Enuresis is a symptom that is frequently encountered in child psychiatric evaluations. Careful assessment is required to identify specific urologic, developmental, psychosocial, and sleep-related etiologies. For most children with enuresis, however, a specific etiology cannot be determined. Treatment then involves supportive approaches, conditioning with a urine alarm, or medications--imipramine or desmopressin acetate. The psychosocial consequences of the symptom must be recognized and addressed with sensitivity during the evaluation and treatment of enuresis.

Topics: Adolescent; Child; Combined Modality Therapy; Conditioning, Psychological; Deamino Arginine Vasopressin; Enuresis; Humans; Psychotherapy; Renal Agents; Severity of Illness Index

Topics: Adolescent; Antidepressive Agents, Tricyclic; Child; Deamino Arginine Vasopressin; Enuresis; Humans

Nocturnal enuresis is a common problem that can be troubling for children and their families. Recent studies indicate that nocturnal enuresis is best regarded as a group of conditions with different etiologies. A genetic component is likely in many affected children. Research also indicates the possibility of two subtypes of patients with nocturnal enuresis: those with a functional bladder disorder and those with a maturational delay in nocturnal arginine vasopressin secretion. The evaluation of nocturnal enuresis requires a thorough history, a complete physical examination, and urinalysis. Treatment options include nonpharmacologic and pharmacologic measures. Continence training should be incorporated into the treatment regimen. Use of a bed-wetting alarm has the highest cure rate and the lowest relapse rate; however, some families may have difficulty with this treatment approach. Desmopressin and imipramine are the primary medications used to treat nocturnal enuresis, but both are associated with relatively high relapse rates.

Topics: Adolescent; Adrenergic Uptake Inhibitors; Behavior Therapy; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Imipramine; Renal Agents; Sleep

Topics: Adult; Child; Deamino Arginine Vasopressin; Drug Administration Schedule; Enuresis; Family Practice; Humans; Quality of Life; Renal Agents; United States

Topics: Adolescent; Antidepressive Agents, Tricyclic; Child; Deamino Arginine Vasopressin; Enuresis; Humans

Enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15-20% of five year olds, and up to 2% of young adults.. To assess the effects of desmopressin on nocturnal enuresis in children, and to compare desmopressin with other interventions.. We searched the Cochrane Incontinence Group trials register. Date of the most recent search: March 2002. The reference list of a previous version of this review was also searched.. All randomised trials of desmopressin for nocturnal enuresis in children were included in the review. Comparison interventions included placebo, other drugs, alarms or behavioural methods. Trials focused solely on daytime wetting were excluded.. Two reviewers independently assessed the quality of the eligible trials, and extracted data.. Forty one randomised trials involving 2760 children (of whom 1813 received desmopressin) met the inclusion criteria. The quality of many of the trials was poor. Desmopressin was compared with another drug in four trials, and with alarms in seven. Desmopressin was effective in reducing bedwetting in a variety of doses and forms. Each dose of desmopressin reduced bedwetting by at least one night per week during treatment compared with placebo (e.g. 20 microg: 1.34 fewer wet nights per week, 95% CI 1.11 to 1.57). Children on desmopressin were more likely to become dry (e.g. RR for failure to achieve 14 dry nights with 20 mcg 0.84, 95% CI 0.79 to 0.91). However, there was no difference after treatment was finished. There was no clear dose-related effect of desmopressin, but the evidence was limited. Data which compared oral and nasal administration were too few to be conclusive. While desmopressin was better than diclofenac or indomethacin, and comparison with tricyclic drugs (amitriptyline and imipramine) suggested that they might be as effective as desmopressin, the data were inconclusive due to small numbers. There were more side effects with the tricyclics. In one small trial, desmopressin resulted in more wet nights than alarms towards the end of treatment (WMD 1.4, 95% CI: 0.14 to 2.66) and the chance of failure or relapse after alarms was less (RR 9.17, 95% CI 1.28 to 65.90). Although there were fewer wet nights during alarm treatment supplemented by desmopressin compared with alarms alone (WMD -1.35, 95% CI -2.32 to -0.38), the data are inconclusive about whether this is reflected in lower failure (RR 0.88, 95%CI 0.52 to 1.50) or subsequent relapse rates (RR 0.58, 95% CI 0.31 to 1.10).. Desmopressin rapidly reduced the number of wet nights per week, but there was some evidence that this was not sustained after treatment stopped. Comparison with alternative treatments suggested that desmopressin and tricyclics had similar clinical effects, but that alarms may produce more sustained benefits. However, based on the available limited evidence, these conclusions can only be tentative. Children should be advised not to drink more than 240 ml (8 oz) fluid during desmopressin treatment in order to avoid the possible risk of water intoxication.

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Randomized Controlled Trials as Topic; Renal Agents

Topics: Acupuncture Therapy; Administration, Intranasal; Antidepressive Agents, Tricyclic; Behavior Therapy; Child; Combined Modality Therapy; Deamino Arginine Vasopressin; Enuresis; Humans; Randomized Controlled Trials as Topic; Treatment Outcome

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; Clinical Trials as Topic; Deamino Arginine Vasopressin; Enuresis; Follow-Up Studies; Humans; Long-Term Care; Renal Agents; Treatment Outcome; Vasopressins

Nocturnal enuresis (bedwetting) is a common inherited medical condition affecting both children and adults. It is not due to laziness. It can be distressing, embarrassing, humiliating and has a negative impact on self esteem and mood especially in children and young people over the age of 10 years.. To assist busy general practitioners develop a better understanding of bedwetting and the importance of its diagnosis and treatment.. Spontaneous remission rates over the age of 10 years are low at 5% per year and approaches often tried at home such as waking to void, reward charts or fluid restriction are not effective. However, treatment with alarm systems or desmopressin for those who fail to respond to alarms is successful in over 90% of cases.

Topics: Adolescent; Adult; Behavior Therapy; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Remission, Spontaneous; Renal Agents

The purpose of this review is to highlight and comment upon important areas of enuresis research.. Current areas of pathophysiological focus are nocturnal urine production, in which alternative mechanisms other than deficient vasopressin secretion has been implicated in some patients. Bladder reservoir function has gained renewed interest, and has proved to be one of the best predictors of treatment response to desmopressin. Various aspects of central nervous system function, including arousability and pontine reflexes, are in focus, and molecular genetics has provided firm evidence of a link between enuresis and different chromosomal markers. The therapeutic focus is directed towards a differential approach based upon the underlying mechanism and towards combination therapies such as alarm devices and desmopressin as well as anticholinergic agents and desmopressin. Furthermore, new exciting treatment concepts such as laser acupuncture have shown promising results in initial studies.. Despite recent advances in our understanding of nocturnal enuresis, we are still far from understanding in detail this socially discomfiting and scientifically intriguing condition, and many controversies remain. However, the substantiation that enuresis is a heterogeneous condition that requires a differential approach has provided the basis for further progress.

Topics: Arginine Vasopressin; Deamino Arginine Vasopressin; Enuresis; Humans; Urinary Bladder; Urodynamics

Nocturnal enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15-20% of five year olds, and up to 2% of young adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs can be great. Simple behavioural methods of treating bedwetting include reward systems such as star charts given for dry nights, lifting or waking the children at night to urinate, retention control training to enlarge bladder capacity (bladder training) and fluid restriction.. To assess the effects of simple behavioural interventions on nocturnal enuresis in children, and to compare these with other interventions.. We searched the Cochrane Incontinence Group trials register. The reference list of a previous version of this review was also searched. Date of the most recent search: December 2001.. All randomised or quasi-randomised trials of simple behavioural interventions for nocturnal enuresis in children up to the age of 16. Trials focused solely on daytime wetting were excluded.. In a previous version of this review, trials up to 1997 were independently assessed by two reviewers. Previous trials were re-assessed, and further trials were assessed for quality, and data were extracted by another reviewer.. Twelve reliable trials met the inclusion criteria, involving 748 children of whom 365 received a simple behavioural intervention. However, within each comparison each outcome was addressed by single trials only, precluding meta-analysis. In single small trials, reward systems (e.g. star charts), lifting and waking were each associated with significantly fewer wet nights, higher cure rates and lower relapse rates compared to controls. There was not enough evidence to evaluate retention control training (bladder training), whether compared with controls or dry bed training, or used as a supplement to alarms, or versus desmopressin. Cognitive therapy may have lower failure and relapse rates than star charts, but this finding was based on one small trial only. One small trial of poor quality suggested that star charts were initially less successful than amitriptyline but this difference did not persist after the treatments stopped.. Simple behavioural methods may be effective for some children, but further trials are needed, in particular in comparison with treatments known to be effective, such as desmopressin, tricyclic drugs and alarms. However, simple methods could be tried as first line therapy before considering alarms or drugs, because these alternative treatments may be more demanding and may have adverse effects.

Topics: Adolescent; Antidepressive Agents, Tricyclic; Child; Child, Preschool; Cognitive Behavioral Therapy; Deamino Arginine Vasopressin; Enuresis; Humans; Randomized Controlled Trials as Topic; Renal Agents; Reward

Enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15-20% of five year olds, and up to 2% of young adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs to the children can be great.. To assess the effects of alarm interventions on nocturnal enuresis in children, and to compare alarms with other interventions.. The following electronic databases were searched: MEDLINE to June 1997; AMED; ASSIA; BIDS; BIOSIS Previews (1985-1996); CINAHL; DHSS Data; EMBASE (1974 to June 1997); PsycLIT and SIGLE. Organisations, manufacturers, researchers and health professionals concerned with enuresis were contacted for information. The reference sections of obtained studies were also checked for further trials. Date of the most recent search: July 1997.. All randomised trials of alarm interventions for nocturnal enuresis in children were included in the review. Trials were eligible for inclusion if: children were randomised to alarm treatment compared with controls, other behavioural methods or drugs for nocturnal bedwetting; participants with organic causes for their bedwetting were excluded; and baseline assessments of the level of bedwetting were reported. Trials focused solely on daytime wetting were excluded.. Two reviewers independently assessed the quality of the eligible trials, and extracted data.. Twenty two randomised trials met the inclusion criteria, involving 1125 children who received treatment with alarms. The quality of many of the trials was poor, and many comparisons were addressed only by single trials. Children treated with alarms were significantly more likely than untreated controls to become dry during treatment (RR for failing to achieve 14 dry nights 0.27, 95% CI 0.19 to 0.39) and failing to remain dry (RR 0.58, 95%CI 0.46 to 0.74). There was insufficient evidence to judge whether one type of alarm is better than another and whether alarms alone were as good as or better than other behavioural interventions alone or as a supplement to alarm treatment. Desmopressin or tricyclics seem as effective as alarms while on treatment. There was limited evidence to suggest that the relapse rate might be lower after stopping alarm treatment than after desmopressin (RR 0.11, 95% CI 0.02 to 0.78).. Alarm interventions are an effective treatment for nocturnal bedwetting in children. Desmopressin and tricyclics appeared as effective while on treatment, but this effect was not sustained after treatment stopped, and alarms may be more effective in the long term. Comparisons between drug and behavioural treatments are needed, and should include relapse rates after treatment is finished.

Topics: Case-Control Studies; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Humans; Nephrology; Randomized Controlled Trials as Topic; 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

The authors do not have all of the data about enuresis, and many children are subject to relapses or failure of treatment. There is no cause for despondency, however. Enuresis is no longer a mystery. Good data exist about the natural history, epidemiology, and etiology of enuresis. In addition, multiple treatment modalities are available to practitioners. This article has sought to review the scientific literature and to relate the authors' experience with enuresis. The authors recommend a treatment program for children with monosymptomatic nocturnal enuresis that includes removal of caffeine from the diet. Enuretic children do not consume enough fluid, and the authors recommend that the daily fluid requirement be divided during the day: 40% in the morning, 40% in the afternoon, and 20% in the evening, with no restriction of fluid. Normalization of small functional bladder capacities may help to cure enuresis and has an effect on the efficacy of other therapies. Treatment of enuretics with antibiotics is effective in children with UTI, bacteriuria, or cystitis cystica. DDAVP has been shown to be effective in the treatment of enuresis, especially in children who have achieved a normal functional bladder capacity. Bladder alarm systems also offer a potential cure of enuresis, are inexpensive, and show a low relapse rate.

Topics: Behavior Therapy; Child; Child Development; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Humans; Physical Examination; Renal Agents; Urinary Bladder; Urodynamics; Vasopressins

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

Children suffering from nocturnal enuresis have better self-esteem when they stay dry. A medical examination is necessary in order to exclude specific causes. The choice of treatment should be based on: motivation and age of the child, nocturnal polyuria versus bladder capacity, possibilities to borrow an alarm device, and follow-up. Informed choice treatment should be offered. Treatment with an alarm device and minimum standards are discussed. Desmopressin for short-term treatment or for three month periods are recommended for patient who respond to desmopressin. If organic causes are suspected, the child has diurnal incontinence symptoms, or does not stay dry in spite of the recommended treatment, referral to a paediatrician or a paediatric department is recommended. A better program for managing these patients at paediatric departments should be developed in collaboration with other specialists.

Topics: Child; Cues; Deamino Arginine Vasopressin; Enuresis; Follow-Up Studies; Humans; Practice Guidelines as Topic; Renal Agents; Treatment Outcome

Primary nocturnal enuresis is common and has considerable psychological ramifications for children as they get older. It is a familial condition with complex inheritance patterns. The pathophysiology of the condition appears to be related to poor arousal from sleep, nocturia due to deficient vasopressin release in sleep and possibly a decrease in functional bladder capacity especially at night. The mainstay of treatment is the bed-wetting alarm. In recent years, desmopressin nasal spray has found a clinical niche as a short-term solution for children attending school camps or sleeping over at friends' houses and as treatment in the medium term for those unresponsive to treatment with a bed-wetting alarm. It may also be used as an adjunct to the use of the alarm. Treatment with imipramine is increasingly in disfavour because the relapse rate is unacceptably high and fatal overdose is a real possibility.

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Imipramine; Renal Agents

Topics: Antidepressive Agents, Tricyclic; Behavior Therapy; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Imipramine; Renal Agents

Enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15-20% of five year olds, and up to 2% of young adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs to the children can be great.. To assess the effects of desmopressin on nocturnal enuresis in children, and to compare desmopressin with other interventions.. The following electronic databases were searched: MEDLINE to June 1997; AMED; ASSIA; BIDS; BIOSIS Previews (1985-1996); CINAHL; DHSS Data; EMBASE (1974 to June 1997); PsycLIT and SIGLE. Organisations, manufacturers, researchers and health professionals concerned with enuresis were contacted for information. The reference sections of obtained studies were also checked for further trials. Date of the most recent search: July 1997.. All randomised trials of desmopressin for nocturnal enuresis in children were included in the review. Trials were eligible for inclusion if: children were randomised to receive desmopressin compared with placebo, other drugs or other conservative interventions for nocturnal bedwetting; participants with organic causes for their bedwetting were excluded; and baseline assessments of the level of bedwetting were reported. Trials focused solely on daytime wetting were excluded.. Two reviewers independently assessed the quality of the eligible trials, and extracted data.. Twenty one randomised trials involving 948 children treated with desmopressin, met the inclusion criteria. The quality of many of the trials was poor. Desmopressin was compared with a tricyclic drug in two trials, and with alarms in one. Desmopressin was effective in reducing bedwetting in a variety of doses and forms. Each dose of desmopressin reduced bedwetting by at least one night per week during treatment (eg 20microg: 1.56 fewer wet nights per week, 95% CI -1.94 to -1.19). Participants on desmopressin were 4.6 times more likely to achieve 14 consecutive dry nights (95% CI 1.38 to 15.02) compared with placebo. However, there was no difference after treatment was finished. There was no apparent dose-related effect of desmopressin, but the evidence was limited. Data which compared oral and nasal administration were too few to be conclusive. Desmopressin and imipramine (a tricyclic drug) were equally effective in one small trial. Amitriptyline (another tricyclic) was not consistently better than desmopressin either alone or when used as a supplement. In a single trial, desmopressin was initially superior to using an alarm in reducing the number of wet nights per week: WMD -1.7 (95% CI: -2.96 to -0.45), but this result was not sustained; after three months of treatment, patients using the alarm had 1.4 fewer wet nights per week than with desmopressin: (95% CI: 0.14 to 2.65). Participants receiving the alarm intervention were also nine times less likely to relapse than those given desmopressin: RR 9.2 (95% CI: 1.28 to 65.9). Combining alarm and drug therapy was found to be superior to alarm treatment alone. The addition of desmopressin to an alarm schedule resulted in one less wet night per week: (95% CI: -1.55 to -0.45).. Desmopressin rapidly reduced the number of wet nights per week, but there was some evidence that this was not sustained after treatment stopped. Comparison with alternative treatments suggested that desmopressin and tricyclics had similar clinical effects, but that alarms produced more sustained benefits. However, based on the available evidence, these conclusions can only be tentative. There was some evidence of minor side effects of desmopressin in the included trials, such as nasal irritation and nose bleeds. However, the risk of water intoxication associated with over-drinking before bedtime has been reported. Patients and their families need to be warned of potential adverse effects and advise

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Renal Agents

To review the medical and psychological literature concerning enuresis treatments in light of the Chambless criteria for empirically supported treatment.. A systematic search of the medical and psychological literature was performed using Medline and Psychlit.. Several review studies and numerous well-controlled experiments have clearly documented the importance of the basic urine alarm alone as a necessary component in the treatment of enuresis or combined with the "Dry-Bed Training" intervention, establishing them as "effective treatments." Other multicomponent behavioral interventions that also include the urine alarm such as "Full Spectrum Home Training" have further improved the outcome for bed-wetters, but are classified as "probably efficacious" at this time because independent researchers have not replicated them. Less rigorously examined approaches that focus on improving compliance with treatment or include a "cognitive" focus (i.e., hypnosis) warrant further study.. We recommend a "biobehavioral" perspective in the assessment and treatment of bed-wetting and suggest that combining the urine alarm with desmopressin offers the most promise and could well push the already high success rates of conditioning approaches closer to 100%. Much important work is yet to be completed that elucidates the mechanism of action for the success of the urine alarm and in educating society about its effectiveness so that its availability is improved.

Topics: Behavior Therapy; Biofeedback, Psychology; Child; Clinical Trials as Topic; Deamino Arginine Vasopressin; Enuresis; Equipment and Supplies; Evidence-Based Medicine; Humans; Renal Agents; Treatment Outcome

Secondary nocturnal enuresis accounts for about one quarter of patients with bed-wetting. Although a psychological cause is responsible in some children, various other causes are possible and should be considered. This article reviews the epidemiology, psychological and social impact, causes, investigation, management, and prognosis of secondary nocturnal enuresis.

Topics: Child; Deamino Arginine Vasopressin; Diabetes Complications; Diagnosis, Differential; Enuresis; Humans; Imipramine; Prognosis; Renal Agents; Sleep Apnea, Obstructive

Primary nocturnal enuresis is common, and if left untreated has considerable psychological ramifications on children as they get older.. To explain the main treatments for nocturnal enuresis.. By far the most successful treatment is the bed wetting alarm. In recent years desmopressin nasal spray has also found a clinical niche as a short term solution for children attending school camps or sleeping over at friends' houses. It may also be used as an adjunct to the use of the alarm. Treatment with imipramine is increasingly in disfavour because the relapse rate is unacceptably high and fatal overdose is a possibility.

Topics: Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Drinking Behavior; Electronics; Enuresis; Humans; Patient Education as Topic; Prevalence; Renal Agents

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

Lasting cure rates in monosymptomatic nocturnal enuresis (MNE), using the alarm, imipramine or desmopressin, have been quoted as 43%, 17% and 22%, respectively. The low cure rates in addition to the number of different treatments indicate insufficient knowledge of MNE. Only research on arginine vasopressin (AVP) levels and nocturnal enuresis is unique in attempting to find a group within the MNE population that could benefit from substitution therapy with desmopressin. AVP levels are restored or amplified during desmopressin treatment. However, low nocturnal AVP production with high nocturnal urine output may be indicative of a disturbance in circadian rhythm. Pre-clinical data suggest a role for melatonin in the regulation of endogenous AVP and in the regulation of the sleep/wake cycle.

Topics: Arginine Vasopressin; Child; Child, Preschool; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Infant; Male; Treatment Outcome; Urodynamics

Enuresis is the result of multifactorial processes. Enuretic patients often exhibit an abnormal diurnal rhythm of plasma vasopressin in addition to high nocturnal urine production. Renal function is considered to be a core factor in influencing the volume of fluid delivered to the bladder. Animal studies have suggested that the amount of fluid delivered to the bladder is dependent upon the state of hydration and/or the amount of protein present in the animal's diet. The state of hydration, or diuresis, may also influence the permeability of the terminal collecting ducts to water and urea and the hydro-osmotic response of the kidney to desmopressin. Multiple agents, including vasopressin, glucagon, calcitonin, parathyroid hormone, beta-adrenergic agonist, insulin, angiotensin II, prostaglandins and calcium and magnesium ions influence sodium transport in the thick ascending limb, indicating that all of these factors may potentially play a role in enuresis.

Topics: Animals; Deamino Arginine Vasopressin; Dietary Proteins; Enuresis; Humans; Kidney Concentrating Ability; Renal Agents; Urodynamics; Water-Electrolyte Balance

Desmopressin has a proven pharmacological effect in most enuretic patients, although a clinical response is not seen in all patients. Numerous questions about the current treatment status of desmopressin include the specific anti-enuretic effect of desmopressin, the effect of desmopressin on sleep and the use of desmopressin as a possible cure for enuresis. The Swedish Enuresis Trial has produced some very positive results on the long-term use of desmopressin, showing a 61% response rate (> 50% reduction in wet nights). Desmopressin has proven to be highly effective when used in combination with other treatments, including the alarm and oxybutinin, and after urotherapy. It is suggested that imipramine should not be used to treat enuresis unless the patient has attention deficit hyperactivity disorder. Bladder instability is also an important factor to consider when selecting treatment for enuresis. Bladder dysfunction (detrusor overactivity) can be the cause of lack of clinical response to either desmopressin or alarm treatment; in such cases, following a cystometrogram, patients should be treated with detrusor-relaxing drugs, and urotherapy should be considered as the first treatment option. The most effective treatment for enuresis is the treatment chosen by the patient and their families. Desmopressin and urotherapy have had promising results, with desmopressin acting as a bridge until spontaneous or treatment-induced remission occurs.

Topics: Child; Clinical Trials as Topic; Deamino Arginine Vasopressin; Enuresis; Humans; Renal Agents; Treatment Outcome; Urodynamics

Primary nocturnal enuresis (PNE) is prevalent among the pediatric population, but not all professionals are aware of the current research regarding the etiology and treatment of this disorder. This paper presents a broad overview of PNE, including etiology and evaluation, with a specific emphasis on treatment issues. The most current treatments (imipramine, desmopressin acetate arginine vasopressin, enuresis alarms) are discussed, including recent research on their effectiveness. In considering the recent data on long-term efficacy, overall cost, and safety, the treatment of choice appears to be the enuresis alarm for those families who are capable of following protocols. Desmopressin acetate arginine vasopressin is a safe alternative that has the advantage of quick response and ease of administration.

Topics: Adrenergic Uptake Inhibitors; Child; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Imipramine; Male; Renal Agents

Topics: Deamino Arginine Vasopressin; Enuresis; Humans; Multiple Sclerosis; Randomized Controlled Trials as Topic; Renal Agents; Urinary Bladder, Neurogenic; Urination Disorders

This survey describes the evolution of our concept of monosymptomatic bedwetting over the last decades. It takes you briefly through psychology and enuresis. The minor role of bladder pathology is described ending up with focusing on the mismatch between bladder capacity at night-time and urine production. Monosymptomatic bedwetting should currently be regarded as an umbrella diagnosis allocated to children where daytime urinary problems have been excluded. Within the diagnosis of monosymptomatic bedwetting we can nowadays identify at least two groups. One is related to children who have a large night-time urine production and a normal bladder capacity, and the other is related to children who have a large night-time production, but a bladder capacity too small for the normal urine production. The genetic aspects are currently investigated. The results and this kind of research will probably end up in a further subgrouping.

Topics: Deamino Arginine Vasopressin; Denmark; Enuresis; Female; Humans; Male; Renal Agents; Self Concept; Sleep; Urinary Tract Physiological Phenomena

Topics: Antidepressive Agents, Tricyclic; Behavior Therapy; Child; Combined Modality Therapy; Comorbidity; Deamino Arginine Vasopressin; Diagnosis, Differential; Enuresis; Female; Humans; Male; Patient Care Team; Urinary Incontinence

Nocturnal enuresis (NE) can result from an interaction of unstable detrusor contractions, delayed arousal from sleep, and nocturnal polyuria. Some children with NE can hold urine well for several hours during the day and have isolated nocturnal enuresis, while others manifest diurnal voiding symptoms (DVS) as well, including urinary frequency, urgency, urge incontinence, and pelvic withholding. The pathogenesis of NE in patients with isolated NE may be different than in those with NE and DVS. In children with NE and DVS, detrusor instability may play a major role in the causation of their voiding problems, whereas delayed arousal from sleep in response to a full bladder may be a major contributor to NE in patients with isolated NE. The treatment should address the underlying pathogenic factors. The commonly used treatment regimens are described. Motivation and efforts of the child in training the bladder are vital to achieving cure of enuresis.

Topics: Antidepressive Agents, Tricyclic; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Renal Agents; Urinary Bladder; Urination; Urodynamics

Nocturnal enuresis is a very common disorder in childhood. Classification and evaluation through patient history, physical examination, ultrasound of the kidneys and bladder including residual volume, dipstix and urine output protocol are necessary for successful treatment. Genetic, family-associated factors and a lowered nocturnal ADH-secretion are the main causes considered today. Next to behavioral therapy and conditioning, pharmacotherapy form the mainstay of therapy. Desmopressin is indicated when the nocturnal urinary volume exceeds the actual bladder capacity. Together with the right indication and optimal dosage, the therapy should be given for at least 4 to 6 weeks before step-by-step reduction, resulting in a success rate of up to 80%.

Topics: Behavior Therapy; Child; Combined Modality Therapy; Deamino Arginine Vasopressin; Enuresis; Humans; Patient Care Team

We present a case of a 29-year-old woman with a long history of nocturnal enuresis who developed symptomatic hyponatremia from water intoxication shortly after beginning desmopressin. A MEDLINE search in the English language revealed 13 prior case reports. All patients presented with seizure, mental status changes, or both. Two distinct presentations occurred: one group of patients maintained a stable course with desmopressin and developed symptoms related to an outside factor. The other group of patients were new to desmopressin and had a profound water intoxication response from its use. While the underlying cause was from simple overhydration, the quickness of this unanticipated adverse effect is noteworthy. The importance of counseling to ensure a family's and a patient's understanding of the effects of desmopressin as well as monitoring electrolytes periodically may help identify and prevent this serious iatrogenic complication.

Topics: Administration, Intranasal; Adolescent; Adult; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Hyponatremia; Infant; Male; Renal Agents; Water Intoxication

The significance of a positive family history in predicting responsiveness to desmopressin (DDAVP) treatment was evaluated in 71 children with nocturnal enuresis. A good response to treatment was recorded in 91% of those children with a positive family history compared with only 7% of those with a negative family history. A review of the published literature further supports the predictive value of a positive family history and also confirms the importance of a broad definition for family history-including persistent nocturia. The importance of defining the family history is also discussed in terms of response to some other therapies for nocturnal enuresis.

Topics: Adolescent; Child; Child, Preschool; Clinical Trials as Topic; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Pedigree; Predictive Value of Tests; Renal Agents; Treatment Outcome

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: Administration, Inhalation; Child; Deamino Arginine Vasopressin; Enuresis; Family Practice; Female; Humans; Referral and Consultation; Renal Agents

Topics: Adolescent; Age Factors; Antidepressive Agents, Tricyclic; Behavior Therapy; Case Management; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Managed Care Programs; Primary Health Care; Remission, Spontaneous; Renal Agents; Treatment Outcome

Prospective controlled studies on the treatment of enuresis with desmopressin (DDAVP) indicate that cure rates (complete dryness) while on therapy are markedly lower than are response rates (decrease in wet nights). In an attempt to explain this discrepancy, we analyzed the etiological mechanisms for enuresis and found evidence that most children are not cured by DDAVP because their nocturnal wetting is not actually caused by the defect which DDAVP therapy aims to cure: low nocturnal vasopressin secretion with high nocturnal urinary output. Our study suggested that an arrest in the normal development of two separate areas of the central nervous system is necessary for enuresis to occur in many patients, yet cure of enuresis occurs if either developmental delay is eliminated. This hypothesis of a dual developmental delay helps to unify many diverse and often seemingly contradictory scientific observations about this condition and to explain why many patients react inconsistently to treatment aimed at a single etiology, yet eventually become dry.

Topics: Circadian Rhythm; Deamino Arginine Vasopressin; Electroencephalography; Enuresis; Humans; Renal Agents; Sleep; Vasopressins

Treatment of nocturnal enuresis with DDAVP is associated with a low incidence of adverse effects. The only reported serious adverse effect is seizure or altered level of consciousness due to water intoxication. We reviewed 14 articles that reported data on serum sodium in patients treated with DDAVP for nocturnal enuresis and 11 articles that reported patients who developed a seizure or altered level of consciousness during treatment with DDAVP for nocturnal enuresis. Excess fluid intake was identified as a contributing factor in 6 of the 11 case reports.. Hyponatremia is a potential adverse effect in patients with nocturnal enuresis who are treated with DDAVP. To prevent this adverse effect we recommend that the patients prescribed DDAVP for nocturnal enuresis should be counseled not to ingest more than 240 ml (8 ounces) of fluid on any night that DDAVP is administered.

Topics: Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Humans; Hyponatremia; Renal Agents

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

Wetting and voiding dysfunction in children represent a wide spectrum of disorders ranging from uncomplicated nocturnal enuresis, which is not associated with significant uropathology, to more complicated functional voiding dysfunction, which, in the worst of cases, can result in severe deterioration of both bladder and renal function. A complete understanding and thorough evaluation of these clinical entities allow a classification that lends itself to rational and tailored therapy. Optimal response rates can be achieved only with a disciplined and well-defined approach to the evaluation and management of these children.

Topics: Antidepressive Agents, Tricyclic; Behavior Therapy; Child; Child, Preschool; Cholinergic Antagonists; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Toilet Training; Urination Disorders

The efficacy of desmopressin in the treatment of functional enuresis, known for 15 years, has received very little attention in the psychiatric literature. This review seeks to remedy this and to asses critically its effectiveness, risks and side effects, as well as the implications for the understanding and management of enuresis.. Treatment trials, reports of unwanted effects, and literature on mechanisms of action were reviewed.. Desmopressin is more effective than placebo in controlled trials, but only one quarter of patients become "dry." Individuals who wet the bed 4 nights per week or more can expect a one-third reduction in their wet nights with a single intranasal dose of desmopressin before bedtime. Relapse rates upon cessation of treatment are very high, while side effects appear to be few. However, there are increasing reports of hyponatremic seizures. There is a group of patients in which bed-wetting appears to be the result of insufficient nocturnal secretion of vasopressin.. Desmopressin is a simple-to-use and effective drug for the treatment of nocturnal enuresis; it has opened important new avenues of inquiry, but more information is required about its long-term effectiveness and unwanted side effects.

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Recurrence; Vasopressins

Topics: Administration, Oral; Adolescent; Adult; Child; Clinical Trials as Topic; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Drug Administration Schedule; Enuresis; Humans; Renal Agents; Tablets

A literature search revealed 23 studies that have reported on the type or frequency of side effects or complications associated with the use of desmopressin (DDAVP, Rhône-Poulenc Rorer Pharmaceuticals Inc, Collegeville, Pennsylvania) for the treatment of enuresis. Thirty-one (4.3%) side effects were reported in 717 patients. Seizure secondary to water intoxication is a potential complication of treatment with desmopressin and was reported in six patients, usually in association with excess fluid intake during the evening or day preceding the use of desmopressin. Desmopressin appears to have a favorable safety profile. Patients should be specifically instructed not to ingest excess fluids during the evening prior to administration of desmopressin.

Topics: Clinical Trials as Topic; Deamino Arginine Vasopressin; Drinking; Enuresis; Humans; Meta-Analysis as Topic; Seizures; Water Intoxication

Topics: Behavior Therapy; Child; Child, Preschool; Cross-Cultural Comparison; Cross-Sectional Studies; Deamino Arginine Vasopressin; Enuresis; Female; France; Humans; Imipramine; Incidence; Male; Patient Acceptance of Health Care

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

Desmopressin is a potent antidiuretic for nocturnal enuresis with few and mostly insignificant adverse reactions. Almost 80 years ago, the antidiuretic effects of extracts of the posterior pituitary were first reported. The molecular structure of the peptide vasopressin arginine vasopressin (AVP) became known in 1956, and by 1967, a synthesized modification of AVP, known as DDAVP, or desmopressin, was introduced. Toxicity studies performed on experimental animals support the conclusion that desmopressin is considerably more potent as an antidiuretic than AVP and has an exceptional safety margin. Further, clinical experience reveals that from 1974 to June 1992 only 21 patients using desmopressin had serious adverse reactions (water intoxication), and no fatalities occurred. Seven of 10 children with nocturnal enuresis who receive desmopressin stop their bedwetting completely or reduce it significantly, with best results noted in children over 10 years of age. Given these results, the preferred treatment in Europe for children with nocturnal enuresis is the sequential combination of desmopressin and the enuresis alarm.

Topics: Adolescent; Animals; Child; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Enuresis; Europe; Humans

Conclusive evidence of a polyuric etiology from a failure of vasopressin elevation led to a new pharmacologic approach to the treatment of childhood nocturnal enuresis. Desmopressin acetate, a vasopressin analogue, has been used successfully since 1978 to treat this condition. Desmopressin's efficacy at doses of 5 to 40 micrograms has been demonstrated in Europe and the United States. Similarly, its safety has been established, and it is a first-line choice for physicians worldwide.

Topics: Child; Clinical Trials as Topic; Deamino Arginine Vasopressin; Enuresis; Europe; Female; Humans; Male; Safety; United States; Vasopressins

Desmopressin acetate (DDAVP) is promoted to treat nocturnal enuresis but indications for its use are unclear. We reviewed all randomized controlled trials to determine (1) short- and long-term efficacy, (2) responders, (3) dose-response curve, (4) side effects, and (5) comparative efficacy with other treatments.. A Medline search of the English language literature from January 1966 to August 1992, supplemented by contact with the drug companies, yielded 18 articles which were true randomized controlled trials (11 cross-over and 7 parallel studies).. The 18 randomized controlled trials included 689 subjects for most of whom some other type of treatment had failed. All studies found decreased mean frequency of wetting ranging from 10% to 91%, but only 24.5% of subjects achieved short-term dryness. One study of DDAVP responders directly tested long-term dryness and 21% stayed dry. In three studies that incidentally reported on long-term effects 5.7% stayed dry after stopping DDAVP: There was wide variation in the type of patient included. Seven studies addressed prognostic factors. Children more than 9 years old and with fewer initial wet nights do better. Four studies seem to include almost exclusively monosymptomatic children with nocturnal enuresis (ie, primary nocturnal enuresis, positive family history, and no urinary symptoms). Results were no better than those which included mixed symptoms. Five studies attempted to address the dose-response issue. Despite some methodological issues, there is probably some dose-response effect. Side effects were infrequent in the 589 subjects who received DDAVP as opposed to placebo. No cases of water intoxication and no significant shifts in electrolytes were reported in the four studies which measured them. Nasal stuffiness, headache, epistaxis, and mild abdominal pain seem to be the only side effects noted, and these were uncommon. Only one study compared DDAVP with conditioning alarms. Alarm patients had 10% fewer wet nights and a better long-term result.. DDAVP reduces wet nights in children for whom other treatments have failed but it produces complete dryness in a minority, and this is often a temporary effect. The literature focuses on short-term efficacy. The true role of DDAVP will be known when samples are carefully selected, prognostic factors are examined, and more comparisons with other treatments are conducted focusing on long-term outcomes. On the basis of current knowledge, DDAVP is inferior to conditioning alarms as a primary therapy.

Topics: Child; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Enuresis; Female; Humans; Male; Randomized Controlled Trials as Topic; Time Factors

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

Topics: Administration, Intranasal; Adolescent; Adult; Child; Child, Preschool; Clinical Trials as Topic; Deamino Arginine Vasopressin; Drug Administration Schedule; Enuresis; Humans

It is estimated that enuresis occurs in 5 to 7 million children in the United States. The treatment approach for enuresis is controversial, in large part due to a lack of consensus as to the exact cause of enuresis. Several factors either alone or together may contribute to this syndrome. In addition, there is strong evidence of a genetic component to enuresis. Pharmacotherapy continues to be the preferred treatment for both physicians and families. The most widely used drugs include antidepressants, anticholinergics, and desmopressin. The tricyclic antidepressant imipramine has been used extensively since the 1960s. The exact mechanism of action in enuresis is unknown although it appears to be related to the anticholinergic and antispasmodic effects of the drug. The most common adverse effects reported with imipramine include personality changes, insomnia, anorexia and anxiety. There has been renewed interest in antidiuretic treatment of enuresis. Researchers have found that enuretic children do not have the ability to reduce urine volume at night or concentrate the urine they produce during the night. Clinical trials with desmopressin administered by nasal inhalation report a marked reduction in enuretic episodes. Adverse effects were limited to nasal complaints, rhinitis, or epistaxis. Additional long term studies are needed to delineate desmopressin's role in therapy. Although the number of options for treatment of enuresis is expanding, criteria to predict patient response need to be defined.

Topics: Adolescent; Antidepressive Agents, Tricyclic; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Parasympatholytics

Topics: Adult; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Prevalence; Scandinavian and Nordic Countries; Sleep; Urodynamics; Vasopressins

In comparison with the highly significant effect of the apparative behavior therapy of enuresis, tricyclic antidepressants, desmopressin and anticholinergic drugs all fail to show statistically significant results. The author presents a model to illustrate and explain how the apparative behavior therapy of enuresis works. The therapy's main aim is for patients to learn active control of the bladder. From this theoretical point of view the aforementioned pharmacological treatments of enuresis cannot yield effects that last a long time after discontinuation of medication. By reducing the frequency of micturition at night only, they prevent active learning of bladder control.

Topics: Antidepressive Agents, Tricyclic; Behavior Therapy; Child; Conditioning, Operant; Deamino Arginine Vasopressin; Enuresis; Humans; Parasympatholytics; Urination

An update of the pathogenesis and treatment of monosymptomatic bedwetting is presented. This frequently occurring entity seems to have a multifactorial pathogenesis incorporating arousal disturbances and disturbances to the circadian rhythm of diuresis modulating hormones. It has recently been substantiated that the bladder reservoir function in monosymptomatic bedwetting is normal. This is further underlined by the fact that treatment of instability of the bladder has proven futile. In a substantial part of the monosymptomatic bedwetters the changes in circadian rhythm of antidiuretic hormone can be counteracted by desmopressin diacetate (DDAVP), which abolishes the symptom in more than 2/3 of the patients. Monitoring circadian rhythms of arginine vasopressin (AVP) and treatment with DDAVP have led to increased understanding of the pathogenesis of monosymptomatic bedwetting and opened new fields of investigation.

Topics: Arginine Vasopressin; Child; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Mental Disorders; Polyuria; Sleep Wake Disorders; Urinary Bladder Diseases

The role played by antidiuretic hormone in enuresis remains controversial. As a symptomatic treatment, desmopressin (DDAVP) has already proved to be a useful addition to the measures applied against this condition.

Topics: Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Humans; Polyuria; Vasopressins

The current management of nocturnal enuresis is based on simple therapeutic schedules, available if the child, his parents and physician, are determined. The treatment first includes motivational therapy and bladder training exercises. If bedwetting is not controlled, conditioning alarm procedures can offer a high rate of positive results with a low risk of relapse. Tricyclic antidepressants should be avoided because of their severe cardiac and hepatic potential side-effects, and because they provide quite the same short and long-term results than desmopressin. Intranasal desmopressin (20 to 40 micrograms/day) offers a 40 to 60% rate of positive results, and can be administrated over a long period in relapsing patients.

Topics: Antidepressive Agents, Tricyclic; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Psychotherapy

In summary, all children and families who present with nocturnal enuresis should be offered education, reassurance, and ongoing support as a premier component of any treatment regimen. At the same time, the family should be informed about all the treatment options that exist with a goal of tailoring the specific treatment to the individual patient. In most cases, this approach will lead to child, family, and physician satisfaction.

Topics: Behavior Therapy; Counseling; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Imipramine; Male; Parents; Recurrence; Urinary Bladder

Arginine vasopressin preparations have been used in the treatment of diabetes insipidus for many years. Compared with older antidiuretic agents, the synthetic analog desmopressin is more potent, longer acting and easier to use. It is available for intravenous, subcutaneous and intranasal administration. Desmopressin may be useful in the treatment of hemostatic disorders such as von Willebrand's disease and hemophilia A. It has also been used for nocturnal enuresis. The vasopressor effects of arginine vasopressin preparations have been exploited for use as a temporizing measure in controlling acute gastrointestinal bleeding. Side effects such as hyponatremia and water intoxication are uncommon when these drugs are used with proper precautions.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Enuresis; Gastrointestinal Hemorrhage; Hemorrhagic Disorders; Humans; Vasopressins

Topics: Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Humans; Recurrence

Topics: Adolescent; Adult; Child; Deamino Arginine Vasopressin; Enuresis; Humans

Because of its selective antidiuretic activity, desmopressin is recognized as the drug of choice for central diabetes insipidus. Compared with previously available treatments, it has a greatly enhanced therapeutic profile, allowing more specific antidiuresis without adverse reactions. Its selective antidiuretic activity is used with advantage in the treatment of nocturnal enuresis and as a diagnostic test of tubular function. Desmopressin is available for intranasal and parenteral administration; antidiuretic doses range from 10 to 40 micrograms intranasally and from 2 to 4 micrograms intravenously or subcutaneously. For its hemostatic effect, a single infusion of desmopressin at a dose of 0.3 microgram/kg has been used in most studies. Well-documented evidence shows that desmopressin is safe and efficacious as a selective antidiuretic agent for the treatment of central diabetes insipidus and nocturnal enuresis and as a diagnostic test of tubular function. Even at the 15-fold higher doses used in bleeding disorders, desmopressin appears to be well tolerated.

Topics: Adult; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Enuresis; Hemostatics; Humans; Kidney Concentrating Ability; Osmolar Concentration

Topics: Adolescent; Adult; Child; Child, Preschool; Clinical Trials as Topic; Deamino Arginine Vasopressin; Enuresis; Humans; Osmolar Concentration

Topics: Adult; Circadian Rhythm; Deamino Arginine Vasopressin; Drug Evaluation; Enuresis; Humans; Imipramine

Desmopressin (dDAVP), a synthetic analog of the neurohypophyseal nonapeptide arginine vasopressin, has enhanced antidiuretic potency, markedly diminished pressor activity, and a prolonged half-life and duration of action compared to the natural hormone. Desmopressin is the treatment of choice for central diabetes insipidus and can be administered either intranasally or parenterally. A newly approved indication is treatment of mild classical hemophilia and von Willebrand's disease, in which deficient concentrations of factor VIII and von Willebrand's factor are transiently increased to levels that allow minor surgery.

Topics: Anemia, Sickle Cell; Animals; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Synergism; Enuresis; Hemophilia A; Humans; Kidney Concentrating Ability; Learning; Memory Disorders; Structure-Activity Relationship; Urinary Incontinence; von Willebrand Diseases

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.

Topics: Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Imipramine; Male; Nocturnal Enuresis; Prospective Studies; Treatment Outcome

Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Enuresis; Humans; Imipramine; Nocturnal Enuresis; Prospective Studies

To 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.. One 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.. Relapse 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).. Our 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.

Topics: Administration, Sublingual; Adolescent; Antidiuretic Agents; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Recurrence

Relapse after cessation of desmopressin is an important problem in treating patients with enuresis. Structured withdrawal of desmopressin tablets has been shown to decrease relapse rates. However, scientific data are lacking on the structured withdrawal of the fast melting oral formulation of desmopressin. We compared relapse rates of structured withdrawal using placebo and direct cessation in a population of patients with enuresis who were desmopressin responders.. Patients diagnosed with enuresis and responding to desmopressin from 13 different centers were involved in the study. Patients were randomized into 4 groups. Two different structured withdrawal strategies were compared to placebo and direct withdrawal. Sample size was estimated as 240 (60 patients in each group), with a power of 0.80 and an effect size of 30%. Randomization was performed using NCSS statistical software (NCSS, Kaysville, Utah) from a single center. The relapse rates of the groups were compared using chi-square testing. Logistic regression analysis was performed to define the independent factors having an effect on relapse rates.. Desmopressin treatment was initiated in 421 patients, and 259 patients were eligible for randomization. Relapse rates were 39 (1%) and 42 (4%) for the structured withdrawal groups, which were significantly less than for direct withdrawal (55, 3%) and placebo (53, 1%). Logistic regression analysis revealed that initial effective dose of 240 μcg, greater number of wet nights before treatment and nonstructured withdrawal were associated with higher relapse rates.. We found that structured withdrawal with the fast melting oral formulation of desmopressin results in decreased relapse rates. Application of a structured withdrawal program was also an independent factor associated with reduced relapse rates, together with lower initial effective dose and number of wet nights per week. Relapse after cessation of desmopressin is an important problem, and in this study structured withdrawal was observed to be associated with decreased relapse rates compared to placebo and direct withdrawal.

Topics: Antidiuretic Agents; Child; Chronic Disease; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Prospective Studies; Secondary Prevention; Single-Blind Method

ADHD is common among children with comorbidity of enuresis. Findings concerning prepulse inhibition (PPI) of startle reflexes are controversial. Although PPI is improved through desamino-arginine vasopressin (dDAVP) in enuresis, some patients also improve concomitant ADHD through dDAVP. This study aims to evaluate whether methylphenidate (MPH) also improves PPI in ADHD.. Nineteen ADHD patients were investigated in a prospective, double-blind, crossover study with MPH versus placebo. PPI was measured as a reduction of acoustic startle reflexes. Subgroups of gender, ADHD subtype, and baseline PPI were analyzed.. Median baseline PPI of ADHD patients (51.7%) was below the value of age-matched normal controls (73%, p = .090). MPH showed no improvement in the whole group, or the subgroups gender or subtype. Reduced baseline PPI was significantly improved (22.5%-39.3%, p = .039).. Heterogeneity of ADHD is confirmed with a wide range of baseline PPI. The improvement of reduced baseline PPI through MPH suggests impaired sensorimotor gating in this subgroup.

Topics: Acoustic Stimulation; Adolescent; Attention Deficit Disorder with Hyperactivity; Central Nervous System Stimulants; Child; Cross-Over Studies; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Methylphenidate; Prospective Studies; Reactive Inhibition; Reflex, Startle; Treatment Outcome

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

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Treatment Outcome; Urinary Bladder; Urination

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

To (1) identify abnormalities in arginine vasopressin (AVP, a water-conserving hormone) secretion and release in nursing home (NH) residents with nighttime urinary incontinence (UI); and (2) perform a pilot test of desmopressin acetate (ddAVP, a synthetic analog of the naturally occurring hormone) replacement in these residents.. Diagnostic evaluation and open-label treatment trial.. Two community nursing homes in a metropolitan area.. Male and female NH residents 65 years of age and older with nighttime UI.. Characterizations of AVP status followed by a 7-day open-label trial of oral ddAVP (either 0.1 mg or 0.2 mg).. Water deprivation test results, AVP levels, voided volumes, number of voids, incontinent episodes, number of nighttime checks found wet (out of 6 total checks per night).. All participants had measurable AVP levels of 2.0 pg/mL or higher. Six of 10 individuals had an abnormal water deprivation test. Two of 4 participants on 0.2 mg of ddAVP and 2 of 6 participants on 0.1 mg had a 200 mL or more mean reduction in nighttime urine volume. Both ddAVP dosages yielded a mean reduction of 0.7 fewer nighttime wet checks found wet. One participant in each group developed hyponatremia (1 of 6 on 0.1 mg and 1 of 4 on 0.2 mg). Hyponatremia resolved with discontinuation of the drug.. Both 0.1 mg and 0.2 mg of ddAVP given to carefully screened NH residents for 7 days produced a modest average reduction in nighttime urine volume and number of nighttime incontinent episodes that is likely of little clinical importance. The role of ddAVP in this population requires further research.

Topics: Administration, Oral; Age Factors; Aged; Aged, 80 and over; Antidiuretic Agents; Arginine Vasopressin; Deamino Arginine Vasopressin; Diapers, Adult; Enuresis; Female; Geriatric Assessment; Humans; Hyponatremia; Male; Nursing Homes; Pilot Projects; Sodium; Time Factors; Treatment Outcome; Urodynamics; Water Deprivation

To determine the pharmacodynamic properties of a new oral lyophilisate formulation of desmopressin (in single doses of 30, 60, 120, 240, 360 or 480 microg) in children with known primary nocturnal enuresis (PNE) and thus identify those dosages that could provide a duration of action corresponding to a typical length of night-time sleep in children with PNE; additional objectives were to determine the safety and tolerability of desmopressin in this population.. Children with PNE (mean three or more wet nights/week), aged 6-12 years, were randomized into a double-blind, placebo-controlled study. An overhydration technique was used before dosing to suppress endogenous vasopressin production and thereby ensure that any antidiuresis could be attributed to treatment. Dosing with desmopressin or placebo occurred when urinary production was >0.13 mL/min/kg. Urinary volume, osmolality and duration of urinary-concentrating action (above three threshold levels: 125, 200 and 400 mOsm/kg) were determined as endpoints.. All 72 participants receiving desmopressin had a pharmacodynamic response to the drug, while there was no change in urinary output in the 12 placebo-treated patients. There was a clear relationship between desmopressin dose and duration of action and osmolality during action, although the three highest-dose groups had similar results. The mean duration of action of desmopressin at the lowest osmolality threshold level was 3.6-10.6 h, according to dose; for the highest threshold, the values were 1.3-8.6 h.. Desmopressin, as the oral lyophilisate, causes a marked decrease in urinary output in hydrated children with PNE. A small dose range (120-240 microg) is likely to control diuresis for a period corresponding to a night's sleep (7-11 h) in most children with PNE. However, some patients might require a higher dose to obtain antidiuresis for the complete night.

Topics: Administration, Oral; Antidiuretic Agents; Child; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Double-Blind Method; Enuresis; Female; Humans; Male; Osmolar Concentration; Treatment Outcome

The objective of this multicenter randomized controlled trial was to compare the efficacy of enuresis alarms, oral desmopressin, and combined treatment in Chinese children with monosymptomatic primary nocturnal enuresis. We assigned 105 children aged 7-15 years to receive alarms (group 1, 35 patients), oral desmopressin 400 mug (group 2, 38 patients), or combined therapy (group 3, 32 patients) for 12 weeks; patients were then followed for 12 weeks after treatment. The wetting frequency decreased during treatment by 46%, 52%, and 73% in groups 1, 2, and 3, respectively. In groups 2 and 3, but not in group 1, there was rebound post treatment, but significant improvements persisted at 12 weeks. The complete and partial response rates were 22.9% and 20%, respectively in group 1, 42% and 10.5% in group 2, and 62.5% and 15.6% in group 3. By Kaplan-Meier analysis, group 1 had a significantly poorer response than groups 2 and 3. Of the responders, 20%, 60%, and 40% in groups 1, 2, and 3, respectively, relapsed after stopping treatment. In conclusion, enuresis alarms and/or oral desmopressin were less efficacious in Chinese than in Western societies. Desmopressin produced an immediate effect but relapses were common. Alarms took several weeks to produce a benefit, which was persistent on follow-up.

Topics: Adolescent; Child; Combined Modality Therapy; Deamino Arginine Vasopressin; Enuresis; Equipment and Supplies; Female; Follow-Up Studies; Hong Kong; Humans; Male; Renal Agents; 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

To evaluate the effectiveness of alarm-based combination therapy using desmopressin and imipramine for primary monosymptomatic nocturnal enuresis.. Of the 105 patients, 37 were treated with alarm monotherapy (monotherapy group), 35 were treated with desmopressin combined with an alarm (desmopressin group), and 33 were treated with imipramine combined with an alarm (imipramine group). The therapeutic effects were evaluated at 3 and 6 months. The relapse rates and predictive factors of the therapies were also studied.. No significant differences were found in the changes in the frequency of wet nights among the three groups, although the frequencies in all three groups decreased significantly with the therapeutic duration. Although the improvement rates at 3 months did not differ among the three groups, the improvement rate of 80% in the desmopressin group and 79% in the imipramine group at 6 months were greater than the 59% rate in the monotherapy group. After cure, no patients relapsed in the monotherapy group, and 3 (43%) each did so in the desmopressin and imipramine groups. In comparing the improved cases in each group, no significant differences were found in background factors.. Desmopressin and imipramine combined with an alarm was no more effective than alarm monotherapy. As for alarm monotherapy, other therapeutic modalities should be considered if it has not proved effective after 3 months. In such a situation, combination therapy may be effective as a second choice. No predictive factors for the therapeutic effects in the three modalities were found.

Topics: Adolescent; Child; Combined Modality Therapy; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Imipramine; Male; Prognosis

Nocturnal polyuria is considered a major pathogenetic factor in nocturnal enuresis, and the antidiuretic drug desmopressin, given at bed-time, is consequently recognized as a first-line treatment alternative. The aim of this open, non-randomized study was to see whether diuretic medication, given in the afternoon, could give similar therapeutic benefit.. Sixty-three children suffering from primary, monosymptomatic, nocturnal enuresis were included in the study by their primary care paediatrician. After 14 days without any treatment and 14 days for which 0.4 mg of desmopressin was given orally at bed-time, the children were given furosemide 1 mg/kg in the afternoon for 14 consecutive days. The numbers of wet and dry nights were recorded.. The numbers of wet nights at baseline, during desmopressin treatment and during furosemide treatment were 10.2+/-3.5, 6.4+/-4.6 and 8.2+/-4.5, respectively. Both drugs were significantly better than no treatment, but only a small proportion of patients became completely dry: 24% on desmopressin and 12% on furosemide. Desmopressin was significantly better than furosemide. Three children who showed no therapeutic effect on desmopressin treatment had a favourable response to furosemide.. Furosemide, given in the afternoon, has minor therapeutic potential in nocturnal enuresis.

Topics: Administration, Oral; Adolescent; Antidiuretic Agents; Child; Child, Preschool; Deamino Arginine Vasopressin; Diuretics; Drug Administration Schedule; Enuresis; Female; Follow-Up Studies; Furosemide; Humans; Male; Treatment Outcome; Urodynamics

Aim of the study was to determine the role of nocturnal and daytime urine volume, osmolality and ion excretions in the pathogenesis of primary monosymptomatic enuresis nocturna (PMEN) and in the prediction of response to desmopressin and conditioning therapies. Fifty-five children with PMEN between the ages 5 and 15 years were included to the study. The patients were randomly divided into three groups Group 1: Twenty enuretics having intranasal desmopressin 1x 20 microg treatment for 2 months Group 2: Twenty enuretics having conditioning therapy for 2 months. Group 3: Fifteen enuretics having intranasal izotonic solutions as placebo. The control group consisted of 15 healthy children. Urine osmolality, sodium, potassium, chloride, magnesium and creatinine levels were investigated in both daytime and nighttime urines. Fractional sodium, potassium, magnesium, chloride excretions were calculated. Wilcoxon, Mann-Whitney U, Kruskal-Wallis, Chi-square, Student's t and Pearson correlation tests were performed. The ratio of night/daytime urine osmolality was significantly decreased in enuretic children. In addition, the ratio of night/daytime urine Cl and K excretions were also significantly decreased in enuretics. Response rate to desmopressin and conditioning treatments were statistically higher than placebo control. The difference between response rates of desmopressin and conditioning therapies was not found statistically significant. Pretreatment values of urine volume osmolality and ions were not observed as predictive factors in response to desmopressin or conditioning therapy. In conclusion, nightly decreased potassium and chloride excretions were found to have a role in the pathogenesis of primary enuresis nocturna. Urine volume, osmolality and ion excretions are not suggested to be used in the prediction of response to desmopressin and conditioning therapies.

Topics: Adolescent; Antidiuretic Agents; Behavior Therapy; Child; Chlorides; Deamino Arginine Vasopressin; Enuresis; Humans; Osmolar Concentration; Potassium; Prospective Studies; Treatment Outcome

To test the hypothesis that desmopressin facilitates acquisition of continence, we aimed to establish whether, in children with nocturnal enuresis who are desmopressin nonresponders, adjunct desmopressin increases the rate of sustained continence after treatment with a conditioning alarm. Study design Patients with nocturnal enuresis (n=358; age range, 6-16 years) completed a 4-week "run-in" course of intranasal desmopressin (20-40 microg). Of these, 207 defined as nonresponders (<50% reduction in wet nights) were randomly assigned to receive either desmopressin (n=101) or placebo (n=106) nasal spray, together with conditioning alarm therapy for 8 weeks. Principal outcome measures were remission (28 continuous dry nights) and relapse (>2 wet nights in 2 weeks after having achieved remission).. Remission rates were similar in both groups (51.5% desmopressin, 48.1% placebo; 95% CI on difference, -10%, 17%; P=.63), and relapse rates were not significantly different (13.5% vs 5.9%; 95% CI on difference, -3.7%, 19%; P=.19). Although remission rates were similar, children treated with desmopressin had significantly more dry nights during treatment than those in the placebo group.. Desmopressin did not act synergistically with alarm treatment to achieve remission. Therefore, we infer that in partial or nonresponders, desmopressin does not enhance learning.

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Recurrence; Remission Induction; Renal Agents

Since antidiuretic treatment with desmopressin in the evening has proven effective against enuresis, it would not be surprising if diuretic treatment in the afternoon would have similar effects. We are currently testing this in an open pilot investigation.. A total of 33 children including 12 girls with a mean age +/-SD of 7.6 +/- 2.3 years with monosymptomatic enuresis were recruited from an outpatient primary care setting. Wet and dry nights were recorded for 2 weeks without medication, 2 weeks with 0.4 mg desmopressin orally at night and 2 weeks with 1 mg/kg furosemide 4 to 5 hours before bedtime.. The mean number of wet nights +/-SD during the 3 periods was 10.2 +/- 3.0, 6.7 +/- 4.7 and 7.8 +/- 4.5, respectively. The effects of desmopressin and of furosemide were statistically significant (p <0.0001 and p = 0.001), although the 2 treatments did not differ (p = 0.08). Only 6 children had a complete response (ie greater than 90% reduction in wet nights) to desmopressin and 5 responded to furosemide. Interestingly, 2 children had a clearly better response on furosemide than on desmopressin.. The treatment of enuresis with diuretic medication in the afternoon may be beneficial but needs to be tested in randomized controlled trials.

Topics: Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Diuretics; Enuresis; Female; Furosemide; Humans; Male; Pilot Projects; Renal Agents; Time Factors

Several studies provide evidence regarding the effect of desmopressin (DDAVP) on the sleep of adults. Therefore, we investigate whether this effect has a role in children with primary nocturnal enuresis treated intranasally with DDAVP.. A prospective, randomized, placebo controlled, double-blind, crossover study was performed. Patients were assigned to 2 groups by lottery. Arousability was determined by a special bell apparatus with an adjustable sound pressure level. The wet nights per week and the results of the arousal tests were compared using the signed rank test.. A total of 20 children with primary nocturnal enuresis 6 to 15 years old were enrolled in the study, 2 of whom had to be excluded. There were no marked differences in age or weight between the groups. The number of wet nights per week decreased significantly with DDAVP treatment. Moreover 14 patients slept more soundly with DDAVP and only 4 were more difficult to awake after the medication. This difference was significant.. This study revealed an effect of DDAVP on arousability of enuretic children as well as its previously known action for the treatment of primary nocturnal enuresis. This result is consistent with the known action of DDAVP on sleep of elderly adults. It suggests that the cause of primary nocturnal enuresis lies in the structure of sleep of the affected patients.

Topics: Adolescent; Arousal; Child; Cross-Over Studies; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Prospective Studies; Renal Agents

In a prospective study we evaluate the efficacy of intermittent desmopressin (DDAVP) every other day for patients with nocturnal enuresis relapse who need additional therapy.. Between January 2000 and August 2001, 71 boys and 52 girls 6 to 22 years old (mean age 12.5) were treated with 0.2 mg DDAVP daily for monosymptomatic nocturnal enuresis. After an initial 2 weeks of dose titration the nonresponders were given 0.4 mg DDAVP daily. Those who did not respond to this dose were excluded from study. The remaining patients took desmopressin for 3 months. Patients with persistent enuresis after 3 months of treatment were given intermittent 0.2 or 0.4 mg DDAVP every other day. Followup was performed 6 weeks later.. Of 123 patients 92 completed the study. Mean followup after beginning intermittent DDAVP therapy was 9.2 months (range 6 to 18). Of the 92 patients 45 responded to the 0.2 mg daily dose (group 1) and continued treatment for at least 3 months, while the dose was titrated to 0.4 mg for the remaining 47 (group 2). There were 23 patients who did not respond to 0.4 mg DDAVP and they were excluded from the study. After cessation of the drug 21 group 1 patients (46.6%) and 13 group 2 patients (54%) still had enuresis, and they were placed on intermittent therapy. After 6 weeks 15 of these 34 patients had complete and 13 of the remaining 19 had partial response, while the 6 nonresponders continued on daily DDAVP. Overall the complete and partial response rate of intermittent treatment was 20 of 21 group 1 patients (95%) and 8 of 13 group 2 (61.5%).. For some enuretic patients with relapse after cessation of initial 3-month therapy, intermittent DDAVP may be an effective alternative long-term treatment.

Topics: Administration, Oral; Adolescent; Adult; Algorithms; Child; Deamino Arginine Vasopressin; Drug Administration Schedule; Enuresis; Female; Follow-Up Studies; Humans; Male; Prospective Studies; Recurrence; Renal Agents

Nocturnal enuresis is a heterogeneous condition with various treatment options of both pharmacological and psychological origin. The three systems model previously proposed by us suggests a framework to facilitate understanding, identify a child's needs and specify the appropriate treatment option. In this study we sought to investigate the model in clinical practice in a group of children with severe nocturnal enuresis, with particular reference to pharmacological treatment.. A total of 66 children were assessed using a schedule for identifying mono- and non-monosymptomatic nocturnal enuresis, and were administered either desmopressin (0.4 mg) or anticholinergic medication (5-10 mg), respectively. Children were assessed at 4 weeks, with those failing to meet the success criterion being offered combination treatment for a further 4 weeks.. Success rates for monotherapy were 49% and 33% for desmopressin and anticholinergic medication, respectively, with an overall success rate of 74.5%, including those who went on to combination treatment. Good clinical signs were identified for those successfully treated with anticholinergic medication.. This study endorses the three systems approach in clinical practice.

Topics: Adolescent; Child; Cholinergic Antagonists; Deamino Arginine Vasopressin; Drug Therapy, Combination; Enuresis; Female; Humans; Male; Renal Agents; Treatment Outcome

To investigate the urodynamic profiles of adults with primary nocturnal enuresis (PNE) and the association of the urodynamic profile findings with the efficacy of desmopressin and/or tolterodine pharmacotherapy. At least 2% of adults are enuretic during the night. The diagnostic and treatment approach for PNE is empirically the same in children and adults.. A total of 20 nocturnal enuretic patients (12 women and 8 men) with a mean age of 27.1 years (range 20 to 42) were studied. They had wet their bed at least twice per week for the past 6 months. Urodynamic studies, including filling and voiding cystometry, pressure-flow study, and pelvic floor electromyography with superficial electrodes, were performed on all patients. Two of them had daytime symptoms, and two had prior failed desmopressin therapy. All patients began taking oral desmopressin 0.4 mg for 1 month. Their continence was assessed and tolterodine 4 mg was added for those in whom desmopressin alone failed. The patients responsive to desmopressin alone or desmopressin plus tolterodine were weaned from medication at 6 and 12 months to reassess continence. The mean follow-up period was 11.6 +/- 3.3 months (range 4 to 14).. Urodynamic studies of 20 PNE adult patients revealed detrusor instability in 10 (50%), hypocompliance in 8 (40%), nonneurogenic detrusor-sphincter dyssynergy in 1 (5%), and no abnormality in 10 (50%). Of the 20 patients, 19 (95%) had no voiding bladder problems. Of the 10 patients responsive to desmopressin alone, 6 (60%) had a normal urodynamic profile; the remaining 4 (40%) had detrusor instability and/or hypocompliance. Of the 5 patients who received desmopressin and tolterodine, 3 achieved continence. The overall continence rate was 86% (13 of 15), and 12 (92%) of the 15 patients required maintenance therapy. In 2 patients (13.3%), desmopressin and tolterodine therapy failed. The efficacy of desmopressin alone and of desmopressin plus tolterodine were not related to the urodynamic profile findings (P >0.05). The urodynamic profile was also not related to the relapse rate after any form of pharmacotherapy (P >0.05).. PNE persisting into adulthood may be associated with abnormal urodynamic findings. Patients may benefit from urodynamic studies, because if the findings are abnormal, they might have the best chance of successful treatment.

Topics: Adult; Aging; Benzhydryl Compounds; Cresols; Deamino Arginine Vasopressin; Drug Administration Schedule; Drug Therapy, Combination; Enuresis; Female; Follow-Up Studies; Humans; Male; Muscarinic Antagonists; Phenylpropanolamine; Renal Agents; Tolterodine Tartrate; Urodynamics

To evaluate the long-term (12 months) efficacy and safety of oral desmopressin (DDAVP).. A total of 256 healthy children (6-18 years old) with nocturnal enuresis with a frequency of > or = 10 wet nights during a 4-week observation period were eligible for inclusion in the study. Initially 0.2 mg of DDAVP was given for 14 nights. Those achieving a > 90% reduction in the number of wet nights over the observation period (full responders) began a 12-week continuous treatment period at this dose. The remaining children received 0.4 mg for an additional 14 nights. Those achieving a > or = 50% reduction in the number of wet nights (responders) commenced a 12-week continuous treatment period at this dose. Children with a < 50% reduction in the number of wet nights at this point were withdrawn from the study. Each 12-week treatment period was followed by a treatment-free period of 7-28 days. Children who remained dry during that period were assigned a full response and terminated the trial. Children with > or = 2 wet nights during that period immediately began a new 12-week treatment period at the previous dose. This was repeated for 12 months and thereafter the medication dose was tapered by halving over a 4-week period.. A total of 117/236 children who completed the titration period (49.6%; 95% confidence interval 40-57%) responded (> 50% reduction over baseline). Throughout the study their response rate remained constant at approximately 74%. Continuous treatment reduced the median number of wet nights during the observation period from 5.75 to 1.00 per week. A total of 12.4% of children received the 0.2 mg dose and 87.6% the 0.4 mg dose. The proportion of full responses increased over the course of the study from 5.8% to 37.5%. DDAVP was well tolerated: the majority of reported adverse events were mild, although two adverse events leading to withdrawal were reported.. Oral DDAVP provides an effective and well-tolerated means of providing long-term control in children with nocturnal enuresis. Long-term treatment increases the response rate.

Topics: Administration, Oral; Adolescent; Canada; Child; Deamino Arginine Vasopressin; Enuresis; Female; Follow-Up Studies; Humans; Male; Renal Agents; Time Factors; Treatment Outcome

To test the hypotheses that vasopressin deficiency or hypercalciuria are important in polyuric and non-polyuric bedwetting, as nocturnal polyuria is a pathogenetic factor in enuresis responsive to antidiuretic therapy with desmopressin.. Vasopressin deficiency has been implicated as a cause of nocturnal polyuria, but measurements of vasopressin in plasma have given contradictory results, because the hormone is released in pulses. Urinary levels reflect the secretion over longer periods. Hypercalciuria has also been proposed as a pathogenetic factor. Twenty-eight enuretic children who responded to desmopressin therapy with or without added anticholinergic agents (diuresis-dependent enuresis, DE), 15 children with therapy-resistant enuresis (not diuresis-dependent, NDE) and 51 continent controls were assessed. Urinary vasopressin, calcium and osmolality were measured in the morning after a 12-h thirst provocation. Urine production was recorded for 2 days.. Because most data were not normally distributed, the values are expressed as the median (range). There were no differences in urine osmolality; i.e. con-trols 919 (636-1232), DE 849 (462-1149), NDE 968 (664-1191) mOsml/kg); vasopressin, controls 34 (8-983), DE 26 (9-295), NDE 50 (9-116) pmol/L; or calcium excretion (expressed as the calcium/creatinine ratio), controls 0.16 (0.01-0.71), DE 0.14 (0.04-0.67), and NDE 0.23 (0.03-0.69). The DE group produced more urine, at 18.4 (9.2-52.5) mL/kg/day, than the other groups, i.e. control 12.7 (8.3-42.8) and NDE 12.1 (6.3-36.8) mL/kg/day (P = 0.008).. All enuretic children with nocturnal polyuria do not have vasopressin deficiency. The urinary calcium excretion does not differ between enuretic and dry children.

Topics: Adolescent; Calcium; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Infant; Male; Renal Agents; Vasopressins

To collect data on voiding patterns at baseline (no treatment) and during short-term desmopressin treatment, with special reference to the functional and the mean bladder capacity.. The study included 120 children (aged 6-16 years) with monosymptomatic nocturnal enuresis. While at home they recorded their fluid intake and diuresis in two separate periods, i.e. 2 weeks as a baseline registration and another 2 weeks during desmopressin titration. On four study days the children recorded the time and volume of all voids and of fluid intake. From the diaries their functional and mean bladder capacities, 24-h diuresis and day/night ratio of diuresis were determined.. The mean 24-h diuresis was significantly lower during short-term desmopressin treatment. In most of the enuretics the mean day/night ratio increased on desmopressin treatment. The mean functional and mean bladder capacities were unaffected by desmopressin. Those not responding had bladder capacities of approximately 100 mL less than full responders. Regardless of response, practically all the enuretics in the study had a smaller functional bladder capacity than expected for their age. Among responders the morning void was significantly larger than the following voids during the day, and among non-responders the fourth void was significantly larger than the previous voids in the day. Desmopressin treatment did not influence these volumes significantly.. Short-term desmopressin treatment does not affect functional and mean bladder capacity; 24-h urine production was reduced significantly (P<0.01) during desmopressin treatment.

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Enuresis; Female; Follow-Up Studies; Humans; Male; Renal Agents; Retrospective Studies; Treatment Outcome; Urinary Bladder Diseases; Urination; 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

Topics: Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Follow-Up Studies; Humans; Male; Renal Agents; Time Factors

Several treatment modalities for children suffering from monosymptomatic nocturnal enuresis are available, but desmopressin is a well-established option. On the other hand, alternative nonpharmacological therapies such as laser acupuncture are more frequently requested by the parents. To our knowledge, there is no prospective randomized trial which evaluated the efficacy of such an alternative approach in comparison with the widespread use of desmopressin.. Forty children aged over 5 years presenting with primary nocturnal enuresis underwent a previous evaluation of their voiding function to assure normal voiding patterns and a high nighttime urine production. Then the children were randomized into two groups: group A children were treated with desmopressin alone, and group B children underwent laser acupuncture. All children were investigated after a minimum follow-up period of 6 month to evaluate the duration of the response.. The children of both groups had an initial mean frequency of 5.5 wet nights per week. After a minimum follow-up period of 6 months reevaluation revealed a complete success rate of 75% in the desmopressin-treated group. Additional 10% of the children had a reduction of their wet nights of more than 50%. On the other hand, 6 months after laser acupuncture, 65% of the randomized children were completely dry. Another 10% had a reduction of the enuresis frequency of more than 50% per week. 20% of the children in the desmopressin-treated group did not respond at all as compared with 15% in the acupuncture-treated group. Statistical evaluation revealed no significant differences among the response rates in both groups.. Im comparison with pharmacological therapy using desmopressin, our study shows that laser acupuncture should be taken into account as an alternative, noninvasive, painless, cost-effective, and short-term therapy for children with primary nocturnal enuresis in case of a normal bladder function and high nighttime urine production. Success rates indicated no statistically significant differences between the well-established desmopressin therapy and the alternative laser acupuncture.

Topics: Acupuncture Therapy; Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Laser Therapy; Male; Prospective Studies; Renal Agents

To investigate predictive factors for the outcome of treatment of primary monosymptomatic nocturnal enuresis (PMNE) with desmopressin.. Data from a large open multicentre study were analysed. The study comprised 399 children with PMNE who were recruited for long-term desmopressin treatment. Before treatment a history was taken and the children observed for 4 weeks. After a 6-week dose-titration period with desmopressin, the children were classified into four groups depending on the response rate.. The children who improved during desmopressin treatment were older, had fewer wet nights during the observation period and had only one wet episode during the night, mostly after midnight. Many of them did not require the maximum dose of desmopressin to become dry. No hereditary factor for the response to desmopressin was found.. Those most likely to be permanently dry with desmopressin treatment are older children who respond to 20 microg desmopressin and who do not wet frequently.

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Female; Genetic Diseases, Inborn; Humans; Male; Predictive Value of Tests; Renal Agents; Treatment Outcome

We confirmed findings that oral desmopressin safely decreases the number of wet nights in children with enuresis and identified doses at which acceptable responses can be obtained.. We evaluated the safety and efficacy of oral desmopressin in a double-blind, placebo controlled, parallel group, randomized, multicenter trial of 193 children 6 to 16 years old with documented primary nocturnal enuresis. The study was conducted in 2 phases: 1) a 2-week dose ranging phase in which children received desmopressin (0.2, 0.4 or 0.6 mg.) or placebo at bedtime and 2) an 8-week dose titration phase that followed a 2-week placebo washout. Patients received 0.2 mg. desmopressin or placebo for the first 2 weeks and then the dose was increased in 0.2 mg. increments at 2-week intervals until the patient was completely dry or was receiving 0.6 mg. Patients were instructed to limit fluid intake. Mean decrease from baseline in the number of wet nights, percentage of responding patients and safety were assessed at 2-week intervals.. There was a statistically significant linear response to oral desmopressin at doses from 0.2 to 0.6 mg. during the dose ranging phase (p < or =0.05). The decrease in wet nights after 2 weeks of treatment with desmopressin was 27%, 30% and 40% at 0.2, 0.4 and 0.6 mg. doses, respectively, compared to 10% with placebo. All doses were statistically significantly different from placebo (p < or =0.05). During the dose titration phase all placebo treated and 87% of desmopressin treated patients were receiving the maximum dose of 3 tablets nightly because they had not been completely dry in the previous 2 weeks. Nevertheless, 44% of desmopressin treated patients had achieved at least a 50% reduction from baseline in the number of wet nights per 2 weeks at the lower doses of 0.2 and 0.4 mg. Most adverse events (rhinitis, pharyngitis, headache and increased cough) were mild to moderate in severity, unrelated to treatment and resolved before the study was completed.. Oral desmopressin administered at bedtime to children with primary nocturnal enuresis was significantly better than placebo for decreasing episodes of bed-wetting (p <0.05). A linear dose-response relationship was observed (p <0.05). An acceptable response to treatment (50% or greater reduction from baseline in wet nights per 2 weeks) was seen at all doses of desmopressin. Oral desmopressin, up to 0.6 mg. for 8 weeks, was well tolerated.

Topics: Administration, Oral; Adolescent; Child; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Renal Agents

The use of desmopressin in patients with primary nocturnal enuresis is based on the hypothesis of a nocturnal lack of endogenous arginine vasopressin. However, in addition to the kidney, other targets of desmopressin are known. Therefore, we examined whether the administration of desmopressin influences central nervous function in children with primary nocturnal enuresis.. Our prospective, randomized, double-blind, placebo controlled cross-over study was performed on 40 children with nocturnal enuresis. Patients were randomly assigned to receive either 20 microg. desmopressin intranasally or 0.9% saline solution. Each group comprised 19 and 21 to children, respectively. After 2 weeks the groups were switched. The children were tested for short-term memory and reaction time to both treatments. Statistical analysis was done using the Wilcoxon matched pairs test.. Median patient age was 8.0 years (range 6 to 13). During desmopressin treatment children in both groups had a significant decrease of wet nights (5.3 to 3.2 per week). In contrast to reaction time, short-term memory was significantly different between both groups (p <0.05).. Our results demonstrate an increase in short-term memory after desmopressin treatment in children with nocturnal enuresis. This finding indicates the central nervous system as a target involved in the pathogenesis of nocturnal enuresis as well as the therapeutic benefit of desmopressin treatment.

Topics: Adolescent; Child; Cross-Over Studies; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Memory, Short-Term; Prospective Studies; 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

We evaluated the combination of alarm and desmopressin versus alarm monotherapy for the treatment of nocturnal enuresis.. A double-blind, placebo controlled study of alarm therapy combined with desmopressin for children with nocturnal enuresis is described. Of 93 patients 47 were randomized to receive alarm therapy and 40 microg. intranasal desmopressin for 3 weeks followed by 20 microg. desmopressin for 3 weeks (group 1) and 46 received alarm therapy and placebo (group 2). After 6 weeks on alarm therapy and medication or placebo, both groups received an additional 3 weeks of alarm monotherapy. A specialized nurse practitioner advised patients and families of the treatment to be given at home and in the outpatient department. Bed-wetting frequency was evaluated before during and 2 weeks and 6 months after treatment.. A significantly greater reduction in the number of wet nights was observed after the first 3 weeks of treatment in group 1. However, after long-term followup no significant differences in bed-wetting frequency were noted.. There is a temporary, positive effect on enuresis using desmopressin combined with alarm therapy. However, both treatment modalities have a low long-term success rate of 36% to 37%.

Topics: Adolescent; Child; Combined Modality Therapy; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Prospective Studies; Renal Agents

Sixty-two children with nocturnal enuresis (43 boys, 19 girls aged 6-15 years) were treated with either desmopressin (Adiuretin-SD) (n = 32) or sodium diclofenac (n = 30). Desmopressin was effective in 85% of children and diclofenac in 33%. In children with primary nocturnal enuresis, the glomerular filtration rate was normal, whereas diuresis and solute excretion during the night were increased. Compared with healthy children, the nightly excretion of sodium was elevated by 43.7% and magnesium by 58.4%. A high correlation was found between the free water reabsorption and solute clearance (P < 0.001) in children with nocturnal enuresis. Changes in kidney function in nocturnal enuresis appear to be due to a decrease in the water and ion reabsorption in the thick ascending limb of Henle's loop because of a changed regulation of ion transport in this part of the nephron. Administration of desmopressin or a decrease in prostaglandin production after diclofenac administration restores the ion and water transport in the kidney, which results in the disappearance of nocturnal enuresis. The results indicate a role of changes in regulation of ion transport in renal tubules in the pathogenesis of one of the forms of primary nocturnal enuresis.

Topics: Adolescent; Algorithms; Anti-Inflammatory Agents, Non-Steroidal; Child; Deamino Arginine Vasopressin; Diclofenac; Diuresis; Enuresis; Female; Humans; Kidney Function Tests; Male; Osmolar Concentration; Renal Agents

Previous studies have suggested changes in self-concept with successful treatment of primary nocturnal enuresis (PNE), but behavioral changes have not been reported as a consistent associated finding.. To determine if self-concept and behavior change after 6 months of treatment of monosymptomatic PNE by conditioning alarm or desmopressin acetate (DDAVP).. Randomized, controlled trial in an inner-city hospital clinic. Subjects were 182 children referred or recruited through media publicity, randomly assigned both to 1 of 8 pediatricians and 1 of 3 treatment groups (alarm, DDAVP, or placebo). Included were children >7 years old with PNE, no daytime symptoms, bladder capacity >50% expected, and wetting >3 times a week. Excluded were children with central nervous system disorders or developmental delays, and those currently on DDAVP or alarm. Subjects completed the Piers-Harris Children's Self-Concept Scale and Harter's Perceived Competence Scale for Children (PCSC) at initial visit and after 6 months of treatment. Parents completed the Achenbach Child Behavior Checklist (CBCL) at the same times.. After 6 months of treatment the Piers-Harris total score showed a highly significant treatment by period interaction effect for DDAVP, a significant effect for alarm, and no effect for placebo. For children who achieved 75% dryness the CBCL showed a treatment by improvement interaction effect that was highly significant for DDAVP and placebo with no effect for alarm. For the PCSC there were no treatment or outcome interaction effects. After 6 months of treatment there were significant changes over time unrelated to outcome or treatment in the Piers-Harris Subscales and in the CBCL Internalizing and Externalizing Scores, and the Social Thought and Attention Problems Subscales. The PCSC was more stable with no changes in total score, and positive changes over time in only 2 Subscales, Scholastic and Social.. Children's self-concept improved with the type of treatment and amount of success. Parents' perceptions of behavior improve with type of treatment and amount of success. Children rate their self-concept and some physical attributes better after treatment with any of DDAVP, alarm, or placebo regardless of outcome. Frequent follow-up with emotional support and encouragement appear to be important components of an efficacious intervention for children with nocturnal enuresis.

Topics: Child; Child Behavior; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Renal Agents; Self Concept

To evaluate the efficacy of intranasal desmopressin (DDAVP) and retention control training (RCT) for monosymptomatic nocturnal enuresis in childhood and to assess the predictive value of daytime functional bladder capacity for both methods.. A total of 114 children with monosymptomatic nocturnal enuresis, of whom 99 (86.8%) wetted the bed every night, were treated with 1 of the 2 methods: intranasal DDAVP in 54 and RCT in 60 subjects.. Twenty-one of 54 patients (38.9%) and 14 of 60 patients (23.3%) in the DDAVP group and the RCT group, respectively, achieved strong improvement (p = 0.061). Forty-five of 54 (90.0%) in the DDAVP and 35 of 60 (58.3%) in the RCT group had a more than 50% decrease in wet nights (p = 0.004). In the DDAVP group, the functional bladder capacities at baseline in responders and nonresponders were 82+/-22% and 56+/-20% of the predicted bladder capacity for their age (p<0.001). In the RCT group, responders and nonresponders did not differ in functional bladder capacity at baseline.. DDAVP treatment is more effective than RCT in decreasing the number of wet nights in childhood nocturnal enuresis, but not so effective in children with a low functional bladder capacity. Daytime functional bladder capacity is a valuable predictor of response to DDAVP, but not so to RCT.

Topics: Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Exercise Therapy; Female; Humans; Male; Renal Agents; Urinary Bladder; Urodynamics

We evaluate the therapeutic effectiveness of treating monosymptomatic primary nocturnal enuresis (PNE) that has persisted into adulthood.. Patients older than 18 years with persistent monosymptomatic primary nocturnal enuresis were treated with 20 to 40 microg. desmopressin (DDAVP) nightly for 6 months. If the patients remained incontinent on maximal pharmacotherapy or if they became incontinent after cessation of DDAVP we initiated treatment with an enuretic alarm for 6 months. Patients not responsive to DDAVP or the enuresis alarm were given a trial of 50 mg. imipramine nightly. All patients were reassessed for continence 18 months after initiation of the treatment protocol.. We treated 29 patients of a median age of 20 years (range 18 to 33) who were enuretic more than 4 nights per week. With the initial DDAVP treatment 19 (66%) became continent (enuresis 0 or 1 night a month) but after discontinuation of DDAVP only 2 (7%) remained continent. Of the 27 patients subsequently treated with an enuretic alarm 9 (33%) became continent and 18 had persistent enuresis. Of these 18 patients 11 resumed DDAVP and became dry, while 7 nonresponsive to DDAVP were given imipramine and 2 (29%) are continent.. Overall, 83% of patients (24 of 29) achieved continence, including 38% (11 of 29) who are continent off all treatment modalities and 45% (13 of 29) who are currently continent on pharmacotherapy (11 on DDAVP and 2 on imipramine). The remaining 17% of patients (5 of 29) have persistent primary nocturnal enuresis recalcitrant to all therapeutic attempts.

Topics: Adolescent; Adult; Age Factors; Combined Modality Therapy; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Prospective Studies; Renal Agents

The aim of the study was to compare the efficacy and safety of different doses of DDAVP spray treatment (20 to 40 mcg/day) in patients with primary monosymptomatic nocturnal enuresis (defined as three or more wet nights per week).. 237 patients (152 males, 75 females; age range 5-17 years), with no infections or organic abnormalities of the urinary apparatus and no neurological disorders, were admitted into the trial. The experimental design was planned as an "open study" with five different treatments schedules (5 groups). The daily doses of DDAVP at bedtime in groups 1 and 2 were 20 and 30 mcg, respectively, for 6 weeks. In groups 3 and 4 the daily doses for the first 2 weeks were 20 and 30 mcg, respectively, and then, after a washout period of 2 weeks, the daily doses for the two groups were 30 and 20 mcg, respectively. A dose-response study (20 to 40 mcg/day) was carried out in group 5.. DDAVP spray therapy in primary monosymptomatic nocturnal enuresis was found to be resolutive in 70-75% of treated patients. No difference in response was found between the patients treated with the daily dose of 20 and those on 30 mcg. No important reactions were observed in patients treated with DDAVP spray at the different daily dose (20 to 40 mcg) or for different periods of time (up to 6 weeks).. DDAVP spray therapy at a dose of 20 mcg/day was effective in 70-75% of primary monosymptomatic nocturnal enuretics. In non-responders the daily dose of DDAVP should be increased to 30 to 40 mcg.

Topics: Administration, Intranasal; Adolescent; Chi-Square Distribution; Child; Child, Preschool; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Enuresis; Female; Follow-Up Studies; Humans; Italy; Male; Renal Agents; Time Factors; Treatment Outcome

Monosymptomatic nocturnal enuresis is common in healthy school children. Treatment is often required because of social and psychological convenience. We therefore conducted a randomized prospective trial using either desmopressin (D) or alarm (A).. Patients (n = 135) aged 6 to 16 years were enrolled between January 1992 and December 1994. Desmopressin (Minirin spray, Ferring SA) was given intranasally at a dose of 20 micrograms at bedtime and increased to 40 micrograms after 2 weeks if partial result was obtained. The alarm was a pad-bell device (Wet-stop, Sega) and the sound source was attached to the upper part of the pajamas. Inclusion criteria were: primary monosymptomatic nocturnal enuresis in healthy children, age > or = 6 years, absence of previous treatment using either desmopressin or alarm. The aim of the treatment was to achieve 100% dry nights. Patients were evaluated after 15 days on therapy by phone call and thereafter by attending the outpatient clinic at 2-3 and 4-6 months. At the time of the second evaluation, a switch from alarm to desmopressin (or vice-versa) was proposed to those who did not respond to the initial treatment.. In group D (n = 62), only 27 children were included since 12 (19%) were switched to alarm and 23 (37%) were excluded because they were either non-compliant or lost to follow-up. In group A (n = 73), only 31 were included since six (8%) were switched to desmopressin and 36 (49%) were excluded for the same reasons as in group D. Prior to inclusion, the percentage of dry nights was 21% in group D and 14% in group A. After 15 days on therapy, patients from group D achieved 80% dry nights compared to 50% in group A (P = 0.001). After 3 months, patients from group D attained 85% dry nights vs 90% in group A. After 6 months, children from group A achieved 94% dry nights vs 78% in group D (P = 0.01).. Desmopressin offers better short-term results than enuresis alarm but the latter is significantly more efficient in the long term. In France, the alarm device is not reimbursed by the national health service and therefore is poorly accepted, as suggested from the high rate of patients lost to follow-up.

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Enuresis; Female; France; Humans; Infant, Newborn; Male; Monitoring, Physiologic; Patient Acceptance of Health Care; Patient Selection; Prospective Studies; Reimbursement Mechanisms; Renal Agents; Treatment Outcome

To examine the relation between nocturnal vasopressin release and response to treatment with the vasopressin analogue 1-desamino-8-D-arginine vasopressin (DDAVP) in children with primary monosymptomatic nocturnal enuresis.. Children were recruited from a specific enuresis clinic and entered into a defined treatment programme. Nocturnal vasopressin concentrations were measured every 15 minutes over a four hour period during overnight admission.. Sixty seven children were eligible for entry into the study, 35 of whom agreed to overnight sampling. There was a quadratic relation between mean plasma AVP and response to treatment with DDAVP, with very high or very low concentrations being unresponsive. Plasma AVP profiles ranged from low concentrations with little variability to high concentrations with wide variability.. The ability to respond to DDAVP is related to endogenous AVP production and is influenced by neuronal patterning in early infancy. The best predictors of success with treatment were a past history of breast feeding, mean nocturnal AVP concentration, and the height of the child. The response was adversely affected by poor weight at birth and poor linear growth. The study suggests differing causes of nocturnal enuresis related to different patterns of AVP release.

Topics: Adolescent; Age Factors; Arginine Vasopressin; Biomarkers; Body Height; Breast Feeding; Child; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Renal Agents; Treatment Outcome

Desmopressin (an analogue of antidiuretic hormone) holds an important place in the treatment of primary nocturnal enuresis. According to some long-term trials its action is mainly symptomatic. The benefit of treatment and persistence of the effect in relation to the expected decline of enuresis in 15% children/1 year is discussed.. The open multicentre trial lasted 42 months. In the first stage 265 patients (164 boys, 101 girls) aged 9.4 +/- 2.8 (5-18 years) were given desmopressin (nasal drops) to achieve a 4-week dry integral. Enuresis stopped in 207/265 (78.1%) children within six (median) weeks of treatment after an effective dose of 10.5 micrograms (median) based on titration. During the second stage 55/265 children (25 boys and 30 girls) proceeded with treatment for 2-30 (median 12) months, one boy did not complete the trial. An effective dose was administered for 3.5 months (median) and then the dose declined depending on the effect by 3.5 micrograms (1 drop) per months (median). In the titration stage enuresis receded in 89.1% (49/55) children. After the first year of the trial there were 72.7% responders (p < 0.001, as compared with the assumed decline), after two years 70.9% (p < 0.01) and after three years 61.1% children (p < 0.05). The trial was completed by 61.1% (33/54) children as respondents. 23 of them 17-38 months after termination of treatment. 29.6% (16/54) patients were relapsing responders on long-term treatment, 5.6% (3/54) patients completed the trial as partial responders and 3.7% (2/54) children as non-responders. Minor side-effects were recorded during the titration stage in 4.5% children, during long-term treatment 5.4% children. The osmolality of morning urine increased during treatment regardless of the final effect (p < 0.01). The authors did not find a significant relationship between age, sex, familial incidence of enuresis, period of treatment and the achieved effect.. The authors provided evidence of a rapid onset of the effect of desmopressin and a high effectiveness throughout the trial. The osmolality of the morning urine was not a reliable predictive factor of the effect. In the authors opinion long-term treatment is important for development of regulation and regression of complaints. During a relapse the authors recommend return to maintenance treatment and gradual discontinuation after 6-12 months. Desmopressin treatment is in the authors' opinion safe, well tolerated and very useful.

Topics: Administration, Intranasal; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Prospective Studies; Renal Agents

We tested the role of the bladder in the pathogenesis of desmopressin resistant enuresis by evaluating the influence of urine production on the timing of the enuretic event and the response to anticholinergic medication.. We gave 33 children with monosymptomatic nocturnal enuresis resistant to the standard 0.4 mg. oral dose of desmopressin 0.4 and 0.8 mg. desmopressin and placebo tablets for 5 nights each in a double-blind crossover fashion. The time of enuresis or nocturia was documented. All 9 children who had at least 1 dry treatment period during the randomized portion of the study then received open label treatment with 0.8 mg. desmopressin. Nonresponders to this regimen and the remainder of the children were offered anticholinergic treatment.. Average time between bedtime and voiding was 5.0, 5.6 and 5.0 hours during the nights with placebo, and 0.4 and 0.8 mg. desmopressin, respectively (p = 0.12). Of the 9 children subsequently treated with 0.8 mg. desmopressin 5 became completely dry. Of the remaining 28 children given anticholinergic treatment 20 responded.. Antidiuresis does not delay the enuretic event in children with desmopressin resistant enuresis. This finding and the favorable response to anticholinergic medication favor the hypothesis that these children have nocturnal bladder instability. A subgroup of enuretic children responds to high but not normal doses of desmopressin.

Topics: Adolescent; Child; Cross-Over Studies; Deamino Arginine Vasopressin; Double-Blind Method; Drug Resistance; Enuresis; Female; Humans; Male; Renal Agents

The Swedish Enuresis Trial (SWEET) was conducted to evaluate the long-term safety and efficacy of intranasal desmopressin treatment in children with primary, monosymptomatic nocturnal enuresis (PMNE). The study had an open, multicentre design and comprised a 4-wk observation period, a 6-wk dose titration period (with 20-40 microg desmopressin) and a 1-y, long-term treatment period. A treatment-free week was introduced every 3 mo to identify dry patients. In total, 399 children aged 6-12 y with PMNE were recruited. Of these, 245 patients (61%) experienced > or = 50% reduction in the number of wet nights during the last 4 wk of dose titration compared with the observation period. These responders entered the long-term phase of the trial. The mean number of wet nights per week decreased from a median of 5.3 (range 1.3-7.0) during the observation period to a median of 0.8 (range 0.0-5.0) during the last 3-mo period. Seventy-seven children became dry, 63 (83%) within 6 mo of treatment initiation. The percentage of children who became dry was similar in all age groups. Significantly fewer children in the lowest age group were defined as responders (52%; 95% CI 45, 59) among the 6-7-y-olds compared to 65% (56, 74) and 81% (72, 90) in the two older age groups. Desmopressin was well tolerated. No serious drug-related adverse events were recorded and no clinical symptoms of hyponatraemia were reported. The SWEET trial has demonstrated that desmopressin is both safe and effective for the long-term treatment of PMNE, with a significant therapeutic effect also in children of 6-7 y of age.

Topics: Administration, Intranasal; Child; Confidence Intervals; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Drug Administration Schedule; Enuresis; Female; Follow-Up Studies; Humans; Long-Term Care; Male; Patient Compliance; Renal Agents; Sweden

To determine the efficacy and safety of oral desmopressin (DDAVP) treatment in Asian children with nocturnal enuresis.. This was a multicentre randomized placebo-controlled double-blind cross-over study. Patients were randomized to either active treatment with oral 400 mg DDAVP or placebo, with a 2-week medication-free period between the cross-over. Children with primary monosymptomatic nocturnal enuresis, aged between 7 and 18 years, with a minimum frequency of wetting of 6 nights or more during a 2-week observation period were recruited. Efficacy was measured by reduction in the average number of wet nights per week.. Of the 37 children initially recruited, the outcomes for 34 children were included in the final cross-over analysis, as they had complete data for both the treatment periods. Statistical analysis by ANOVA showed that there was no significant difference between the medication-free period and the pretreatment period. However, the average number of wet nights per week for the DDAVP treatment period (2.5+/-2.7) was significantly lower than that of the placebo treatment period (4.5+/-2.1) (P < 0.0001). In terms of the safety profile, there was no significant change in bodyweight, blood pressure, serum sodium, serum osmolality, and urine osmolality following DDAVP treatment.. Oral DDAVP is a safe and efficacious drug for the short-term treatment of children with primary nocturnal enuresis.

Topics: Administration, Oral; Adolescent; Analysis of Variance; Asia; Child; Cross-Over Studies; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Renal Agents

The objective of this study was to identify a cost-effective method of predicting a therapeutic response to desmopressin (DDAVP) by correlating daytime functional bladder capacity, age and urine osmolalities in patients with monosymptomatic nocturnal enuresis.. Thirty-five children out of 51 who initially presented to our institutions were included in the study. The remainder was excluded for lack of complete data. Constipation was actively addressed and was managed by administration of evening enemas for 3 consecutive days and dietary adjustment prior to initiating the study. Each micturition as measured throughout the day and the maximal daytime functional bladder capacity was determined as the largest void over a 2-day period. Urine samples were collected at home at 08:00, 16:00 and 22:00 (times that would best reflect the fluctuations in plasma vasopressin levels). Intranasal DDAVP was then administered, titrating the dose over a 2-week period. The initial dose was 10 micrograms and the dose was increased 10 micrograms every 3 days.. The response to DDAVP was then evaluated and of the 35 children, 27 demonstrated a complete response to DDAVP (all at doses between 10 and 30 micrograms). These were then related to the possible predictive factors. There was a significant correlation between a high maximum daytime functional bladder capacity and response to DDAVP (p = 0.006). Similarly, age was also predictive of a good response to DDAVP treatment (p = 0.008). However, spot urine osmolalities were not predictive of a response to DDAVP (p > 0.1).. Functional bladder capacity is a reliable predictor of response to desmopressin; children with larger capacities are more likely to exhibit a successful response. Older children have a better response rate than younger ones. Spot urine osmolality measured on specimens collected in the home setting is not predictive of response to desmopressin.

Topics: Administration, Intranasal; Adolescent; Age Factors; Child; Child, Preschool; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Osmolar Concentration; Predictive Value of Tests; Renal Agents; Urinary Bladder; Urination

To compare the efficacy of desmopressin and indomethacin and also determine the prostaglandin E2 (PGE2) concentrations in the patient and control groups.. Eighty-five children with primary nocturnal enuresis were followed up for a baseline period of 4 weeks, during which they recorded wet and dry nights. After this period, the patients were divided into three groups that used desmopressin, indomethacin, or placebo for 4 weeks. The dosage of desmopressin (group A, n = 31 ) was 20 microg/day and the dosage of indomethacin (group B, n = 29) was 100 mg/day. The placebo group (group C) consisted of 25 patients. We determined the serum PGE2 and urine PGE2 concentrations before and after treatment in the three groups and in a control group.. Treatment with desmopressin and indomethacin resulted in significantly more dry nights during the 4 weeks of observation than did placebo (P <0.005). The number of dry nights was also significantly different in the desmopressin group than in the indomethacin group (P <0.01). In the total patient group, the mean serum and urine PGE2 concentrations were significantly different from the control group's serum and urine PGE2 concentrations (P <0.001). There was a significant decrease in the serum and urine PGE2 concentrations in group A and group B after the treatment period (P <0.01).. Desmopressin and indomethacin were found to be more effective than placebo. We conclude that prostaglandins have an important role in the pathophysiology of primary nocturnal enuresis.

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Dinoprostone; Enuresis; Follow-Up Studies; Humans; Indomethacin; Renal Agents

To study the long-term efficacy and safety of desmopressin treatment in children with primary monosymptomatic nocturnal enuresis.. Children (aged 6-12 years) with nocturnal enuresis were recruited into an open multicentre trial. All children underwent an observation period of 4 weeks before starting a 6-week dose-titration period with desmopressin. If the number of wet nights decreased by more than half during medication, they began long-term treatment on 20-40 microg desmopressin. To test for cure and avoid overtreatment, the medication was interrupted for one week every third month.. Of the 399 children forming the intention-to-treat cohort, 245 halved their number of wet nights and started long-term treatment. During the periods off medication, 77 children were dry and at the end of the study another 73 (still on medication) reduced the number of wet nights to < or =10% of that during the observation period. A further 51 children halved the number of wet nights compared with the observation period. No serious adverse events occurred.. Long-term treatment with nasal desmopressin at a main dose of 40 microg is an effective and safe treatment for monosymptomatic nocturnal enuresis.

Topics: Administration, Intranasal; Child; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Enuresis; Female; Humans; Long-Term Care; Male; Renal Agents; Treatment Outcome

The combination of desmopressin (DDAVP) and behavioral therapy for treatment of nocturnal enuresis was compared with use of each of these modes alone. We randomly assigned 226 enuretic children being treated in primary care clinics of a major medical center in the largest health maintenance organization in Israel into 3 groups: Group A) DDAVP plus behavioral therapy (double-blind); Group B) behavioral therapy plus placebo (double-blind); and Group C) DDAVP alone (open group). DDAVP (20 micrograms/naris) and placebo were administered by intranasal spray. Both pharmacologic and behavioral therapy were initiated after a 2-week observation period and continued for 8 weeks. All patients were followed for 2 months after completion of treatment. A significant reduction in the number of wet nights/week was registered for all 3 groups: 49% in Group A, 45% in Group B, and 19% in Group C. After controlling for confounding factors, no significant difference in effect was noted among the 3 types of treatment during the trial period. However, on follow-up the results for the DDAVP patients were significantly less stable compared with the other 2 groups (p = 0.015). Minor side effects were registered, but none of the participants withdrew from the trial. To our knowledge, this is the largest randomized trial of nocturnal enuresis conducted to date. Our findings suggest that simply discussing the problem with the patient and family leads to improvement, and that behavioral therapy is also beneficial. DDAVP can help, but the relapse rate on discontinuation is high.

Topics: Adolescent; Behavior Therapy; Child; Combined Modality Therapy; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Recurrence; Renal Agents; Treatment Outcome

We evaluated the efficacy and safety of 2 oral doses of desmopressin compared to 20 micrograms. nasal spray and baseline values in the treatment of primary nocturnal enuresis.. A multicenter study was done comparing oral dosages (200 and 400 micrograms.) of desmopressin (4-week, randomized, double-blind phase followed by 12 weeks of open label treatment with 400 micrograms.) to 20 micrograms. nasal spray in 66 adults and adolescents 12 to 45 years old with primary nocturnal enuresis.. No significant differences were found between the 2 doses of desmopressin tablets or between the tablets and 20 micrograms. nasal spray during the double-blind phase. However, patients who initially received 200 micrograms. desmopressin tablets experienced fewer wet nights after they completed 12 weeks of open label treatment when the dose was escalated to 400 micrograms. tablets. Those who received 400 micrograms. tablets initially maintained response during this phase. Desmopressin tablets were well tolerated at both dose levels: 96% of patients and 94% of physicians rated the tolerability as excellent.. Desmopressin tablets are an effective and safe alternative for treatment of nocturnal enuresis.

Topics: Administration, Intranasal; Administration, Oral; Adolescent; Adult; Child; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Middle Aged; Renal Agents

Extensive studies of the epidemiology of nocturnal enuresis (NE) in Western countries indicate that the prevalence of this condition is relatively high (7-10% of children aged 7 years are enuretic). In the current study, questionnaires to assess the epidemiology of NE in Hong Kong were completed by 3521 school children, aged 4-12 years, the majority of whom (99.8%) were ethnic Chinese. Analysis of these questionnaires revealed a lower prevalence of monosymptomatic NE in this population of children (3.5%) compared with the results of studies conducted in Western countries. Furthermore, NE was found to be associated with arousal difficulties, nightmares, a positive family history of enuresis, poor school performance and poor relationships with classmates. A second study conducted to evaluate the response to desmopressin treatment of 25 children with severe monosymptomatic NE showed that 84% had a good response (> 50% reduction in the number of wet nights). Taken together, the results of these studies suggest that children with NE in Hong Kong may represent a more homogeneous population than in other countries, and that there is a strong genetic component in the aetiology of NE in this country. These children appear to be particularly responsive to treatment with desmopressin.

Topics: Age Distribution; Asian People; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Hong Kong; Humans; Male; Phenotype; Prevalence; Renal Agents; Sex Distribution; Surveys and Questionnaires; Treatment Outcome

A 2-week, home-based study was conducted on 75 children with nocturnal enuresis to monitor the frequency of enuretic episodes and the volume of nocturnal urine production. The objectives of the study were to correlate nocturnal urine production to the occurrence of nocturnal enuresis and response to desmopressin (Minirin, DDAVP) treatment. Furthermore, patient compliance was evaluated. Enuresis episodes and nocturnal urine production was recorded every night during two base-line weeks without treatment and during 2 weeks with 20-40 micrograms desmopressin at bedtime. During both periods fluid intake and micturition volumes were recorded for 2 days. Desmopressin response was defined as > 50% reduction in wet nights during treatment. It was found that patient compliance was acceptable in most patients. Regarding urine output it was found that base-line nocturnal urine production was significantly higher during nights when enuresis occurred than during "dry" nights and significantly higher in desmopressin responders compared with desmopressin non-responders. During treatment with desmopressin, nocturnal urine production in desmopressin responders decreased to levels similar to those of non-responders. The results confirm inpatient circadian studies of urine output and emphasise the importance of nocturnal polyuria in patients with monosymptomatic enuresis. The response to desmopressin was found to correlate with the occurrence of nocturnal polyuria. Home studies were considered to be a useful tool in the characterisation of patients with nocturnal enuresis.

Topics: Administration, Intranasal; Adolescent; Adult; Child; Deamino Arginine Vasopressin; Enuresis; Evaluation Studies as Topic; Female; Home Care Services; Humans; Male; Monitoring, Physiologic; Patient Compliance; Polyuria; Prevalence; Renal Agents; Water-Electrolyte Balance

The efficacy of repeated treatment attempts using desmopressin (Minirin, DDAVP), either alone, alternately or in combination with an alarm device, were evaluated in 96 patients with primary nocturnal enuresis who were slow, delayed or non-responders to therapy. At follow-up, 52% of the patients were cured and off therapy, an additional 26% had achieved dryness when using desmopressin regularly or on special occasions, and 22% were still wetting. It can be concluded that desmopressin therapy can be successfully commenced at the age of 5 years. Repeated treatment attempts can lead to achievement of dryness at an earlier stage. However, they probably do not influence the final outcome.

Topics: Administration, Intranasal; Child; Child, Preschool; Deamino Arginine Vasopressin; Drug Administration Schedule; Enuresis; Female; Follow-Up Studies; Humans; Male; Renal Agents; Treatment Outcome

The objective of the current study was to find a cost-effective way of correlating spot urine osmolalities, bladder capacity and age in patients with monosymptomatic nocturnal enuresis with response to treatment with desmopressin (Minirin, DDAVP). A total of 35 children fulfilled the entry criteria and were included in the study. Constipation was eliminated in these children by appropriate enema treatment and diet adjustment prior to enrollment. Urine samples were collected at home at times that would best reflect fluctuations in plasma vasopressin levels (08:00, 16:00 and 22:00) over three consecutive 24-hour periods. Maximal functional bladder capacity was determined from the largest voided volume. A 2-week dose-titration treatment period with intranasal desmopressin was then conducted. With doses of desmopressin being increased by 10 micrograms every 3 days. Response to desmopressin treatment was then assessed and factors that were observed to be markers of a favourable response were noted. Of the 35 children, 27 demonstrated a complete response to desmopressin treatment, at doses of 10-30 micrograms. Spot urine osmolalities were not predictive of the response to desmopressin (P > 0.1). In contrast, there was a significant correlation between a high maximum functional bladder capacity and response to desmopressin (P = 0.006). Age was also predictive of a good response to desmopressin treatment (P = 0.008).

Topics: Administration, Intranasal; Adolescent; Age Factors; Child; Child, Preschool; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Enuresis; Female; Humans; Incidence; Logistic Models; Male; Osmolar Concentration; Predictive Value of Tests; Probability; Renal Agents; Risk Factors; Treatment Outcome; Urinalysis; Urinary Bladder; Urine

Home recordings were used to study the effect of alarm treatment, over a period of 6 weeks, in children with monosymptomatic nocturnal enuresis. Vasopressin day/night ratios were shown to be a good indicator of alarm treatment success. Serial measurement of plasma vasopressin levels is, however, unsuitable for use in the clinic, as extensive analyses would have to be performed to obtain the necessary results. Use of an alarm increased nocturnal bladder capacity, but had no effect on daytime bladder capacity, sleep patterns, vasopressin secretion, nocturnal urine output or pelvic floor activity. In addition, the results of the study suggest that an alarm treatment period of 2 months would lead to more successful results than the 6 weeks used in the study.

Topics: Behavior Therapy; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Monitoring, Physiologic; Renal Agents; Treatment Outcome; Urinary Bladder; Vasopressins

The efficacy of alarm monotherapy (35 children) was compared with the efficacy of alarm treatment in combination with 40 micrograms desmopressin (Minirin, DDAVP) nasal spray (36 children). At the end of the treatment period, children receiving combination therapy had more dry nights per week (mean: 6.1) than children using an alarm alone (mean: 4.8). In addition, more children achieved an initial success (4 weeks of dryness) following combination treatment (27 children [75%]) compared with alarm monotherapy (16 children [46%], P < 0.005). This improvement with alarm plus desmopressin was particularly pronounced in children with severe wetting (> or = 6 nights per week), family problems or behavioural problems. It may, therefore, be appropriate to manage children in these categories with an enuresis alarm supplemented with desmopressin to improve treatment outcome.

Topics: Behavior Therapy; Child; Child, Preschool; Combined Modality Therapy; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Renal Agents; Treatment Outcome

A case control study was designed to study self-esteem in children with nocturnal enuresis and daytime incontinence. The patients and the controls were recruited from the normal population in the town of Umeå, Sweden. Medical and psychological examinations were performed before the start of treatment. Follow up investigations were carried out at 3 and 6 months after starting treatment. Self-esteem was measured using a Swedish self-answering questionnaire that was known to have good psychometric properties. Statistically significant impairment of self-esteem was observed between patients and control children before starting treatment (P < 0.001). After 6 months treatment, the patients had the same levels of self-esteem as the control group. Self-esteem was significantly better in patients that were totally dry at 6 months follow up compared with the patients with persisting urinary problems (P < 0.01). Children from lower socioeconomic groups were found to have lower self-esteem than children from higher socioeconomic groups; boys were also found to have lower self-esteem than girls.

Topics: Age Factors; Behavior Therapy; Case-Control Studies; Child; Deamino Arginine Vasopressin; Enuresis; Female; Follow-Up Studies; Humans; Male; Prognosis; Quality of Life; Renal Agents; Self Concept; Sex Factors; Sweden; Urinary Incontinence

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

Primary monosymptomatic nocturnal enuresis (PMNE) is often not openly discussed in Asian societies. We report the parental view of PMNE in Singapore, its impact on patients and their families and the traditional beliefs and its influence on subsequent management. A screening questionnaire was used in evaluating 30 children enrolled in a clinical trial on the use of oral Desmopressin for the treatment of PMNE. Primary monosymptomatic nocturnal enuresis was familial in 56.7% of patients. Fifty per cent of them were previously unevaluated. Earlier remedial attempts included bedtime fluid restriction and voiding (100%), incentive measures (43.3%), traditional practices (26.7%), punishment (20%), drugs (16.7%), psychotherapy (100%) and bladder training (3.3%). Perceived causes of PMNE were maturational delay (50%), deep sleep (50%), familial (43.3%), behavioural problems (43.3%) and excessive fluid intake (26.7%). Reasons for seeking treatment included restricted outdoor activities (90%), parental fatigue (86.7%), disrupted sleep for the household (46.7%) and fear of underlying pathology (26.7%). Perceived adverse effects on patients included social stigma (83.3%), disrupted sleep (33.3%) and impaired school performance (13.3%). Primary monosymptomatic nocturnal enuresis can thus be a chronic distressing problem in Asian communities.

Topics: Adolescent; Asia; Attitude to Health; Child; Chronic Disease; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Parents; Renal Agents; Singapore; Surveys and Questionnaires

Desmopressin nasal spray has proved to be efficacious treatment of primary nocturnal enuresis. Oral desmopressin tablets would be a more easily used, convenient vehicle for our patients and their parents. We evaluated the effectiveness of oral desmopressin in decreasing the number of wet nights in patients with primary nocturnal enuresis.. We performed a double-blind, placebo controlled, parallel group trial of oral desmopressin in 141 children 5 to 17 years old with documented primary nocturnal enuresis at 14 sites. Patients were screened for number of wet nights for 2 weeks before study entry. A minimum of 3 wet nights weekly for 2 consecutive weeks was required for study entry. Patients were randomized to receive 200, 400 or 600 mcg. desmopressin or placebo before bedtime. Fluids were restricted 2 hours before bedtime based on body weight. The primary efficacy variable was mean decrease in the number of wet nights recorded during the last 2-week treatment period. The percentage of responding patients and mean decrease from baseline in number of wet nights at 2, 4 and 6 weeks were also assessed.. The decrease in wet nights was 9, 20, 30 and 36% for placebo, and 200, 400, and 600 mcg. desmopressin orally per day, respectively. The 600 mcg. dose of oral desmopressin daily was statistically significantly different (p < 0.05) from placebo in decreasing wet nights. A complete or near complete response (0 to 2 wet nights) was noted in 3, 18, 33 and 24% of the patients who received placebo, and 200, 400 and 600 mcg. oral desmopressin daily, respectively. The 400 and 600 mcg. treatment groups were statistically significantly different (p < 0.05) from placebo. A less than 50% decrease in wet nights was noted in 83, 79, 64 and 61% of the patients who received placebo, and 200, 400 and 600 mcg. oral desmopressin daily, respectively. Oral desmopressin exhibited a dose response in the treatment of primary nocturnal enuresis. The linear trend for the decrease in wet nights was statistically significant (p < 0.05).. A dose of 600 mcg. oral desmopressin daily significantly decreased the mean number of wet nights when administered for 6 weeks. A higher dose may be necessary for an improved response.

Topics: Administration, Oral; Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Renal Agents

The purpose of this study was to determine the efficacy and safety of long-term treatment of nocturnal enuresis with desmopressin intranasal spray. Sixty-five children with primary nocturnal enuresis with a mean age of 11.3 years (range 7-17) underwent a 2-week observation period followed by dose titration period of 1 week. Those children completely dry with desmopressin entered a randomized, placebo-controlled, double-blind phase lasting 2 weeks, followed by a 6-month open treatment. The enuretic status of the children was documented for 2 weeks after the treatment was stopped. Eleven children had no change from baseline wetting with desmopressin. Thirty-two children receiving 20 mg and 9 children with 40 mg desmopressin were completely dry. Thirteen children were wet 1-2 nights per week, which was better than in the pretreatment period. During the 6-month open-treatment period, the effect of desmopressin was found to be stable. No side effects or adverse reactions were encountered. Two weeks after the treatment was stopped, 25 children were still completely dry (38% of the initial study population, 50% of the responders). The cure rate appeared to continue beyond 18 months after discontinuation of the treatment.

Topics: Administration, Intranasal; Adolescent; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Renal Agents; Treatment Outcome

To measure the effect of intranasal desmopressin (l-deamino 8-D-arginine vasopressin, DDAVP) on urine osmolality in a group of patients with persistent primary enuresis, and to determine whether changes in osmolality can the predict response to treatment.. Thirty-seven patients with persistent primary nocturnal enuresis were entered into a double-blind placebo-controlled crossover trial of 20 micrograms intranasal DDAVP spray. Morning urinary osmolality was measured on two occasions during each phase of treatment and the clinical response recorded in a diary.. Thirty-one patients (22 males and nine females) were evaluable at the end of the trial period. A good clinical response, defined as enuresis on two nights or fewer each week, occurred in 12 of 31 (39%) patients, but complete continence was attained in only two. The response was better in older patients and in those with less frequent enuresis. The mean and peak urinary osmolality of the morning urine samples were higher while on treatment with DDAVP compared with placebo, but this difference was not statistically significant and the response did not predict a good clinical outcome in improving the enuresis.. Treatment with DDAVP can produce a socially acceptable level of dryness in some patients with refractory nocturnal enuresis. However, the early morning urinary osmolality, as a reflection of changes in nocturnal osmolality, was not useful in distinguishing this group or in selecting those who will respond to treatment.

Topics: Administration, Intranasal; Adolescent; Child; Cross-Over Studies; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Osmolar Concentration; Renal Agents; Treatment Outcome

We report our experience with the use of desmopressin in the spina bifida population that is dry during the day but wet at night.. From 1994 to 1996, 18 patients with myelodysplasia were treated with desmopressin for persistent nocturnal enuresis. Initial dose was 40 mcg. before bedtime, decreased by intervals of 10 mcg. every 3 weeks. Patients were kept on the minimum dose required to keep them dry. We reviewed morning catheterized volumes, side effects and dosages needed to stay dry, and compared augmented patients with nonaugmented patients.. Of 18 patients 14 (78%) reported marked improvement in nocturnal enuresis. Of 6 augmented patients 5 (83%) are dry compared to 9 of 12 nonaugmented patients (75%). There were no adverse side effects from the use of desmopressin. Average dose to stay dry was 20 mcg. for augmented and 30 mcg. for nonaugmented patients. Of the 4 patients who had persistent nocturnal incontinence despite desmopressin 3 (75%) became dry with a single catheterization in the middle of the night.. Desmopressin is successful in treating nocturnal enuresis in the spina bifida patient with diurnal continence.

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Renal Agents; Spinal Dysraphism

The relationship of functional bladder capacity as well as other variables to the responsiveness to desmopressin in children with monosymptomatic nocturnal enuresis was investigated.. A total of 95 children 8 to 14 years old with monosymptomatic nocturnal enuresis (6 or more of 14 nights wet) were evaluated in a double-blind study followed by open label crossover extension using 20 to 40 mcg. desmopressin. Evaluated predictors of response included patient age, gender, race, family history, number of baseline wet nights, urine osmolality parameters and maximum functional bladder capacity (as a percent of predicted bladder capacity based on the formula, patient age + 2 x 30 = cc). Responders to desmopressin were classified as excellent (2 or less of 14 nights wet) or good (50% or greater decrease but more than 2 of 14 nights wet) and nonresponders were defined by a less than 50% decrease in wet nights.. Of the 95 patients 25 (29.5%) achieved an excellent response to desmopressin and 18 (18.9%) had a good response for a cumulative response rate of 45.3%. The remaining 52 patients (54.7%) were nonresponders. There were no significant differences between responders and nonresponders in regard to gender, race, positive family history or baseline urine osmolality parameters. Response to desmopressin was associated with older age, fewer baseline wet nights and larger bladder capacity. Patients with a functional bladder capacity greater than 70% predicted bladder capacity were 2 times more likely to respond to desmopressin.. The responsiveness of children with nocturnal enuresis to desmopressin is adversely affected by reduced functional bladder capacity. The results of this study have implications regarding the potential use of combination pharmacotherapy with desmopressin and an anticholinergic for enuretic patients who are nonresponsive to single drug therapy.

Topics: Adolescent; Child; Cross-Over Studies; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Prospective Studies; Renal Agents; Urinary Bladder

Twenty-three patients (5 to 15 years of age) with primary nocturnal enuresis were treated with desmopressin (DDAVP) according to a four-step protocol with weekly reductions of daily doses (1 to 0.25 microgram/kg body weight) thus including aspects of behavior-oriented "bladder retention training". The rate of wet nights was significantly reduced while patients were on medication (p < 0.02), but the sample as a whole returned to baseline levels after medication was stopped. Six subjects (26%) were non-responders. A variety of psychological and psychosocial single factors did not significantly affect the outcome. However, a subgroup of seven patients assessed as "psychologically non-distressed" revealed better results both on medication (p < 0.02; reduction 73%) and off medication (p > or = 0.05; reduction 39%) compared to a "distressed" subgroup (N = 16). Both groups showed significant changes in wet nights over the treatment course (p < 0.02 and p > or = 0.002, respectively). There was no clear-cut relationship between laboratory data (urine volume, osmolality, vasopressin) and outcome in wet nights. Data did not suggest a subgroup of patients with particularly low nocturnal vasopressin (AVP) secretion and, thus, high rates of wet nights. Our results corroborated the finding that DDAVP is an effective substance in reducing wet nights in patients with primary nocturnal enuresis. However, with respect to major reductions and long-term results (off medication), these preliminary findings suggest that "psychological distress" seems to be a very important confounding outcome variable. Thus, careful consideration and assessment of psychological and psychosocial aspects of distress are recommended. Eventually, a combination of DDAVP treatment with counseling and/or psychotherapy may significantly improve results for the majority of patients and families.

Topics: Adolescent; Analysis of Variance; Chi-Square Distribution; Child; Child, Preschool; Clinical Protocols; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Longitudinal Studies; Male; Renal Agents; Stress, Psychological; Treatment Outcome; Vasopressins

Patients with primary nocturnal enuresis were entered into 4 treatment groups: observation, imipramine, desmopressin acetate or alarm therapy. Patients were weaned from therapy 6 months after inclusion in the study and were evaluated for continence at 3, 6, 9 and 12 months after beginning the study protocol. Of the 50 patients under observation 6% were continent at 6 months and 16% were continent within 12 months. Of 44 patients treated with imipramine 36% were continent at 6 months on medication; however, only 16% were continent at 12 months, off medication. Similarly, of the 88 patients treated with desmopressin acetate 68% were continent at 6 months but only 10% were continent at 12 months. Of the 79 patients treated with alarm therapy 63% were continent at 6 months and 56% were dry at 12 months. Although each form of therapy improved continence over observation alone (p < 0.01), only the bed-wetting alarm system demonstrated persistent effectiveness (p < 0.001).

Topics: Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Follow-Up Studies; Humans; Imipramine; Prospective Studies

To determine if urine osmolality parameters can predict whether children with primary monosymptomatic nocturnal enuresis will respond to desmopressin, we conducted a prospective, double-blind, placebo-controlled study in 96 children 8 to 14 years old. Following a 2-week baseline screening interval patients with at least 6 of 14 net nights were randomized to double-blind regimens of desmopressin or placebo. Urine specimens for osmolality were collected at 6 p.m. and 6 a.m. on 3 consecutive days during the baseline and the 2, 14-day treatment periods. A significantly greater proportion of desmopressin treated children had an excellent (2 or fewer wet nights in 14 days) or good (greater than 50% reduction in wet nights) response compared with placebo treated children (p = 0.004 and p = 0.002 for treatment periods 1 and 2, respectively). Children treated with desmopressin reported a significantly lower number of wet nights than placebo treated children during both treatment periods (p = 0.0258 and p = 0.0136, respectively). Children treated with desmopressin had a significantly higher 6 a.m. urine osmolality during both treatment periods and a higher 6 a.m.-to-6 p.m. osmolality ratio (p = 0.004) in the first treatment period compared with the placebo group. Within the desmopressin treatment group clinical responders had a higher 6 a.m. urine osmolality and 6 a.m.-to-6 p.m. urine osmolality ratio than nonresponders during both treatment periods but these differences did not achieve statistical significance. In conclusion, treatment with desmopressin is associated with a significant decrease in the number of wet nights, and a significant increase in nocturnal urine osmolality and nocturnal/diurnal urine osmolality ratios. However, clinical response was not predictable based on baseline or treatment osmolality parameters.

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Osmolar Concentration; Prospective Studies; Urine

The prevalence of enuresis and management options for this condition were studied in our population of sickle cell patients. A total of 91 active patients (6 to 21 years old) followed at our regional sickle cell center was surveyed for the symptoms of primary nocturnal enuresis. Of the 91 patients 27 (29.6%) had primary nocturnal enuresis. Of those with enuresis 17 had homozygous sickle cell anemia, 5 had hemoglobin sickle cell disease, 4 had sickle cell beta + thalassemia and 1 had sickle cell beta zero-thalassemia. Of 10 patients who elected to receive intranasal desmopressin acetate 6 (60%) had complete or partial resolution of nocturnal enuresis. Our data confirm the high prevalence of nocturnal enuresis in patients with sickle cell disease and support the role of desmopressin acetate in the treatment of these patients.

Topics: Adolescent; Adult; Anemia, Sickle Cell; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Prevalence

Seventy-one children with nocturnal enuresis were enrolled in a controlled trial. The children were allocated to two matched groups. Children in both groups used an enuresis alarm until the end of treatment. Children in the first group were treated with 40 micrograms of intranasal desmopressin (Desmospray) for up to 6 weeks at the start of treatment with the alarm. During the observation period treatment there were 2.3 dry nights per week in both groups. At the end of treatment there was a significant difference in the mean number of dry nights per week between the two groups (6.3 in the alarm and desmopressin group and 4.8 in the alarm group) and also in the number of children becoming reliably dry. The combination of desmopressin and alarm was particularly helpful for children with severe wetting and those with family and behavioural problems.

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Renal Agents

Topics: Adolescent; Adrenergic Uptake Inhibitors; Adult; Antidepressive Agents, Tricyclic; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Humans; Imipramine; Polyuria; Renal Agents; Treatment Outcome; Urination; Vasopressins

Topics: Administration, Intranasal; Child; Deamino Arginine Vasopressin; Enuresis; Female; Follow-Up Studies; Humans; Male; Prognosis; Renal Agents; Sweden

Topics: Adolescent; Age Distribution; Child; Child, Preschool; Cross-Over Studies; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Prognosis; Prospective Studies; Renal Agents; Sex Distribution; Treatment Outcome

Topics: Administration, Intranasal; Adult; Antipsychotic Agents; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Haloperidol; Humans; Isoxazoles; Piperidines; Risperidone; Schizophrenia; Schizophrenic Psychology

To assess whether the synthetic vasopressin analogue desmopressin [1-desamino 8-D-arginine vasopressin] is efficacious and safe in the management of nocturia +/- enuresis in patients with multiple sclerosis.. Twenty-two women and 11 men, under 65 years of age, with clinically definite multiple sclerosis and nocturnal frequency +/- enuresis were entered into the study. A two week placebo run-in, to establish normal voiding patterns, followed by a double-blind, placebo-controlled, cross-over study of 20 micrograms intranasal desmopressin at night-time was carried out.. Desmopressin caused a significant decrease in nocturnal urinary frequency, nocturnal urinary volume and the percentage of total daily urine passed at night. There was no significant fall in plasma sodium with desmopressin although there were two cases of asymptomatic hyponatraemia.. Desmopressin is an efficacious and safe treatment for nocturia +/- enuresis in patients with multiple sclerosis.

Topics: Adult; Cross-Over Studies; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Urination Disorders

A response to desmopressin spray is only seen in a proportion of children with enuresis. To investigate whether response is related to nocturnal levels of arginine vasopressin (AVP) 35 children with enuresis, aged 8 to 14 years, had plasma AVP measurements overnight before entering a double blind randomised, placebo controlled crossover study to assess their response to evening treatment with desmopressin spray. There was no significant difference seen between nocturnal AVP levels obtained from children who responded to desmopressin and those who did not. Frequent sampling in six children demonstrated a pulsatile pattern of secretion for AVP. This has implications for studies of nocturnal AVP levels, and questions the validity of using infrequent measurements of AVP to assess it's secretion.

Topics: Administration, Inhalation; Adolescent; Arginine Vasopressin; Child; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male

In recent years the treatment of primary nocturnal enuresis (PNE) with desmopressin (DDAVP) has been promising. The route of administration until now had been intranasal, but because the tablets were introduced for the treatment of diabetes insipidus they have also become available for the treatment of PNE.. To find the optimal dosage of desmopressin tablets and to compare desmopressin's efficacy with placebo in a group of adolescents with severe monosymptomatic enuresis. The long-term safety of desmopressin was also studied in the same group of patients.. The effect of oral desmopressin (1-deamino-8-D-arginine-vasopressin) (DDAVP tablets, Minirin) was investigated in 25 adolescents (ages 11 to 21 years) with severe monosymptomatic nocturnal enuresis. The first part of the dose-ranging study comprised a single-blind dose titration period, followed by a double-blind, crossover efficacy period comparing desmopressin with placebo. The final part was an open long-term study consisting of two 12-week treatment periods. The efficacy of the drug was measured in reductions of the number of wet nights per week.. During the first dose-titration period, the majority of the patients were given desmopressin 400 micrograms, and the number of wet nights decreased from a mean of 4.9 to 2.8. During the double-blind period, a significant reduction of wet nights was observed (1.8 vs 4.1 for placebo). During the two long-term periods, 48% and 53% of the patients could be classified as responders (0 to 1 wet night per week) and 22% and 23.5% as intermediate responders (2 to 3 wet nights per week). No weight gain was observed due to water retention. After cessation of the drug, 44% of the patients had a significant decrease in the number of wet nights.. Oral desmopressin has a clinically significant effect on patients with PNE, and therapy is safe when administered as long-term treatment.

Topics: Adolescent; Analysis of Variance; Cross-Over Studies; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Follow-Up Studies; Humans; Male; Remission Induction; Retrospective Studies; Tablets; Time Factors

The efficacy and safety of 6 weeks of treatment with desmopressin tablets at doses of 200 to 400 micrograms.at bedtime were investigated in 33 children with monosymptomatic nocturnal enuresis. During an initial 1 to 2-week dose titration period 22 patients (67%) became either completely dry or showed improvement, 7 (21%) showed no response and 4 (12%) dropped out of therapy. During tablet treatment 17 patients on 400 micrograms.and 5 on 200 micrograms.at bedtime increased the number of weekly dry nights from 2.0 +/- 1.6 (standard deviation) during a 2-week observation period to 5.2 +/- 1.9 (p < 0.001). During a subsequent 2-week period 40 micrograms.intranasal desmopressin showed a similar overall efficacy, with a mean of 5.4 +/- 1.6 dry nights per week. In addition, intranasal treatment was able to increase the number of dry nights in 2 of the 7 nonresponders to tablet treatment.

Topics: Administration, Intranasal; Administration, Oral; Adolescent; Analysis of Variance; Child; Deamino Arginine Vasopressin; Enuresis; Female; Follow-Up Studies; Humans; Male

Twenty-four adolescents, mean age 13.5 years, with primary nocturnal enuresis (PNE), were studied to evaluate the efficacy of long-term oral desmopressin use. Reduction in mean number of wet nights per week was the criterion for response. Results showed that during 12-week treatment Period I, 48% were full responders (< or = 1 wet night/wk); 22% were intermediate responders (2 to 3 wet nights/wk); and 30% were nonresponders (> 3 wet nights/wk). During 12-week treatment Period II, 53% were full responders, 23.5% were intermediate responders, and 23.5% were nonresponders. Despite a high relapse rate (50% after Period I, 56% after Period II), 17 patients (71%) were completely dry 2 years posttreatment, suggesting a possible curative effect of oral desmopressin. It was concluded that oral desmopressin is comparable to the intranasal formulation, with a good, long-term therapeutic effect in adolescents with PNE.

Topics: Administration, Oral; Adolescent; Adult; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Research Design; Safety; Single-Blind Method

The lack of circadian rhythmicity of plasma arginine vasopressin (AVP) in primary nocturnal enuresis (PNE) in some children is known. The original test protocol is time-consuming and needs excellent compliance by children and parents. The goals of the presented study are the introduction of a simple screening test and the evaluation of the response of treatment using intranasal synthetic vasopressin. Fifty-five children (aged 8.2 +/- 3.1 years) with PNE and 15 children (aged 7.9 +/- 2.4 years) of a control group were investigated. Using a standardized protocol, AVP levels were measured by radioimmunoassay (RIA) under controlled water intake 3 times per day over a period of 72 h. Fourteen of 55 tested children (25.5%) with PNE had a significant decrease in nocturnal AVP when compared to the control group. We measured also an increased nocturnal urine volume and a lower urine osmolality in this enuretic group. Eight of 14 patients (57.1%) with plasma AVP deficiency (AVPD) also had bladder instability. Nine of 14 patients (64.3%) with AVPD with or without concomitant bladder instability were totally dry during desmopressin treatment, but only 2 (14.3%) remained dry after discontinuation of treatment. Our data suggest that nocturnal urine osmolality measurement may reflect AVPD and predict a positive treatment outcome.

Topics: Administration, Intranasal; Arginine Vasopressin; Child; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Osmolar Concentration; Prospective Studies; Urodynamics

Desmopressin acetate (DDAVP) is promoted to treat nocturnal enuresis but indications for its use are unclear. We reviewed all randomized controlled trials to determine (1) short- and long-term efficacy, (2) responders, (3) dose-response curve, (4) side effects, and (5) comparative efficacy with other treatments.. A Medline search of the English language literature from January 1966 to August 1992, supplemented by contact with the drug companies, yielded 18 articles which were true randomized controlled trials (11 cross-over and 7 parallel studies).. The 18 randomized controlled trials included 689 subjects for most of whom some other type of treatment had failed. All studies found decreased mean frequency of wetting ranging from 10% to 91%, but only 24.5% of subjects achieved short-term dryness. One study of DDAVP responders directly tested long-term dryness and 21% stayed dry. In three studies that incidentally reported on long-term effects 5.7% stayed dry after stopping DDAVP: There was wide variation in the type of patient included. Seven studies addressed prognostic factors. Children more than 9 years old and with fewer initial wet nights do better. Four studies seem to include almost exclusively monosymptomatic children with nocturnal enuresis (ie, primary nocturnal enuresis, positive family history, and no urinary symptoms). Results were no better than those which included mixed symptoms. Five studies attempted to address the dose-response issue. Despite some methodological issues, there is probably some dose-response effect. Side effects were infrequent in the 589 subjects who received DDAVP as opposed to placebo. No cases of water intoxication and no significant shifts in electrolytes were reported in the four studies which measured them. Nasal stuffiness, headache, epistaxis, and mild abdominal pain seem to be the only side effects noted, and these were uncommon. Only one study compared DDAVP with conditioning alarms. Alarm patients had 10% fewer wet nights and a better long-term result.. DDAVP reduces wet nights in children for whom other treatments have failed but it produces complete dryness in a minority, and this is often a temporary effect. The literature focuses on short-term efficacy. The true role of DDAVP will be known when samples are carefully selected, prognostic factors are examined, and more comparisons with other treatments are conducted focusing on long-term outcomes. On the basis of current knowledge, DDAVP is inferior to conditioning alarms as a primary therapy.

Topics: Child; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Enuresis; Female; Humans; Male; Randomized Controlled Trials as Topic; Time Factors

It is estimated that enuresis occurs in 5 to 7 million children in the United States. The treatment approach for enuresis is controversial, in large part due to a lack of consensus as to the exact cause of enuresis. Several factors either alone or together may contribute to this syndrome. In addition, there is strong evidence of a genetic component to enuresis. Pharmacotherapy continues to be the preferred treatment for both physicians and families. The most widely used drugs include antidepressants, anticholinergics, and desmopressin. The tricyclic antidepressant imipramine has been used extensively since the 1960s. The exact mechanism of action in enuresis is unknown although it appears to be related to the anticholinergic and antispasmodic effects of the drug. The most common adverse effects reported with imipramine include personality changes, insomnia, anorexia and anxiety. There has been renewed interest in antidiuretic treatment of enuresis. Researchers have found that enuretic children do not have the ability to reduce urine volume at night or concentrate the urine they produce during the night. Clinical trials with desmopressin administered by nasal inhalation report a marked reduction in enuretic episodes. Adverse effects were limited to nasal complaints, rhinitis, or epistaxis. Additional long term studies are needed to delineate desmopressin's role in therapy. Although the number of options for treatment of enuresis is expanding, criteria to predict patient response need to be defined.

Topics: Adolescent; Antidepressive Agents, Tricyclic; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Parasympatholytics

Fifty five children with nocturnal enuresis referred to a hospital enuresis clinic entered a controlled trial to compare the efficacy of one month and three month courses of intranasal desmopressin (Desmospray). There was no significant difference in outcome between the two groups. Overall 36% improved by at least two dry nights/week during treatment, but only five children (18%) in the one month group and three (11%) in the three month group became completely dry and only one in each group remained dry after treatment. To determine whether nocturnal polyuria was associated with a therapeutic response to desmopressin, the nocturnal urine volume, osmolality, and vasopressin concentration were measured in desmopressin responsive enuretics, desmopressin non-responders, and non-enuretic control children. There were no significant differences between the three groups. A three month course of desmopressin is no more effective than a one month course. Although many children will improve during treatment, only a small number become dry and most will relapse when treatment is stopped.

Topics: Adolescent; Arginine Vasopressin; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Osmolar Concentration; Recurrence; Time Factors; Urodynamics

During the period from March to September 1989, 40 children suffering from primary nocturnal enuresis, aged between 5 and 14 years, were included in a study to assess the comparative therapeutical efficacy of DDAVP and acupuncture. Children were divided into four groups of 10: group A was treated with DDAVP, group B was treated with acupuncture, group C was treated with DDAVP and acupuncture and group D was treated with placebo (control). The trial design included 3 periods: observation (2 weeks), treatment (8 weeks) and follow-up (4 weeks). Nineteen children completed the study. The efficacy of treatment, which was expressed as a percentage of dry nights, was high in both the DDAVP and acupuncture groups, when used separately. The combined treatment of DDAVP and acupuncture appeared to be the most efficacious both in terms of the percentage of dry nights at the end of treatment and in relation to the stability of results, even after the end of the study. The paper gives a detailed analysis of correlations between type of treatment and urinary osmolarity.

Topics: Acupuncture Therapy; Adolescent; Child; Child, Preschool; Combined Modality Therapy; Deamino Arginine Vasopressin; Enuresis; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Male; Remission Induction; Time Factors

The effect of intranasal desmopressin on primary nocturnal enuresis was investigated in a study divided into 2 parts in which the first part was a randomized, double-blind, placebo-controlled cross-over study of 52 Finnish school children 5 to 13 years old. A variety of approaches had previously been attempted in most children, including water deprivation, night awakenings, enuresis alarm and imipramine, without success. The patients were randomized to 4 periods of 3 weeks each: 2 periods on placebo and 2 periods on 20 micrograms. desmopressin spray. The entire 12-week treatment period was preceded and followed by control periods (without treatment). The number of dry nights, measured as calculated averages per week, increased significantly (p less than 0.01) from 0.6 dry nights during pre-treatment to 4.3 and 4.6 dry nights per week during the 2 desmopressin treatment periods, respectively. The placebo responses were 2.1 and 2.4 dry nights per week, respectively. The second part of the study was an open dose-finding and drug safety study of a further 3 months in duration. The aim was to evaluate the efficacy and tolerance of 20, 30 and 40 micrograms. doses. All 47 patients who relapsed during the post-treatment period in part 1 were included. During this period 53% of the patients responded fully, 19% were intermediate responders and 28% did not respond. As reported in other studies most patients suffered relapse after treatment. During continued treatment for 3 months at doses between 20 and 40 micrograms. desmopressin was well tolerated, had no effect on body weight or blood pressure and did not cause any adverse reactions.

Topics: Administration, Intranasal; Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Recurrence

Topics: Adolescent; Adult; Child; Child, Preschool; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Humans; Kidney

Topics: Administration, Intranasal; Adolescent; Child; Clinical Trials as Topic; Deamino Arginine Vasopressin; Enuresis; Humans

A series of 22 patients with severe nocturnal enuresis were treated with desmopressin in a randomised double-blind cross-over study. Treatment with 20 and 40 micrograms was highly effective compared with placebo. No difference in dry nights was found between the 2 dosages. Desmopressin proved to be a safe and effective treatment.

Topics: Adolescent; Body Weight; Child; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Double-Blind Method; Enuresis; Female; Humans; Male

Twenty-eight children with primary nocturnal enuresis were blindly allocated at random to a combination of enuresis alarm and 20 micrograms intranasal desmopressin or alarm and placebo for 2 weeks. Patients received the other therapy after a 2-week treatment-free period. The combined treatment of desmopressin and alarm showed 5.1 +/- 0.4 (mean +/- SEM) dry nights per week and resulted in significantly more dry nights per week during the 2 weeks of observation than placebo and alarm (4.1 +/- 0.4, P less than 0.05).

Topics: Adolescent; Child; Clinical Trials as Topic; Combined Modality Therapy; Conditioning, Psychological; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Random Allocation

Topics: Adolescent; Adult; Child; Child, Preschool; Clinical Trials as Topic; Deamino Arginine Vasopressin; Enuresis; Humans; Osmolar Concentration

A single blind dose response study of the effects of treatment with tablets containing 50-400 micrograms of desmopressin was conducted in 15 children with primary nocturnal enuresis. A dose response effect was seen, with the 100, 200, and 400 micrograms doses resulting in significantly more dry nights than when a placebo was used. The response after 200 micrograms was significantly different from that after 100 micrograms (p less than 0.02) but not from that after 400 micrograms. A randomised, double blind, double dummy, cross over study was then carried out in 30 children to compare the effects of a 20 micrograms dose given through a nasal pipette, a 200 micrograms tablet, and a placebo. The numbers of dry nights were significantly greater during both periods of treatment with desmopressin when compared with that using placebo, but there were no differences between the methods of taking the drug. After oral and nasal treatment 41% and 52%, respectively, of the patients improved by more than 50%. Nine children (31%) remained completely dry after treatment.

Topics: Administration, Intranasal; Administration, Oral; Adolescent; Child; Circadian Rhythm; Clinical Trials as Topic; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Double-Blind Method; Enuresis; Female; Humans; Male; Random Allocation

Fifty children with primary nocturnal enuresis were randomised for a study comparing desmopressin (DDAVP) and enuresis alarm. Forty six completed the trial, 24 of whom were treated with 20 micrograms intranasal desmopressin nightly and 22 with enuresis alarm for three months. Failures were crossed over and relapses were continued on the same treatment for a further three months. The improvement rate was 70% in the group given desmopressin and 86% in the group treated with alarm; the difference was not significant. During the first week of treatment the group given desmopressin was significantly dryer, and at the end of the study 10 of these patients relapsed compared with one patient in the group given the alarm. No serious side effects were observed. This study confirms the role of conditioning treatment as preferable in long term treatment of nocturnal enuresis. When this fails or when a safe drug with rapid effect is needed, however, desmopressin is a useful alternative.

Topics: Behavior Therapy; Child; Clinical Trials as Topic; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Random Allocation

Topics: Child; Clinical Trials as Topic; Deamino Arginine Vasopressin; Double-Blind Method; Drug Therapy, Combination; Enuresis; Female; Humans; Imipramine; Male; Random Allocation

A double blind crossover trial of 20 micrograms intranasal 1-deamino-8-d-arginine vasopressin (DDAVP) versus placebo was carried out in 17 children with intractable enuresis aged between 6 and 13 years who had failed to respond to drugs and an enuresis alarm. Fluid intake was not restricted. There was a significant reduction in the number of wet nights. Seven children (41%) were cured or showed considerable improvement, with strong evidence against any placebo effect. The best response was seen in children aged 10 years or over and if urine osmolality after DDAVP reached beyond 1000 mmol/kg or was already at this concentration. The degree of overnight rise in urine osmolality after treatment with DDAVP was not predictable but correlated well with the clinical improvement in nocturnal diuresis present in eight of the children. A further 12 children with equally refractory enuresis were given 20 micrograms of the active drug to take during their school journeys or holidays. Six of them had previously normal overnight urine osmolalities with only two successes, but of the six who had nocturnal diuresis before treatment, five became dry, suggesting that DDAVP acts largely by anti-diuresis and might be most useful in children with nocturnal polyuria.

Topics: Adolescent; Child; Clinical Trials as Topic; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Osmolar Concentration

The effect of desamino-D-arginine vasopressin was investigated in a double-blind study of 37 children more than 9 years old with nocturnal enuresis resistant to conventional therapy. A significant reduction of wet nights was observed but as soon as the medication was stopped the children reverted to earlier bedwetting habits.

Topics: Adolescent; Arginine Vasopressin; Child; Clinical Trials as Topic; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Humans; Random Allocation; Time Factors

The effect of 20 micrograms. desaminocysteine-D-arginine vasopressin intranasally on childhood nocturnal enuresis was studied in a randomized double-blind cross-over series of 54 children. The wetting was significantly less frequent during the 2, 3-week periods on desaminocysteine-D-arginine vasopressin than during placebo periods, or during periods without any treatment. The effect of desaminocysteine-D-arginine vasopressin was reproducible and the efficacy of desaminocysteine-D-arginine vasopressin depended on the frequency of wetting before treatment. After discontinuation of the short treatment enuresis recurred immediately. No side effects were noted. We conclude that desaminocysteine-D-arginine vasopressin may well be used in the management of childhood enuresis, especially in situations when an immediate effect is desirable.

Topics: Adolescent; Arginine Vasopressin; Child; Clinical Trials as Topic; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Humans

Topics: Adolescent; Arginine Vasopressin; Child; Clinical Trials as Topic; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male

A double-blind cross-over trial of DDAVP was carried out in 22 patients aged between 9 and 16 years. The patients had previously failed to respond to other treatments for enuresis. While DDAVP resulted in fewer wet nights during the 14-day period of active treatment, the results did not achieve statistical significance. This is in contrast to previous reports. The dose in this study was 20 micrograms intranasally. Further studies may be valuable, possibly relating dosage to body weight.

Topics: Adolescent; Arginine Vasopressin; Child; Clinical Trials as Topic; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male

To characterize the children with enuresis likely to respond to desmopressin acetate, we performed a double-blind crossover study that included the use of a placebo. During the two weeks of desmopressin administration, six children (12%) had 13 or 14 dry nights, and 15 children (29%) had eight to 12 dry nights. Among the 17 children aged 9 years or older, with four to seven dry nights during the two-week baseline period, 12 children (71%) responded to desmopressin (eight to 14 dry nights). In contrast, none of the 15 children younger than 9 years of age with fewer than three dry nights before therapy responded. During the posttreatment period, only four of the 21 drug responders reported a persistent effect. Desmopressin may be effective in reducing the frequency of enuresis, especially in children older than 9 years of age without nightly enuresis.

Topics: Adolescent; Age Factors; Arginine Vasopressin; Child; Clinical Trials as Topic; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Double-Blind Method; Enuresis; Female; Humans; Male; Random Allocation

The response of desamino-D-arginine vasopressin (DDAVP) was investigated in 32 enuretic children in a double-blind clinical study. The 15 children treated with DDAVP showed a significant reduction in the incidence of bed wetting--from 18.7 +/- 6.5 to 6.5 +/- 9.2 wet nights per 30 days. In 6 children bed wetting stopped entirely, in 6 there was a satisfactory response, and in 3 the response was marginal or there was none. When DDAVP was stopped most children reverted to their earlier bedwetting habits (15.7 +/- 8.9 nights a month). Response to DDAVP was significantly better in children aged more than 10 years (mean age for the entire group). The administration of DDAVP was not associated with any appreciable change in morning urine osmolalities. No adverse effects were noted. It is concluded that DDAVP is effective in nocturnal enuresis, particularly in older children. It is suggested that the cessation of bed wetting may, in part, reflect functional properties of DDAVP rather than antidiuresis.

Topics: Adolescent; Age Factors; Arginine Vasopressin; Child; Clinical Trials as Topic; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Osmolar Concentration

Topics: Adolescent; Arginine Vasopressin; Child; Child, Preschool; Clinical Trials as Topic; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male

Twenty-five patients complaining of nocturia completed a double-blind cross-over trial using desmopressin (DDAVP) and placebo. All had failed to respond to treatment with antispasmodic agents and evening fluid restriction. The drugs were given as a single intranasal dose on retiring. Nocturnal urinary frequency was reduced from a mean of 3.2 episodes to 2.6 with placebo and 1.9 with DDAVP (0.01 greater than P greater than 0.001). Diurnal urinary symptoms were not significantly affected and side effects were minimal. This drug seems to have a place in the treatment of nocturia, where more conventional therapies have failed.

Topics: Administration, Intranasal; Adult; Aged; Arginine Vasopressin; Clinical Trials as Topic; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Middle Aged

Topics: Clinical Trials as Topic; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Follow-Up Studies; Humans; Osmolar Concentration; Placebos; Research; Research Design

Desmopressin (1-desamino-[8-D-Arg]-vasopressin) (DDAVP) was given by nose drops to 22 children with persistent nocturnal enuresis (mean age, 6.6 +/- 2.9 years; range, 4 to 12 years) the evening before sleep. With saline alone as placebo and with comparison to enuretic frequency before the onset of the trial, fortnightly periods were compared under double-blind conditions with the children at home. Pretreatment and placebo fortnights showed wetting frequencies (nights per fortnight) of 10.6 +/- 4.9 and 11.0 +/- 4.4, respectively. The value of the fortnight during desmopressin therapy was 4.2 +/- 4.5, which was significantly different from either of the previous means (P less than .01). Of the 22 subjects, four failed to react to therapy at all. There was decreased enuretic frequency in the remaining 18, of whom 12 decreased markedly or ceased wetting. One month after the trial, seven of the respondents were dry with desmopressin therapy. There was clear evidence of a large nocturnal volume of dilute urine before treatment in six of the respondents in whom such measurements could be reliably made. These children responded to dehydration with urine concentration, however, so that the suggestion can be made that a failure to develop a normal diurnal pattern of urine volume and concentration may underly some cases of enuresis.

Topics: Administration, Intranasal; Arginine Vasopressin; Child; Child, Preschool; Circadian Rhythm; Clinical Trials as Topic; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Osmolar Concentration; Placebos; Sodium Chloride

A double-blind study of 18 children aged 6--12 years suffering from primary nocturnal enuresis without signs of underlying organic disease is reported. 20 microgram of DDAVP (desamino-D-arginine vasopressin, Minirin) was given intranasally at bedtime. The effect was prompt and satisfactory in 8 children and relatively good in another 8 children. No adverse effects were noted. DDAVP is advocated for temporary use in children with nocturnal enuresis needing immediate help.

Topics: Arginine Vasopressin; Child; Circadian Rhythm; Deamino Arginine Vasopressin; Double-Blind Method; Drug Evaluation; Enuresis; Female; Humans; Placebos; Pregnancy

Two central problems with the enuresis alarm are the family workload and the lack of predictors of therapy response. We wanted to look at predictors of alarm response in a setting reflecting clinical reality.. An alarm linked to a smartphone app was provided to enuretic children managed at pediatric outpatient wards. Baseline data (sex, age, daytime incontinence, urgency, previous therapies, arousal thresholds and baseline enuresis frequency) were recorded. Further information, such as enuretic episodes and actual alarm use, was gathered via the app during therapy. Therapy was given for 8-12 weeks or until 14 consecutive dry nights had been achieved.. For the 196 recruited children the outcome was as follows: full responders (FR) 18.4%, partial responders (PR) 20.4%, nonresponders (NR) 22.4% and dropouts 38.8%. We found no clear predictors of response or adherence among baseline data. But as treatment progressed responders reduced their enuresis frequency as compared to NR (week two P = 0.003, week three and onwards P < 0.001). This is further illustrated in the Figure below. Furthermore, the children unable to complete the full treatment had more non-registered nights already from the second week (week two P = 0.005, week three P = 0.002 and so on).. Anamnestic data give little predictive information regarding enuresis alarm response or adherence. Contrary to common belief neither daytime incontinence nor previous alarm attempts influenced treatment success. But after 2-4 weeks of therapy the children with a good chance of treatment success could be discerned by decreasing enuresis frequency, and the families that would not be able to comply with the full treatment showed incomplete adherence already during the first weeks.. Maybe the enuresis alarm strategy should be changed so that the treatment is reassessed after one month and only children with a high chance of success continue. This way, unnecessary frustration for the families of therapy-resistant children may be reduced.

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Nocturnal Enuresis; Treatment Outcome

The alarm is the first-line treatment of nocturnal enuresis. However, the therapy is labour-intensive for both families and healthcare providers. Our aim was to see whether the treatment could be successfully used by the families, without support from healthcare providers.. An alarm linked to an application on a parent's smartphone was used. The app recorded enuretic events and gave instructions. Group A were children supported by a nurse. Group B were patients whose families had bought the alarm and downloaded the app independently.. There were 196 children in group A and 202 in group B. The percentages of full responders, partial responders, non-responders and dropouts were 18.4%, 20.4%, 22.4% and 38.8% in group A and 13.4%, 11.4%, 14.9% and 60.4% in group B. The risk for dropping out of therapy was higher in group B (p < 0.001), whereas the chance for adherent children to become dry did not differ between the groups (p = 0.905).. For families who are able to adhere to alarm therapy the chance of success is just as good when managed independently as when supported by a nurse. But the latter children will have a greater chance of adhering to the full treatment.

Topics: Child; Consumer Behavior; Deamino Arginine Vasopressin; Enuresis; Health Personnel; Humans; Nocturnal Enuresis; Prospective Studies

We evaluated a new bedwetting alarm, GOGOband®® which utilizes real time heart rate variability (HRV) analysis and applied artificial intelligence (AI) to create an alarm that can wake the user prior to wetting. Our aim was to evaluate the efficacy of GOGOband® for users in the first 18-months of use.. A quality assurance study was conducted on data retrieved from our servers, of initial users of the GOGOband® which includes a heart rate monitor, moisture sensor, bedside PC-tablet, and a parent app. There are three sequential modes beginning with Training, Predictive mode and Weaning mode. Outcomes were reviewed and data analysis was done with SPSS and xlstat.. All 54 subjects who used the system from Jan 1, 2020, to June 2021 for more than 30 nights were included in this analysis. The mean age of the subjects is 10.1 ± 3.7 yrs. Subjects wet the bed a median of 7 (IQR6-7) nights per week prior to treatment. Severity and number of accidents per night had no impact on the ability to achieve dryness with GOGOband®. A crosstab analysis was performed which indicated that high compliant users (>80%) can remain dry 93% of the time compared to the whole group 87.7%. Overall ability to achieve 14 dry nights in a row was 66.7% (36/54) with some achieving a median of 16 14-day periods of dryness (IQR 0-35.75).. We found 93% dry night rate in high compliance users in Weaning, this translates to 1.2 wet nights per 30 days. This compares to all users who wet 26.5 nights prior to treatment and 11.3 wet nights per 30 days during Training. The ability to achieve 14 days straight of dry nights was 85%. Our findings indicate that GOGOband® provides a significant benefit to all its users reducing nocturnal enuresis rates.

Topics: Adolescent; Artificial Intelligence; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Nocturnal Enuresis; Renal Agents

Desmopressin plays a major role in the treatment of monosymptomatic enuresis but has the drawback of a high relapse rate after medical treatment. This study investigated the effect of the type of treatment termination on relapse in a large population of patients. A total of 1013 patients who were admitted with bedwetting to our paediatric urology clinic between October 2016 and April 2018 were evaluated retrospectively. Four hundred forty-seven monosymptomatic enuresis patients were treated with 120 μg/day oral desmopressin lyophilisate for 3 months, after which the treatment was terminated in one of two ways: immediate cessation of desmopressin (group 1; N = 209) and structured withdrawal (group 2; N = 238). In the structured withdrawal group, the patients continued to take desmopressin every other day for 15 days. All the patients were followed up 1 month after the drug was withdrawn, and the relapse rates were recorded. One month after cessation of treatment with oral desmopressin lyophilisate, the relapse rate in group 1 was 42.5% (89/209), and that in group 2 was 41.1% (98/238) (p > 0.05).Conclusion: This study, with the highest number of patients among reports in the literature, revealed that the methods used to terminate desmopressin treatment are not significantly different in monosymptomatic enuresis management. What is Known: • It is still unclear how to end the treatment in patients who are started desmopressin because of the complaint of monosymptomatic nocturnal enuresis. • Although there are papers in the literature suggesting that the drug should be discontinued gradually or by reducing the dose, there are also authors stating the opposite. What is New: • This study including vast amount of patients managed with desmopressin reveals that withdrawal strategy has no impact on relapse.

Topics: Antidiuretic Agents; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Nocturnal Enuresis; Recurrence; Retrospective Studies

To determine the association between urine osmolality (Uosm) in patients with primary monosymptomatic enuresis (PMNE) and response to desmopressin (dDAVP) lyophilisate.. This was a prospective cohort study that included 419 children with enuresis seen in outpatient clinic between October 2017 and October 2019. Patient workup included symptom checklist, 48 h frequency/volume chart, kidney and bladder ultrasound, uroflow, urinalysis and culture, spot urine Ca/creatinine, and first-morning Uosm. Patients < 5 years, with secondary enuresis, or loss of follow-up were excluded. Oral dDAVP lyophilisate was recommended to all with PMNE and normal bladder capacity. After 1 month of therapy, initial success was assessed according to ICCS. Significant predictor variables for complete response were identified and analyzed using correlation coefficients and binary logistic regression.. There were 48 patients with PMNE who received dDAVP and were followed for treatment success. Partial and complete responses were achieved for 14 (29.2%) and 20 cases (41.7%), respectively. Older age and lower Uosm were found to be significantly in favor of complete response to dDAVP lyophilisate, P = 0.007 and 0.033, respectively. ROC analysis determined the Uosm of ≤ 814 mOsm/kg as a cut-off value for complete success (sensitivity 65% and specificity 75%, AUC = 68.2%). The odds ratio for complete success for selected cut-off value was 5.57 (95% CI 1.588-19.551, P = 0.007).. High pretreatment morning Uosm (> 814 mOsm/kg) might be suggestive of an alternative treatment to dDAVP lyophilisate in PMNE because of the higher risk of treatment failure.

Topics: Administration, Oral; Antidiuretic Agents; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Freeze Drying; Humans; Male; Osmolar Concentration; Prospective Studies; Treatment Outcome; Urinalysis

Most treatments of nocturnal enuresis (NE) are targeting the main pathophysiological mechanisms, i.e., excess nocturnal urine production, bladder reservoir dysfunction and inability to awaken to a full bladder. Although many children can be effectively treated with only one treatment modality, there is a significant number of treatment-refractory cases. We experience an increasing tendency to combine treatment modalities in those children. However, there is limited evidence regarding the efficacy and safety of such strategies.. We reviewed files from all NE children seen in our outpatient incontinence clinic between January 1st and December 31st 2017 and identified children refractory to first line treatment receiving a combination of at least two treatment modalities concurrently. Age, gender, wet nights per week before treatment, follow-up time, previous treatment with desmopressin or alarm, phenotype of NE, number of simultaneous treatments tried and response as well as registered side effects during treatment was noted. We registered the outcomes and safety of the treatment modalities and evaluated prognostic factors.. We identified 59 children (13 girls) aged 6-15 yrs (mean 9.6 yrs) of whom 30 were monosymptomatic NE (MNE) and 29 were non-monosymptomatic NE (NMNE) patients. They all suffered at least three wet nights per week before treatment. In total, 38 children (61%) became dry on multimodal therapy. Eighteen children (30%) became dry on a combination of two treatment modalities, 16 (27%) on three modalities, and two (3%) on four modalities. Nine children (15%) achieved partial response whereas three (5%) showed no response despite multiple tries with combination therapies. A total of 18 children (30%) reported side effects to one or more of the modalities tried. Side effects that led to discontinuation of the treatment were uncommon (three patients).. Treatment refractory NE represents a challenge for the clinician. Although it seems possible to adequately treat refractory NE patients with multimodal treatment one should be aware of side effects as well as inform the families of the challenges in the treatment of refractory enuresis patients. Future RCT's should focus on providing further evidence for the role of multimodal therapy in NE treatment.

Topics: Adolescent; Child; Combined Modality Therapy; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Nocturnal Enuresis; Retrospective Studies; Urinary Bladder

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

To evaluate whether the efficacy of desmopressin differs between patients with and without nocturnal polyuria.. A total of 65 treatment-naïve children with monosymptomatic nocturnal enuresis were enrolled (45 boys; median age 8.9 years). Patients received desmopressin as their first-line treatment. Four different standards were used (Akashi and Hoashi >0.9 mL/kg/sleeping hour; Hamano >[age + 2] × 25 × 130% mL; the International Children's Continence Society >[age + 1] × 30 × 130% mL; and Rittig >[age + 9] × 20 mL) to assess nocturnal polyuria. The effectiveness of desmopressin was compared between patients with and without nocturnal polyuria according to each standard. A response was defined as a reduction in wet nights of >50%.. The desmopressin treatment efficacy rate was 54% for polyuria and 67% for non-polyuria patients (P = 0.20), 45% for polyuria and 68% for non-polyuria patients (P = 0.08), 54% for polyuria and 59% for non-polyuria patients (P = 0.80), and 52% for polyuria and 61% for non-polyuria patients (P = 0.61), for the Akashi and Hoashi's, Hamano's, International Children's Continence Society and Rittig's standards, respectively.. No difference was observed in the short-term clinical efficacy of desmopressin regardless of the presence of nocturnal polyuria. Thus, this might be a feasible treatment option for patients with nocturnal enuresis without nocturnal polyuria.

Topics: Antidiuretic Agents; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Humans; Infant; Japan; Male; Nocturnal Enuresis; Polyuria

There is a high prevalence of enuresis in children with neurodevelopmental disorders, yet research regarding treatment for this group has been neglected. The efficacy of treatment using bell and pad alarm therapy is not well reported especially in children with neurodevelopmental disorders. This study sought to compare the treatment efficacy of practitioner-assisted bell-and-pad enuresis alarm therapy for children with neurodevelopmental disorders and typically developing children.. This study utilized the data of Apos et al. (2018), a retrospective medical record audit collected from multiple clinical settings across Australia. A total of 2986 patient records (3659 treatment records) were included. The participants were children aged 5-16 years, who were diagnosed with enuresis. Children with a neurodevelopmental disorder (n = 158) had a clinical diagnosis present in the medical history of attention deficit disorder, autism spectrum disorder, or intellectual disability. Children who indicated any of the following comorbidities were excluded: cerebral palsy, brain injury, malformation of the renal tract, previous bladder or renal surgery, spinal cord malformation, spinal cord trauma or tumor, or a neurodegenerative disorder. Treatment success was defined as ≥ 14 dry nights. Relapse was defined as one symptom recurrence per month post-interruption of treatment, as defined by the International Children's Continence Society definitions.. The success rate for children with neurodevelopmental disorders was 62% and typically developing children was 78%. There was no significant difference between the number of treatments received or relapse rates by those children with a neurodevelopmental disorder and typically developing children. The summary figure shows the percentage of children in each group after their first treatment who were successful (success defined as dry for ≥ 14 days), who succeeded (dry for ≥ 14 days) but then relapsed and those who showed no success. The percentage of children with no NDD who were successfully dry after the first treatment was 78%. Children with ID had success after the first treatment of 59%, the lowest of all groups analyzed.. The type of alarm therapy reported in this study is effective for treating enuresis in children with neurodevelopmental disorders.

Topics: Autism Spectrum Disorder; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Neurodevelopmental Disorders; Nocturnal Enuresis; Retrospective Studies

The case history is the primary tool when investigating the enuretic child. To further determine whether nocturnal polyuria or detrusor overactivity is present, a full voiding chart, is the method of choice. However, there is no robust evidence that daytime voiding chart data actually do predict nocturnal detrusor function.. The aim of this study was to assess the predictive value of anamnestic data and the voiding chart in the treatment of children with therapy-resistant enuresis.. The patients all suffered from enuresis resistant to first-line therapy. None of the children had daytime incontinence. In accordance with international recommendations, the children were first treated with anticholinergics. If the therapeutic effect was not satisfactory dosage was adjusted and desmopressin was added. If sufficient treatment effect was not achieved, antidepressant therapy was tried next, combined with desmopressin if needed. Since this was an evaluation of clinical practice, not a randomized trial, treatment success was graded according to family satisfaction, not the actual frequency of wet nights. Thus, only children who reported that they were completely dry were regarded as full responders and those who stated that there was a substantial and useful reduction of wet nights were labeled intermediate responders.. In total, 154 patients were included. Few and inconsistent differences were found between the groups responding or not responding to the various treatment regimens, and this was true both for anamnestic and voiding chart data (see Table). The only statistically significant findings were that responders to antidepressant therapy were older (p = 0.013) than non-responders, and patients who benefited from addition of desmopressin had a higher micturition frequency than those who did not (p = 0.027). The children who needed desmopressin as part of combination treatment to become dry did not have significantly higher nocturnal urine production than those who had no such benefit (p = 0.619). Neither the presence of urgency nor a history of previous daytime incontinence was significantly more common in children responding to anticholinergics (p = 0.375 and 0.072, respectively).. No clear and consistent differences in either anamnestic factors or voiding chart data were found between the patients responding or not responding to the various treatment regimens. Not even urgency could predict anticholinergic efficacy. Somewhat surprisingly, no association between nocturnal polyuria and desmopressin benefit was found.. In this study no prognostic value was found in anamnestic or voiding chart data in children with therapy resistant enuresis.

Topics: Child; Cholinergic Antagonists; Deamino Arginine Vasopressin; Enuresis; Humans; Nocturnal Enuresis; Prognosis; Treatment Outcome; Urinary Incontinence

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.

Topics: Adolescent; Child; Clinical Alarms; Deamino Arginine Vasopressin; Enuresis; Humans; Nocturnal Enuresis; Recurrence

To test the therapeutic effects of Desmopressin (dDAVP) in primary monosymptomatic nocturnal enuresis (PMNE) treatment depending on patients'age.. The prospective research was carried out in the 2014-2018 period, during which 89 patients were observed who were treated with dDAVP due to the previously diagnosed PMNE. The patients were divided into two age groups. The first group (Group 1) consisted of 43 patients age 5 to 6, with the average age of 5.6 ± 0.5, out of whom 35 (81.4%) were boys, and 8 (18.6%) girls. The second group (Group 2) consisted of 46 patients age over 7 to 12, with the average age of 9.7 ± 1.6, out of whom 30 (65.2%) were boys, and 16 (34.8%) were girls. There was no statistically relevant difference according to sex (p = 0.086). After the 3-month treatment, all the patients in both groups were tested for the effects of dDAVP in PMNE treatment.. The average enuresis frequency in the first group (Group 1) before therapy was 26.0 ± 6.2 per month, whereas the average enuresis frequency after therapy was 11.0 ± 8.0 per month (p = 0.040). The average enuresis frequency in the second group (Group 2) before therapy was 23.1 ± 6.2 per month, whereas the average enuresis frequency after therapy was 3.8 ± 3.6 per month (p = 0.036). ANOVA data analysis of repeated measurements has indicated that there is a statistically relevant interaction between the groups (p = 0.006), i.e. enuresis frequency decreases considerably more in the second group (Group 2).. PMNE with dDAVP is noticeably more effective with patients over 7 years of age.

Topics: Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Nocturnal Enuresis; Prospective Studies; Urinary Incontinence

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Nocturnal Enuresis; Urinary Incontinence

To establish the treatment efficacy of practitioner-assisted bell-and-pad alarm therapy in children with enuresis between the ages of 5 and 16 years by retrospective medical chart review of 2861 children in multiple clinical settings.. This review was conducted across 7 Australian clinical practices. The primary outcome measure was the time taken for children with either primary, secondary, monosymptomatic, or nonmonosymptomatic enuresis to be dry for 14 consecutive nights. The secondary outcome measure was to determine relapse rates, defined as 1 symptom recurrence per month post interruption of treatment. Data were analyzed by correlation and χ. The overall success rate of the bell and pad treatment was 76%, irrespective of age. The mean treatment time to achieve dryness was 62.1 ± 30.8 days, and the relapse rate was 23%. Concurrent bowel dysfunction was associated with a slightly lower success rate (74%). Concurrent lower urinary tract symptoms were associated with a lower success rate (73%) and greater relapse (1.75 times more likely to relapse). Children with secondary enuresis had significantly greater success than those with primary enuresis (82% vs 74%).. The type of alarm therapy reported in this study is highly effective. This study will provide the basis for clinical guidelines and practice tools for clinicians, which will help to reduce variation in care pathways for alarm treatment for enuresis.

Topics: Adolescent; Antidiuretic Agents; Australia; Child; Child, Preschool; Clinical Audit; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Recurrence; Retrospective Studies; Treatment Outcome

Topics: Deamino Arginine Vasopressin; Enuresis; Humans; Recurrence

Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Enuresis; Humans; Nocturnal Enuresis; Urinary Incontinence

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

Topics: Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Humans; Nocturnal Enuresis; Polyuria; Urinary Tract Physiological Phenomena

Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male

To evaluate the effectiveness of presence of desmopressin in treating primary enuresis (PE) for children with attention deficit-hyperactivity disorder (ADHD) symptoms.. Children aged from 5 to 12 years with the chief complaint of PE treated with desmopressin were enrolled in pediatric urology clinics. The parent-reported SNAP-IV questionnaire was used to evaluate ADHD symptoms (cut-off value: 90th percentile). Voiding symptoms were assessed by the Dysfunctional Voiding Scoring System (DVSS) questionnaire. The responses to desmopressin were analyzed in children with and without ADHD symptoms.. The study sample comprised 68 children; 27 (39.7%) presented with ADHD symptoms and 41 (60.3%) with non-ADHD symptoms. The children collected from a tertiary referral center may explain the high prevalence of ADHD symptoms in the present study. The total DVSS score in the ADHD symptoms group was significantly higher than in the non-ADHD symptoms group (7.72 versus 5.65, P=0.05). In the ADHD symptoms group, there were significantly higher score in the "pee 1-2 times/day" and "can't wait" subscales of DVSS and lower sleep quality based on the Pediatric Sleep Quality questionnaire, as well as significantly lower peak flow rate and voided volume. The responses to desmopressin for enuresis were comparable between children with ADHD and non-ADHD symptoms.. Approximately 39.7% of PE children presented with ADHD symptoms at urologic clinics. PE children with ADHD symptoms had higher risk of daytime LUTS and comparable response to desmopressin treatment for PE. To evaluate ADHD symptoms and daytime voiding symptoms is important in children with PE.

Topics: Adolescent; Antidiuretic Agents; Attention Deficit Disorder with Hyperactivity; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Urination

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

Topics: Attention Deficit and Disruptive Behavior Disorders; Child Development Disorders, Pervasive; Cholinergic Antagonists; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Urination

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

Topics: Antidiuretic Agents; Attention Deficit and Disruptive Behavior Disorders; Child; Child Development Disorders, Pervasive; Cholinergic Antagonists; Deamino Arginine Vasopressin; Enuresis; Female; Follow-Up Studies; Humans; Incidence; Male; Pennsylvania; Retrospective Studies; Treatment Outcome; Urination

Topics: Antidiuretic Agents; Behavior Therapy; Child; Deamino Arginine Vasopressin; Diagnosis, Differential; Drinking; Enuresis; Humans; Male; Toilet Training

Topics: Adult; Age Factors; Antidiuretic Agents; Child; Clothing; Deamino Arginine Vasopressin; Enuresis; Family Practice; Humans; Polyuria; Urinary Incontinence

Enuresis is defined as nocturnal bed wetting for at least 2 nights per month in children older than 5 years. At this age the prevalence of enuresis is about 15-20%. More than 50% of these children show day time symptoms, such as frequency, urgency and incontinence (non-monosymptomatic enuresis). The other children are asymptomatic during day time and wet the bed during the night time (monosymptomatic enuresis). The main pathogenetic factors are nycturia, detrusor overactivity and reduced arousability. Psychological and psychiatric aspects, genetics and obstipation play an additional role in the etiology. Basic diagnostic investigations are mandatory before treatment. Clinical history, physical examination, sonography of the urinary tract, urinalysis and bladder diary are prerequisites before any therapeutic steps are taken. The cornerstones of primary enuresis therapy are general lifestyle advice, pharmacotherapy and alarm devices. Therapy-resistant children deserve further evaluation and a multidisciplinary therapy approach. After careful evaluation specific therapy is efficient in approximately 80% of patients.

Topics: Antidepressive Agents, Tricyclic; Behavior Therapy; Child; Child, Preschool; Cholinergic Antagonists; Combined Modality Therapy; Cooperative Behavior; Deamino Arginine Vasopressin; Diagnosis, Differential; Enuresis; Female; Humans; Imipramine; Interdisciplinary Communication; Life Style; Male; Ultrasonography; Urinalysis; Urodynamics; Urologic Diseases

Topics: Antidiuretic Agents; Behavior Therapy; Child; Deamino Arginine Vasopressin; Education; Enuresis; Humans; Male; Toilet Training

Imipramine is the only evidence-based treatment available for enuretic children resistant to standard therapy. The drug's antienuretic effect is probably due to noradrenergic facilitation. The drug is, however, potentially cardiotoxic. In this study, the non-cardiotoxic noradrenergic antidepressant reboxetine was tested as an alternative to imipramine.. 61 patients, aged 7-19 years, with enuresis-resistant to desmopressin, the alarm, urotherapy and anticholinergics, were given 4-8 mg reboxetine at bedtime, if necessary combined with desmopressin.. 32 patients became dry on reboxetine treatment, although 21 of them required combination treatment with desmopressin to achieve this. Eighteen children did not respond and eight children discontinued because of side-effects before treatment could be evaluated. No serious adverse events occurred.. These results need to be confirmed with randomized controlled studies, but indicate that reboxetine will become a safe and efficient treatment alternative for enuretic children resistant to standard therapy.

Topics: Administration, Oral; Adolescent; Adrenergic Uptake Inhibitors; Antidiuretic Agents; Child; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Drug Resistance; Enuresis; Female; Follow-Up Studies; Humans; Imipramine; Male; Morpholines; Pilot Projects; Prognosis; Reboxetine; Retrospective Studies; Urination; Young Adult

Enuresis is defined as repeated, spontaneous voiding of urine during sleep in a child five years or older. It affects 5 to 7 million children in the United States. Primary nocturnal enuresis is caused by a disparity between bladder capacity and nocturnal urine production and failure of the child to awaken in response to a full bladder. Less commonly, enuresis is secondary to a medical, psychological, or behavioral problem. A diagnosis usually can be made with a history focusing on enuresis and a physical examination followed by urinalysis. Imaging and urodynamic studies generally are not needed unless specifically indicated (e.g., to exclude suspected neurologic or urologic disease). Primary nocturnal enuresis almost always resolves spontaneously over time. Treatment should be delayed until the child is able and willing to adhere to the treatment program; medications are rarely indicated in children younger than seven years. If the condition is not distressing to the child, treatment is not needed. However, parents should be reassured about their child's physical and emotional health and counseled about eliminating guilt, shame, and punishment. Enuresis alarms are effective in children with primary nocturnal enuresis and should be considered for older, motivated children from cooperative families when behavioral measures are unsuccessful. Desmopressin is most effective in children with nocturnal polyuria and normal bladder capacity. Patients respond to desmopressin more quickly than to alarm systems. Combined treatment is effective for resistant cases.

Topics: Algorithms; Antidepressive Agents, Tricyclic; Antidiuretic Agents; Behavior Therapy; Child; Combined Modality Therapy; Deamino Arginine Vasopressin; Enuresis; Humans; Imipramine; Practice Guidelines as Topic; Precipitating Factors; Treatment Outcome

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

In children with nocturnal bedwetting, the basic diagnostic evaluation to differentiate between monosymptomatic enuresis and organic or functional urinary incontinence is mandatory. When the diagnosis of monosymptomatic enuresis is set, a stepped therapeutic program is available, in which alarm/behavior therapy has a central role. Drug therapy of monosymptomatic enuresis in childhood is an established option and is reserved for certain indications.

Topics: Adolescent; Behavior Therapy; Child; Child, Preschool; Cholinergic Antagonists; Combined Modality Therapy; Deamino Arginine Vasopressin; Diagnosis, Differential; Enuresis; Family Therapy; Female; Humans; Imipramine; Male; Risk Factors

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

Enuresis nocturna is regularly treated by desmopressin, a vasopressin analog. Its side effects, notably neurological, are fortunately rare. We comment on 5 enuretic children on desmopressin who suffered from hyponatremic encephalopathy (natremia 115-127, median 117 mmol/l).. Side effects appeared at therapeutic doses (10-40 mg/d intranasal). An excessive fluid intake at night was often noted, leading to a dilutional hyponatremia. This may be due to a lack of correct information to the parents. These children presented after a period of warning symptoms, such as headache, vomiting and altered consciousness. Parents could have sought earlier medical attention if they had been informed about these symptoms.. In the absence of fluid restriction, severe hyponatremia can occur in enuretic children on desmopressin. It is therefore mandatory for the prescribing doctor to adequately inform patients and parents to limit fluids at night when desmopressin is used, and seek medical help quickly if any sign of intracranial hypertension appears.

Topics: Administration, Intranasal; Antidiuretic Agents; Child; Child, Preschool; Coma; Confusion; Deamino Arginine Vasopressin; Drinking; Enuresis; Female; Glasgow Coma Scale; Humans; Hyponatremia; Intracranial Hypertension; Male; Seizures; Time Factors

To investigate whether the norepinephrine reuptake inhibitor reboxetine is effective as a non-cardiotoxic alternative to imipramine in the treatment of therapy-resistant enuresis.. Twenty-two children with severely socially handicapping enuresis resistant to urotherapy, the enuresis alarm, desmopressin and anticholinergics (all children had tried all these treatments) were given reboxetine, 4-8 mg at bed-time, for compassionate reasons.. Thirteen of the children (59%) achieved complete dryness with reboxetine, either as monotherapy or combined with desmopressin. Side-effects were minor and did not lead to discontinuation of treatment.. Although the results of this study need to be confirmed in randomized, placebo-controlled trials, reboxetine may prove to be a useful treatment for therapy-resistant nocturnal enuresis.

Topics: Adolescent; Adrenergic Uptake Inhibitors; Child; Cohort Studies; Congenital Abnormalities; Deamino Arginine Vasopressin; Disabled Children; Dose-Response Relationship, Drug; Drug Administration Schedule; Enuresis; Female; Follow-Up Studies; Humans; Imipramine; Male; Morpholines; Probability; Prospective Studies; Quality of Life; Reboxetine; Risk Assessment; Severity of Illness Index; Treatment Outcome

Topics: ADAM Proteins; ADAMTS13 Protein; Administration, Intranasal; Child; Deamino Arginine Vasopressin; Enuresis; Female; Hemostatics; Humans; Purpura, Thrombotic Thrombocytopenic; Recurrence; Syndrome; Thrombosis

The aim of this paper was to examine the early morning spot urine osmolality and some other parameters easily detected from home chart recordings and history as predictive of the therapeutic response to desmopressin in children with monosymptomatic nocturnal enuresis.. Sixty seven monosymptomatic nocturnal enuretic children were included in the study. Age, sex, family history, the number of family members and siblings, existence of urgency symptoms, the history of urinary tract infection, sleep patterns, the number of wet nights per month and bedwetting in the same night were recorded. Additionally, spot morning urine osmolality was examined. All children were given desmopressin for at least 2 months. At the end of the treatment period, patients considered as responders and non-responders were compared in all these parameters.. Although there was considerable overlap between groups, lower spot urine osmolality was the only data we found statistically significant as predictive of response to desmopressin. Moreover, male predominance, fewer wet nights per month and bedwetting per night were also associated with a better response.. We believe that it is important to characterize such different subgroups that could be used as predictors of a good response to desmopressin.

Topics: Antidiuretic Agents; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Osmolar Concentration

Desmopressin has been used extensively for primary nocturnal enuresis and it is associated with a low incidence of adverse effects. The only reported serious side effect is seizure or altered levels of consciousness resulting from water intoxication, which has been reported for the nasal spray. We describe 18 children with clinical symptoms of water intoxication due to the prolonged bioactivity of desmopressin nasal spray.. We evaluated 18 patients with clinical suspicion of prolonged desmopressin bioactivity during treatment with intranasal desmopressin for primary nocturnal enuresis. The control group consisted of 50 children with primary nocturnal enuresis and proven nocturnal polyuria who were treated with the same desmopressin regimen.. All patients had prolonged maximal urinary concentration capacity and delayed restoration of daytime diluting capacity (p <0.01). Of the patients 15 had the characteristic clinical symptoms of water intoxication with vomiting, headache, decreased consciousness and hyponatremia. We suspect that these symptoms are secondary to prolonged desmopressin bioactivity.. Prolonged desmopressin bioactivity may increase the risk of water intoxication.

Topics: Adolescent; Antidiuretic Agents; Child; Deamino Arginine Vasopressin; Enuresis; Female; Half-Life; Humans; Male; Prospective Studies; Time Factors; Water Intoxication

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

The risk of pyelonephritis in children with asymptomatic cystitis or bacteriuria, using desmopressin for primary nonpoliuric nocturnal enuresis, is not known. The aim of this study was to study whether there is a risk of pyelonephritis in rats with cystitis using desmopressin. Wistar rats (n = 28) were divided into four groups of cystitis (groups I-IV). DDAVP (2 microg daily) and saline (0.5 ml daily) were injected intramuscularly for 7 days in groups II and IV and groups I and III, respectively. The urinalysis, urine culture, and 24-h urinary volume (UV(24)) were assessed for all rats on days 1, 3, 5, and 7. In groups III and IV these studies were also performed on days 14, 21, and 28. Serum creatinine was determined on day 7 in all rats and on day 28 in groups III and IV. Groups I and II and groups III and IV were killed at the end of days 7 and 28, respectively. Kidneys and urinary bladders were graded subjectively for inflammation and fibrosis. Inflammation and fibrosis scores in kidney and bladder tissues were not different between DDAVP or saline-injected rats in cystitis groups at weeks 1 and 4. No fibrosis was found in any of the urinary bladders on histological examination. Ascendant pyelonephritis was detected in each of the four rats in DDAVP-administered and saline-administered cystitis groups. The histopathologic scores of the renal tissue with pyelonephritis showed no correlation with the daily urine volume, the positive test results for urine leukocyte esterase with dipstick test, the urine culture results for E. coli based on colony-forming unit per milliliter, or serum creatinine levels in cystitis groups. It was found that the administration of DDAVP to cystitis groups did not increase the risk of ascendant pyelonephritis.

Topics: Animals; Antidiuretic Agents; Carboxylic Ester Hydrolases; Creatinine; Cystitis; Deamino Arginine Vasopressin; Enuresis; Escherichia coli; Male; Pyelonephritis; Rats; Rats, Wistar; Risk Factors; Urine

Topics: Adolescent; Antidiuretic Agents; Brain Diseases; Deamino Arginine Vasopressin; Diabetes Insipidus; Electroencephalography; Enuresis; Female; Humans; Hyponatremia; Male; Middle Aged

Our experiences of managing nocturnal enuresis in Greek children at our Outpatient Clinics of Pediatric Urology are described. Between March 2001 and October 2003, 142 children with primary nocturnal enuresis (93 boys and 49 girls), aged 7-18 years old (mean: 9.0+/-0.5) were included in this prospective study. Initially, behavioral conditioning therapy, using a body-worn urinary alarm, was instructed in all cases. If no improvement was recorded, 40 microg of intranasal desmopressin was administered, initially for three months. If urodynamic studies demonstrated pure detrusor instability, anticholinergics (5 mg oxybutinine or 2 mg tolterodine) were given instead. Combination medication (desmopressin and anticholinergics) was administered for coexisting diurnal enuresis, which was present in 8 children. Among the 142 children the overall response rate was 51.41%. Successful response was recorded in 16 children practicing conditioning behavioral therapy, in 47 receiving desmopressin (with or without anticholinergics), and in 10 children receiving only anticholinergics. During the follow-up period (mean: 6.2 months), no serious side effect was recorded. The use of desmopressin, and anticholinergics in specific subgroups, was found to be effective and safe for the management of nocturnal enuresis in children.

Topics: Administration, Intranasal; Adolescent; Behavior Therapy; Child; Cholinergic Antagonists; Deamino Arginine Vasopressin; Enuresis; Female; Greece; Humans; Male; Prospective Studies; Renal Agents; Treatment Outcome

Topics: Adenoidectomy; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Fluid Therapy; Hemophilia A; Humans; Hyponatremia; Postoperative Care; Postoperative Complications; Renal Agents; Seizures; Tonsillectomy; Water Intoxication

To verify the safety of desmopressin treatment and its associated side-effects in a large number of patients.. The study was conducted in accordance with the guidelines of the Italian Club for Nocturnal Enuresis, whose criteria are: age >5 years; absence of malformations and infections of the urinary tract; absence of psychological disorders or neurological alterations; number of "wet nights" >5-7; control of liquid intake during the afternoon and evening; monitoring of serum electrolytes before beginning treatment; control of body weight before the beginning of treatment and during the first 4-5 days of therapy; and the informed consent of the parents. The therapeutic regimen provided for a maximum dose of desmopressin of 40 microg/day (four puffs/nostril or two tablets), starting from an initial dosage of 20 microg/day (two puffs/nostril or one tablet) 1 h before going to bed. The study involved two groups of patients with monosymptomatic enuresis: some of them had been administered desmopressin in the form of a spray and others in the form of tablets.. A small percentage of patients presented mild, transient side-effects; in no case were severe side-effects verified.. Desmopressin is a safe drug with a low incidence of side-effects.

Topics: Adolescent; Antidiuretic Agents; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Treatment Outcome

Topics: Antidiuretic Agents; Antipsychotic Agents; Clozapine; Deamino Arginine Vasopressin; Enuresis; Glasgow Coma Scale; Humans; Hyponatremia; Male; Middle Aged; Schizophrenia; Severity of Illness Index; Sodium

In the last few years, there have been reports that children with nocturnal enuresis frequently have hypercalciuria. Likewise, children with desmopressin-resistant enuresis have recently been reported to have a higher renal concentration capacity than patients with desmopressin-sensitive enuresis.. To study renal function and urinary calcium excretion and to register familial history of enuresis and urolithiasis in a group of children with enuresis, whether responders or nonresponders to desmopressin, followed-up in our hospital.. A cohort of 60 patients (42 boys and 18 girls) who were referred to the hospital because of nocturnal enuresis.. Hypercalciuria was detected in 26 children (43.3 %) and hypocitraturia in eight (13.3 %). The frequency of hypercalciuria was higher in desmopressin-resistant patients than in desmopressin-sensitive patients, but this difference was not statistically significant. Sonographic renal morphological anomalies were detected in 11 children (18.3 %). No differences in renal handling of water were detected when the patients were distributed according to the grade of sensitivity to desmopressin.. In our cohort we found a high frequency of hypercalciuria in children with nocturnal enuresis. No differences were observed in maximal urinary osmolality among desmopressin-resistant and desmopressin-sensitive children.

Topics: Antidiuretic Agents; Calcium; Child; Deamino Arginine Vasopressin; Drug Resistance; Enuresis; Female; Humans; Kidney; Male; Ultrasonography; Urinary Calculi

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

To achieve dryness in children who suffer from persistent bedwetting, it is important to find out which factors play a role in their bedwetting and why previous treatment has failed. The use of a micturition diary is essential. The child's problems and needs have to be identified and treated individually. The enuresis alarm, with the proper guidance, is the preferred form of initial treatment. Desmopressin is particularly suitable in cases of nocturnal polyuria or if the use of the alarm is unfeasible. If the alarm does not have any effect within two weeks or if a rapid result is important, a combination of desmopressin and the alarm is advisable. Bedwetting combined with daytime micturition problems is often indicative of a small bladder capacity and/or detrusor instability. In these children bladder training and/or treatment with an anticholinergic drug (possibly combined with desmopressin) may be effective.

Topics: Behavior Therapy; Child; Child, Preschool; Combined Modality Therapy; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Renal Agents; Treatment Outcome

Topics: Child; Cues; Deamino Arginine Vasopressin; Enuresis; Female; History, 20th Century; Humans; Male; Mythology; Psychotherapy; Renal Agents

We evaluated desmopressin (DDAVP) treatment in patients with neuropathic bladder secondary to neural tube closure defects (NTDs) and nocturnal incontinence.. We selected 25 patients, that is 10 males (40%) and 15 females (60%), between ages 7 and 16 years (mean 9.8) with neuropathic bladder secondary to NTDs without a ventricular-peritoneal shunt. All had a low pressure bladder and presented with daytime continence between catheterizations but had persistent nocturnal urine loss 7 nights weekly. They underwent treatment with oral DDAVP according to a certain design, namely an initial dose of 0.2 mg for 3 weeks, which was increased to 0.3 or 0.4 mg for another 3 weeks in nonresponders. The average dose was 0.2 mg. At the effective minimal dose (bedwetting decrease greater than 50%) patients continued for 6 months and then decreased by intervals of 0.05 mg every 2 weeks. In the event of recurrence treatment continued for 1 year.. All patients responded to treatment during the nighttime hours except 1 who suspended treatment after 4 weeks. There were no adverse effects from DDAVP.. Treating nocturnal bedwetting with DDAVP in patients with NTDs was effective and safe. Nevertheless, to our knowledge treatment duration has not yet been determined.

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Neural Tube Defects; Renal Agents; Urinary Bladder, Neurogenic

Accurate assessment of bladder dysfunction associated with voiding dysfunctions often necessitates invasive urodynamic (UD) studies. We evaluate the use of a special ultrasound (US) protocol for the assessment of bladder dysfunction compared with urodynamic findings, and for prediction of treatment outcome in children with primary nocturnal enuresis (PNE).. US measurements were performed on 514 children 5 to 18 years old (mean age 11.2) with PNE, and compared with those of 339 normal age matched children. A US protocol was specially designed for the evaluation of bladder parameters using bladder volume and wall thickness index (BVWI %), and expected percentage bladder volume index for kidney volume. Of the enuretic children 218 had severe enuretic symptoms with more than 3 wet nights a week. They underwent urodynamic studies for detailed assessment of any underlying bladder dysfunction. A standard 4-week course of desmopressin was given to these children after the US and UD studies. The US bladder parameters were then correlated with the UD findings and treatment response to desmopressin.. Comparing the BVWI in normal and enuretic children in correlation with functional bladder capacities we were able to delineate bladder wall thickness and capacity as BVWI less than 70-small capacity bladder with thick wall, BVWI 70 to 130-normal bladder capacity with normal wall thickness and BVWI greater than 130-large bladder capacity with thin wall. There were statistically significant correlations between BVWI and treatment response. In addition, there was a high predictive value of normal bladder function with a normal BVWI. Patients with good response to treatment had normal BVWI, whereas poor response to treatment was significantly associated with pathological bladder conditions, that is small bladder capacity with thick bladder wall or large bladder capacity with thin bladder wall (p <0.0001). Of note, abnormalities detected by UD correlated well with bladder abnormalities measured by US.. PNE comprises a diverse spectrum of conditions resulting in a mismatch of nocturnal urine production in excess of nocturnal functional bladder capacity, and underlying bladder dysfunction has an important role in the pathophysiology especially in refractory cases. This US protocol can provide useful predictive clues, which may be helpful to differentiate treatment subtypes, guide clinical management and minimize the need for invasive urodynamic studies.

Topics: Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Prognosis; Renal Agents; Treatment Outcome; Ultrasonography; Urinary Bladder; Urodynamics

We studied the characteristics of a group of monosymptomatic nocturnal enuretics successfully treated with the alarm system, with special reference to changes in functional bladder capacity.. The diaries of 7 girls and 19 boys 7 to 13 years old with severe nocturnal enuresis, small daytime bladder capacity (70% or less of expected capacity for age) and poor or absent response to desmopressin were analyzed. Patients were treated with an alarm until complete dryness was achieved for 21 consecutive nights before ending therapy. Immediately after the treatment they recorded a 1-week followup diary of voiding and fluid intake.. Mean duration of the alarm treatment was 82 days, and there was no change in nocturnal or 24-hour diuresis from baseline to followup. Nocturia developed during the alarm treatment in 48% of the children. The nocturnal diuresis on nocturia nights was significantly higher than on nights without nocturia. Daytime functional bladder capacity increased significantly in children with and without nocturia.. Treatment with an alarm system increases daytime functional bladder capacity significantly in children with and without nocturia. A higher nocturnal urine production on nocturia nights explains why some children have nocturia and others do not.

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Renal Agents; Severity of Illness Index; Urinary Bladder

The use of desmopressin in the treatment of primary nocturnal enuresis (PNE) is accepted and based on the fact that this drug leads to renal water reabsorption. However, recent findings have also implicated that desmopressin regulates other molecules, such as sodium and potassium. We investigate if desmopressin influences renal Ca2+ handling.. A total of 32 children with PNE were enrolled in a prospective study. Patients received a standard 30 microg desmopressin intranasally before going to bed. All patients were treated for at least 4 weeks. Desmopressin was then withdrawn and reintroduced after 2 weeks. Urine samples were collected during all 3 phases of the study. Ca2+ measurement was performed in single morning spot urines as well as in 24-hour collections. Additionally, blood was sampled for analysis of Ca2+. The Wilcoxon signed rank test was used for statistical analysis.. Wet nights decreased an average of 4.75 to 1.0 per week with desmopressin treatment. While blood concentrations did not change with or without medication, urinary Ca2+ excretion was significantly higher while patients were treated with desmopressin. This significant result was the same in single spot as well as in 24-hour samples.. This study demonstrated the increased excretion of Ca2+ by desmopressin treatment in children with PNE. Since Ca2+ is a crucial molecule in growth and development, this finding indicates the necessity of larger followup studies concerning Ca2+ handling and growth in children on long-term desmopressin treatment.

Topics: Adolescent; Calcium; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Prospective Studies; Renal Agents

Topics: Child; Child, Preschool; Clinical Trials as Topic; Deamino Arginine Vasopressin; Electronics; Enuresis; Equipment and Supplies; Humans; Monitoring, Physiologic; Renal Agents; Urination

Monotherapeutic strategies often have only partial success in primary nocturnal enuresis (PNE). This analysis evaluated whether adjuvant treatment strategies improve outcomes. PNE children were submitted to a distinct therapeutic strategy including urotherapy (behavioral modifications), a first-line and, if necessary, a second-line treatment period. Outcome was the relief of bedwetting, the follow-up was 3-79 months. Urotherapy was applied. Nonresponders were assigned to desmopressin as first-line treatment. For complete responders a structured withdrawal program was applied. Partial responders were assigned to adjuvant second-line treatment according to their individual symptomatology, masked at basic investigations, incorporating either anticholinergics (propiverine hydrochloride), biofeedback, alpha-blocker (alfuzosin), alarm or psychotherapy, in addition to desmopressin. Nonresponders were referred to specialized management. The study included 259 children suffering from PNE (92 girls, 167 boys, aged 5-18 years): 42 children were relieved from bedwetting after urotherapy and 136 children had a complete response to desmopressin. Three nonresponders were assigned to specialized management, 61 partial responders had adjuvant treatments, and 17 partial responders had no further treatment. The suggested treatment algorithm resulted in 227 complete responders, 29 partial responders, and 3 nonresponders. The need for preliminary urotherapy is evident. The proposed desmopressin monotherapeutic strategy, incorporating a structured withdrawal program, is more effective than the standard desmopressin treatment module. Applying adjuvant treatment modules improves the complete response rate up to 88%. In partial responders overall efficacy rates are improved further. Nonresponders (1.2%) will be referred to specialized management, but many partial responders will gain improvement sufficient to refrain from invasive procedures.

Topics: Adolescent; Algorithms; Behavior Therapy; Benzilates; Biofeedback, Psychology; Child; Child, Preschool; Combined Modality Therapy; Deamino Arginine Vasopressin; Enuresis; Female; Follow-Up Studies; Humans; Male; Outcome and Process Assessment, Health Care; Psychotherapy; Quinazolines; Recurrence; Retreatment; Treatment Failure; Urodynamics

Topics: Antidiuretic Agents; Child; Coma; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Hyponatremia; Seizures

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Enuresis; Humans; Nurse's Role; Patient Education as Topic; Patient Selection; Renal Agents; Teaching Materials

Topics: Adult; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Renal Agents; Urinary Incontinence; Urinary Incontinence, Stress

Topics: Behavior Therapy; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Renal Agents

Topics: Academies and Institutes; Antidepressive Agents, Tricyclic; Child; Cholinergic Antagonists; Contraindications; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Renal Agents; Sleep Arousal Disorders; South Africa; Urinary Bladder; Vasopressins

Topics: Administration, Oral; Adolescent; Child; Deamino Arginine Vasopressin; Enuresis; Female; Fluvoxamine; Humans; Male; Renal Agents; Selective Serotonin Reuptake Inhibitors

On behalf of the Swedish Enuresis Academy a survey how children with primary enuresis nocturna are handled, a questionnaire about investigation and treatment of the condition was sent to all pediatric clinics in Sweden. It was found, that the care of children with enuresis nocturna is initiated at the age of 5-6 years. After a careful history (especially to exclude daytime incontinence problems or signs of bladder dysfunction), a clinical investigation of the child and an urinalysis (dipslide), treatment is started with bedalarm or desmopressin owing to what the child and parents have chosen after having been offered both alternatives. Bedalarm is available at all pediatric clinics, mostly for hire. Follow up is usually performed by telephone by a specialist nurse or urotherapist. Most children with enuresis nocturna are handled at primary care clinics by general practitioners. To complete the survey a similar study in the primary health care system is therefore suggested.

Topics: Child; Child, Preschool; Cholinergic Antagonists; Deamino Arginine Vasopressin; Enuresis; Equipment and Supplies; Follow-Up Studies; Guideline Adherence; Humans; Pediatrics; Reminder Systems; Surveys and Questionnaires; Toilet Training; Workforce

Topics: Antidepressive Agents, Tricyclic; Deamino Arginine Vasopressin; Enuresis; Humans; Imipramine; Practice Guidelines as Topic

Desmopressin may not be effective for nocturnal enuresis associated with polyuria and hypercalciuria. Nighttime hypercalciuria in an enuretic population from 5 centers and its correlation with nighttime polyuria were verified.. A total of 450 enuretic patients (278 males, 172 females, mean age 9.7 years) were evaluated with 72-hour micturition charts, urinalysis, serum creatinine and osmolarity, diurnal and nocturnal electrolytes with fractional Na+ and K+ urinary excretion, and nocturnal (4 a.m.) plasma vasopressin. Creatinine electrolytes and osmolarity were measured in daytime (8 a.m. to 8 p.m.) and nighttime (8 p.m. to 8 a.m.) urine volumes. Patients were divided into group 1 with nocturnal polyuria and group 2 without nocturnal polyuria. Hypercalciuria was defined as urinary calcium-to-urinary creatinine ratio greater than 0.21. Statistic evaluation was performed using chi-square, Pearson correlation and ANOVA tests.. Nighttime polyuria was demonstrated in 292 bedwetters (65% group 1). Nocturnal hypercalciuria was present in 179 of the 450 children (39.7%), including 125 in group 1 (42.8%) and 54 in group 2 (34.2%), which was statistically significant (chi-square p = 0.008, Pearson correlation test r = 0.157). Daytime calciuria was not statistically modified in either group (group 1 p = 0.054, group 2 p = 0.56). Adrenocorticotropic hormone (ADH) was normal in 18.5% and low in 81.5% of enuretics with nocturnal hypercalciuria. ADH levels and nocturnal hypercalciuria significantly correlated (p = 0.003, r = 0.148). Conversely, the group 2 patients had normal ADH levels.. Nocturnal hypercalciuria has a pivotal role in nocturnal enuresis, as it is significantly associated with low ADH levels and nocturnal polyuria. A new classification of nocturnal enuresis subtypes based on nighttime calciuria levels is mandatory to address treatment properly.

Topics: Adolescent; Adrenocorticotropic Hormone; Calcium; Child; Circadian Rhythm; Creatinine; Deamino Arginine Vasopressin; Diagnosis, Differential; Electrolytes; Enuresis; Female; Humans; Male; Polyuria; Vasopressins

Desmopressin diacetate arginine vasopressin (DDAVP) is a synthetic analogue of the mammalian arginine vasopressin used in the treatment of central diabetes insipidus, bleeding disorders, and incontinence. The primary adverse reaction associated with DDAVP is hypotonic hyponatremia. Hyponatremia has been reported in adults treated with DDAVP for Von Willebrand's disease and hemophilia and in children treated for enuresis, but as yet few cases of hyponatremia developing in enuretic adults treated with DDAVP have been reported. We report the cases of two elderly women taking DDAVP for nocturnal polyuria who developed severe hyponatremia. One patient died in the hospital.

Topics: Aged; Aged, 80 and over; Deamino Arginine Vasopressin; Enuresis; Fatal Outcome; Female; Humans; Hyponatremia; Polyuria; Renal Agents

The neurological control of bladder function and the ability to be dry at night involves not only the acquisition of normal daytime control, but also the establishment of a circadian rhythm in vasopressin release and the ability to arouse to a full bladder during sleep. We postulated that in some children there might be a delay in maturation of the normal neurological pathways involved in establishment of nocturnal continence and examined this by using a specific neuropsychological test.. Children attending an established nocturnal enuresis clinic were examined using the Rey-Osterrieth test to assess the presence or absence of boundary errors in both copy and memory reproductions. The results of the test were scored independently and blind to the response to treatment with the vasopressin analogue DDAVP.. A significant association was found between boundary type errors and response to DDAVP, with non-responders making significantly more errors. No child with three or more errors responded to DDAVP. Using this test, the ability to predict response to treatment was 70%.. It is postulated that the Rey-Osterrieth test, through the presence or absence of boundary errors, reflects a delay in maturation and/or a disorganisation of the retinal-hypothalamic-cortical pathways in the brain. The association previously described with growth hormone neurosecretory dysfunction syndrome would be compatible with this.

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Memory; Neuropsychological Tests; Prospective Studies; Psychomotor Performance; Renal Agents; Retrospective Studies

Topics: Arousal; Child; Deamino Arginine Vasopressin; Diabetes Insipidus, Nephrogenic; Enuresis; Humans; Male; Renal Agents; Urination Disorders

Topics: Child; Deamino Arginine Vasopressin; Diabetes Insipidus, Nephrogenic; Enuresis; Humans; Imipramine; Renal Agents

Childhood enuresis is a common socially disruptive problem. The possible pathophysiological factors include a disorder of sleep arousal, nocturnal polyuria, and low bladder capacity. The evaluation of a patient with nocturnal enuresis is aimed to exclude any organic pathology, UTI and voiding dysfunction. An approach to management of this common disorder is outlined.

Topics: Child; Child Development; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Humans; Renal Agents; Urodynamics

To detect effects of desmopressin on sleep in enuretic children and to look for polysomnographical differences between responders and non-responders to desmopressin treatment.. Twenty-one children with primary nocturnal enuresis were examined polysomnographically before treatment. All but one of the children then received treatment with desmopressin in standard dosage, and the response was documented. Seven of the children underwent a second polysomnographic registration while on treatment.. The time interval (+/- 1 SD) between sleep onset and the enuretic episode was 92 +/- 67 min without medication and 372 +/- 157 min when desmopressin was given (p = 0.003). Standard polysomnographic variables were not affected by the drug. Ten children were desmopressin responders and 10 were non-responders. The total sleep time was 455 +/- 56 min in the former and 408 +/- 31 min in the latter group (p = 0.04). The responders spent 27.4 +/- 5.5% of their total sleep time in rapid eye movement sleep, compared with 18.2 +/- 6.5% in the non-responder group (p = 0.004).. Desmopressin has no major effects on sleep as such but does delay bladder emptying. Enuretic children responding to desmopressin treatment have more rapid eye movement sleep than therapy-resistant children.

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Polysomnography; Renal Agents; Sleep; Treatment Outcome; Urination

To assess the features of adolescent bedwetters, as few data are available on enuresis in this age group.. A specific database for adolescents and young adults was created with the collaboration of various specialists (paediatricians, urologists, gynaecologists, psychiatrists). Questions focused on family and personal history, stressful events, age of attaining urinary and fecal control, characteristics of enuresis (primary vs secondary, monosymptomatic vs enuresis associated with daytime urinary symptoms), school performance, diagnostic examination and physical examinations, and treatment and its response.. Data were collected from 107 enuretic adolescents (mean age 15.3 years, median 14, range 13-23; 63 males and 44 females). A positive family history for enuresis was recorded in 82%. Enuresis was primary in 79 patients (74%), secondary in 28 (26%), monosymptomatic in 76 (71%) and associated with daytime urinary symptoms in 31 (29%). In males monosymptomatic enuresis was significantly more frequent than in females (P < 0.01). Urinary tract infections were reported by 13 patients, all females; eating disorders (anorexia, polyphagia) were present in six. In 85 patients (80%) enuresis was considered severe (> or = three nights/week). Of the 107 patients, 27 (20%) had never consulted a doctor about their problem and 43 (40%) had received no therapy; 66 received desmopressin monotherapy, with a good response (half the number of wet nights) in 44 (79%). There was no relation between response to desmopressin and gender, age, type and severity of enuresis or positive family history of enuresis. Eight patients were provided with a nocturnal alarm but this was not tolerated by two. Altogether, 25 patients refused any therapy or did not comply with the given therapy.. Enuresis can persist into adolescence and be a significant problem; 80% of these patients had severe enuresis and 31% also had associated daytime urinary symptoms, with 40% receiving no previous therapy. The treatment of enuresis can be particularly difficult at this age; 22% of patients did not respond to desmopressin and 23% had low compliance with the given therapy. Enuresis in adolescents requires further study; hopefully more enuretic children will receive adequate treatment before reaching adolescence.

Topics: Adolescent; Adult; Age Distribution; Birth Weight; Cholinergic Antagonists; Databases, Factual; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Italy; Male; Patient Compliance; Sex Distribution; Treatment Outcome

In recent years synthetic vasopressin analogues (particularly desmopressin) emerged as safe and effective representatives of this class of drugs for same clinical indications as natural hormone. It was imperative to create intranasal drug form using synthetic desmopressin compound. The purpose of this work was to develop formulations of intranasal desmopressin drug using synthetic active compound with optimal composition. Aquatic desmopressin intranasal solution was prepared in 0.05 mg/ml concentration using phosphate buffer (pH 4.5-5.5) and following preservatives: nipagin-nipazol 7:3--0.1% or benzalkonium chloride 0.01%. Sterility is the main condition for intranasal drops and hormones as a raw material are thermolabile so it is not possible to apply a thermic sterilisation. Polymeric membrane filters of 0.22 micron pore size were employed as sterilizing filters. In order to control the quality, to determine the stability of desmopressin intranasal drops at long-lasting storage (24 months) and to evaluate the influence of the technological factors we have developed the analytical methods of quality control. According to our quality control data, desmopressin intranasal drops are stable for two years and remain sterile during storage and administration of the drug.

Topics: Administration, Intranasal; Chemistry, Pharmaceutical; Child; Data Interpretation, Statistical; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuretics; Drug Stability; Drug Storage; Enuresis; Filtration; Humans; Renal Agents; Sterilization; Temperature; Time Factors

A 10-year-old male referred to our clinic with the chief complaint of nocturnal enuresis also complained of daytime polyuria, frequency, and polydipsia. The clinical diagnosis was central diabetes insipidus. Since the patient's father had complained of similar symptoms, the arginine vasopressin-neurophysin II gene was examined. This revealed a single base substitution in one of two alleles in the patient, his father, and his grandfather (a C to T transition at nucleotide position 280 at codon 19 in the first exon). In conclusion, a history of polyuria or polydipsia should be carefully noted and the urinary volume and urine gravity or osmolarity examined in cases of nocturnal enuresis.

Topics: Arginine Vasopressin; Brain; Child; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; DNA; Enuresis; Humans; Magnetic Resonance Imaging; Male; Neurophysins; Pedigree; Reverse Transcriptase Polymerase Chain Reaction; Saline Solution, Hypertonic

Topics: Deamino Arginine Vasopressin; Drug Industry; Drug Labeling; Enuresis; Humans; Professional Misconduct; Renal Agents; United Kingdom

We have investigated two unrelated families, in which two children had inherited primary nocturnal enuresis, and nephrogenic diabetes insipidus caused by new mutations in the aquaporin-2 gene (AQP2). The mutant AQP2 proteins were inactive, suggesting that administration of desmopressin could not concentrate the urine in these patients. However, treatment with desmopressin resolved primary nocturnal enuresis completely. This observation questions the notion that desmopressin resolves primary nocturnal enuresis through pharmacological manipulation of renal concentrating ability only. Desmopressin might also act on extrarenal targets such as the central nervous system.

Topics: Child; Deamino Arginine Vasopressin; Diabetes Insipidus, Nephrogenic; Enuresis; Humans; Pedigree; Renal Agents

Topics: Antidepressive Agents, Tricyclic; Child; Cholinergic Antagonists; Deamino Arginine Vasopressin; Enuresis; Equipment and Supplies; Family Practice; Humans; Male

Robert, a nearly 12-year-old boy, traveled an hour to see a new pediatrician. Robert's mom told the pediatrician that Robert had not been seen by a doctor for several years because "no one seems to be able to help him with his problem." Robert had been wetting the bed "ever since he was toilet-trained" at age 2 years. Robert wets the bed about 5 out of 7 nights. He never has daytime accidents. He did not have a history of urinary tract infection, dysuria, urgency, or increased frequency of urination. He has daily bowel movements and denied soiling or accidents. Robert's mom said he had "toilet-trained himself" at age 2 years. Both Robert's mom and maternal grandfather had nocturnal enuresis "into their teenage years." The pediatrician was surprised to learn that another physician had treated Robert with imipramine at age 5 years. The medication worked intermittently and Robert continued to take it for about a year. At age 6 years, Robert's parents saw an advertisement for a bed-wetting alarm. They purchased the alarm but found that Robert never woke up when the alarm sounded. At age 7 years, Robert saw a urologist who told him he would "outgrow the problem." A year later, the urologist prescribed desmopressin acetate (DDAVP) nasal spray, which Robert took on occasion during the next 2 years. Every time he stopped the DDAVP, he resumed wetting the bed. His parents never punished him for his accidents, but they did try restricting fluids after dinner and also woke Robert in the middle of the night and encouraged him to go to the bathroom. Neither of these strategies was successful. Robert said he was "frustrated" and wondered if "I would still be wetting the bed as a grown-up." The pediatrician explained the nature of enuresis to Robert and his mom, provided them with instructions and an order form for a bed-wetting alarm, and arranged a follow-up visit. The next day, during nursery rounds, he asked several of his colleagues about their approaches to the treatment of enuresis. A few used DDAVP, one found imipramine beneficial, and one preferred behavioral treatment with a bed-wetting alarm. The pediatrician became concerned that he had misread the literature on enuresis. He brought the question up at the next pediatric staff meeting at the local hospital. A lively discussion ensued as the physicians realized that they employed a variety of treatments for enuresis. Robert's pediatrician wondered why his colleagues were not using the alarm because the literat

Topics: Administration, Intranasal; Antidepressive Agents, Tricyclic; Child; Deamino Arginine Vasopressin; Enuresis; Equipment Failure; Humans; Imipramine; Male; Renal Agents

Seven cases of cerebral oedema have been observed in enuretic children during low-dose desmopressin (DDAVP) treatment given in a dose of 7-21 microg daily in the Czech Republic between 1995 and 1999, after the drug started to be marketed for this indication and delivered in simple bottles with a dropper. All seven children (age 5-11 years, four boys) experienced a period of unconsciousness but all recovered without sequelae. In most cases, safety measures were underestimated and natraemia was not regularly controlled. Two children developed cerebral oedema after excessive water intake in preparation for uroflowmetry, another one drank much during a hot summer day, in one diabetes insipidus was not recognised and two children were clearly non-compliant with reduced fluid intake on a long-term basis. Only in one child, no risk factor was found. Conclusion. Proper selection and instruction of patients is needed to avert cerebral oedema during treatment with desmopressin for nocturnal enuresis.

Topics: Brain Edema; Child; Child, Preschool; Consumer Product Safety; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Hyponatremia; Male; Renal Agents; Water Intoxication

Intranasal administration of 1-deamino 8-D-arginine vasopressin (DDVAP) used for treatment of nocturnal enuresis (NE), might be expected to have various effects on the nasal mucosa, e.g. altering the clearance by the mucociliary apparatus. We evaluated two samples (brushes) of epithelial surface cells from the nasal mucosa, one from each nostril, of 18 children (ten males and eight females) with a mean age of 7.7 years (range: 5-13 years) who were affected by primary NE. Samples were taken before and 1 and 6 months after administration of DDVAP spray. No qualitative changes in the epithelial surface cells from nasal mucosa were recognized and only non-statistically significant increases in percentages of goblet, ciliated, basal and unciliated cells at 1 and 6 months after therapy were observed. Thus, it appears that DDVAP spray can be used for at least 6 months in children without apparent risk of damage to the epithelial surface cells from the nasal mucosa.

Topics: Administration, Intranasal; Adolescent; Aerosols; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Epithelium; Female; Humans; Male; Nasal Mucosa; Renal Agents

Desmopressin, a synthetic analogue of the antidiuretic hormone, is an effective medication for primary nocturnal enuresis for both children and adults. Its safety is well established. Although it has a favorable side effect profile, because of its pharmacological effect, intranasal desmopressin can rarely induce water intoxication with profound hyponatremia if given without adequate restriction of water intake. The authors describe an adult patient with water intoxication and severe hyponatremia accompanied by loss of consciousness and seizures after 2-day intranasal administration of desmopressin. The present and the previously reported cases emphasize the need for greater awareness of the development of this serious and potentiallyfatal complication. In addition, to adjust the drug to the lowest required dosage, adequate restriction of water intake is recommended, and serum levels of sodium should be measured periodically to allow for early detection of water intoxication and hyponatremia.

Topics: Administration, Intranasal; Adult; Coma; Deamino Arginine Vasopressin; Drinking; Enuresis; Female; Humans; Hyponatremia; Seizures; Water Intoxication

We compared bladder volume and renal concentrating capacity in dry children and 2 distinct groups of children with enuresis to hypothesize about the pathogenesis of various types of enuresis.. A total of 55 dry children and 100 with enuresis underwent an overnight thirst provocation test to assess renal concentrating capacity and completed a 2-day voiding chart to assess functional bladder capacity. The enuretic children were subdivided into 27 desmopressin responders and 73 desmopressin nonresponders before study inclusion.. The desmopressin responder group had lower average renal concentrating capacity +/-1 standard deviation than dry children and desmopressin responders (856 +/- 158 mOsm./kg. versus 939 +/- 147 and 962 +/- 151, respectively, p <0.05). Analogously average daytime urine production in the desmopressin responder group was greater than in dry children and desmopressin responders (22.2 +/- 10.2 ml./kg. body weight versus 15.4 +/- 7.3 and 15.3 +/- 7.2, respectively, p <0.01). Average functional bladder capacity expected for age was less in desmopressin nonresponders than in dry children and responders (52.2% +/- 19.9% versus 79.2% +/- 30.4% and 69.5% +/- 25.7%, respectively, p <0.001).. Desmopressin responders produced larger amounts of less concentrated urine than the other children, while desmopressin nonresponders had smaller bladder capacity than the other groups. These results support the idea that enuretic children who respond favorably to desmopressin treatment have polyuria, whereas children with therapy resistant enuresis have detrusor hyperactivity.

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Kidney Concentrating Ability; Male; Osmolar Concentration; Renal Agents; Urinary Bladder

Topics: Adult; Deamino Arginine Vasopressin; Enuresis; Humans; Hyponatremia; Intellectual Disability; Male; Renal Agents; Seizures

More than 250,000 patients with nocturnal enuresis have been treated with DDAVP in the United States since 1989. It adequately controls nocturnal enuresis in over half of patients with significant improvement in their quality of life. Although the overall incidence of adverse effects associated with treatment of nocturnal enuresis with DDAVP is low, it is not a benign drug particularly when used in patients at extreme of age. A review of the literature and the present case demonstrate that the potential risk factors for hyponatremia following administration of DDAVP include hepatic disease, surgery, stress, pain, renal disorder, excessive fluid intake, and increased dose of DDAVP. Potentially serious side effects of DDAVP administration such as hyponatremia and seizure may be prevented by close monitoring of serum electrolytes, urine output, as well as fluid restriction and avoidance of solutions with low-sodium content.

Topics: Adult; Cerebral Palsy; Deamino Arginine Vasopressin; Drug Monitoring; Enuresis; Humans; Hyponatremia; Intellectual Disability; Male; Renal Agents; Risk Factors; Sodium

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

Topics: Antidepressive Agents, Second-Generation; Antidepressive Agents, Tricyclic; Case-Control Studies; Child; Cross-Over Studies; Deamino Arginine Vasopressin; Enuresis; Female; Fluvoxamine; Humans; Imipramine; Male; Renal Agents; Treatment Outcome

We determined the prevalence of positive family history of nocturnal enuresis in relation to response to desmopressin.. A total of 328 children with nocturnal enuresis and 53 normal children were interviewed to determine the presence of family history of nocturnal enuresis. Response to desmopressin was confirmed in some cases by home recordings of enuresis episodes during 2 baseline weeks and 2 weeks of 20 to 40 microg. desmopressin intranasally.. Significantly more patients than normal children (75% versus 38%, p <0.001) reported a positive family history of enuresis (any relative). The high prevalence of a positive family history of nocturnal enuresis was present in severe/nonsevere or primary/secondary types of enuresis. Of the patients 141 completed 4 weeks of home recordings including 20 with a complete response (greater than 90% reduction in wet nights week), 25 with a partial response (50% to 90% reduction) and 96 with no response (less than 50% reduction). The prevalence of a positive family history (any relative) was no different among the response groups (80%, 84% and 78%, respectively). Similarly, family history, as defined by first order relatives only, showed no relation to treatment response.. A positive family history of nocturnal enuresis is more prevalent in patients with enuresis than in normal children regardless of the nature of the nocturnal enuresis. In contrast to previous reports, a positive family history failed to predict a good response to desmopressin treatment. Hereditary factors are important to consider in desmopressin responding and desmopressin resistant cases.

Topics: Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Prevalence; Renal Agents; Treatment Outcome

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

Early morning urine osmolality was tested in two urinary specimens, one taken immediately upon awakening and the other approximately 30 min thereafter, in 52 enuretic and 15 non-enuretic children. In a follow-up study, using the same study population, urine osmolality and volume were measured sequentially at 3-h intervals at 19.00, 22.00, 01.00, 04.00 and 07.00 h. Thereafter, all enuretics were treated by intranasal DDAVP for a 6-month period. There were no differences in urinary osmolality between enuretic and non-enuretic children when comparing the two early morning specimens. Nor were there any differences between groups in urine osmolalities at 19.00, 01.00 and 07.00 h. In contrast, at 04.00 h, urine osmolality was significantly lower in 17 of 52 enuretics [designated as ADH-negative (ADH-)] compared to the remaining enuretics [designated as ADH-positive (ADH+)] and non-enuretic children (610 +/- 251 vs 995 +/- 195 and 1089 +/- 195 mosmol/kg H2O, respectively, p < 0.05). This decreased osmolality was paralleled by an increase in urine production during the time period 01.00-04.00 (83 +/- 24 vs 52 +/- 18 and 45 +/- 22 ml, respectively, p < 0.05). At the end of the 6-month period of DDAVP treatment, the percentage response was similar between the ADH- and ADH+ enuretics (79% vs 75%). However, the time taken to achieve a response was quicker in the ADH- subjects. These data suggest the existence of a subgroup of enuretics whose underlying pathophysiology is the development of nocturnal polyuria probably due to a relative night-time ADH deficiency. Nocturnal sequential monitoring of urinary osmolality, as described above, allows identification of this subgroup.

Topics: Child; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Osmolar Concentration; Polyuria; Renal Agents; Time Factors; Urination Disorders; Urine; Vasopressins

Primary monosymptomatic nocturnal enuresis is a common complaint in paediatrics. Treatment with desmopressin nasal spray is one of the most often used pharmacological approaches, but concerning therapy interruption, to date no guidelines have yet been established. The aim of this study was to report the use of desmopressin in two monozygotic twin sisters to establish if tolerability and efficacy of treatment can be affected by different modalities of therapy interruption.

Topics: Administration, Intranasal; Child; Deamino Arginine Vasopressin; Diseases in Twins; Drug Administration Schedule; Enuresis; Female; Humans; Hypersensitivity; Twins, Monozygotic

We now understand more about the causes and treatment but must work to overcome the stigma associated with enuresis. Training for professionals needs to be standardised. Terminology also needs to be standardised. European research suggests that the quality of the relationship between professional and child can affect the outcome of treatment. A range of treatments is possible but the first step is a clear assessment of the problem and cause. It is important to take account of the family setting. Never assume incontinence is inevitable for children with special needs and that nothing can be done. Much can be achieved with appropriate training programmes.

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Health Priorities; Humans; Renal Agents; Research; Toilet Training; Treatment Outcome; Urinary Incontinence

Topics: Child; Child Behavior Disorders; Deamino Arginine Vasopressin; Enuresis; Humans; Male; Renal Agents; Time Factors; Water Intoxication

The aim of this study was to investigate sleep and the sleep modulating effect of 1-desamino-8-D-arginine vasopressin (DDAVP) in patients with primary monosymptomatic nocturnal enuresis and controls by means of both conventional polysomnography and computerized electroencephalographic (EEG) power analysis.. Adolescents or adults with primary monosymptomatic nocturnal enuresis (n = 11, 8 females, 3 males: mean age 23.0 +/- 9.8, range 15-49 years) and normal subjects (n = 10, 7 females, 3 males: mean age 23.2 +/- 5.4, range 14-32 years) were admitted to the sleep laboratory of the University Hospital of Aarhus, Denmark, for the investigation of sleep over four consecutive nights. A fixed day-to-night cycle was maintained. Night-time was defined as 23.00-07.00 h. The 1st and 3rd nights were completed without intervention. Sleep was modulated on the 2nd night by a waterload to induce nocturnal micturition. On the 4th night all subjects received DDAVP spray applied intranasally at bedtime. Sleep was evaluated by manual polysomnography according to the rules of Rechtschaffen and Kales and by computerized EEG power analysis on the 1st, 3rd and 4th nights. EEG power was calculated as total power and as power assigned to specific EEG frequency bands.. Enuretics showed a significant increase in the EEG delta power component during baseline sleep compared with controls, whereas no difference was encountered using a manual sleep score. During recovery sleep on the 3rd night EEG power in the enuretic group was increased in all EEG frequency bands apart from the alpha and sigma bands and associated with a shortened total sleep period. DDAVP was not found to influence sleep to any significant extent.. EEG power analysis indicates an increased depth of sleep in enuretics inadequately reflected by a conventional polysomnographic technique. No sleep-modulating effect of DDAVP was detected.

Topics: Adolescent; Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Delta Rhythm; Diagnosis, Computer-Assisted; Enuresis; Female; Humans; Male; Middle Aged; Sleep

Monosymptomatic primary nocturnal enuresis (PNE) is commonly treated with desmopressin (Minirin), resulting in dry nights for approximately 70-85 percent of affected children. However, nocturnal enuresis is sometimes accompanied by signs of bladder dysfunction. A history of urgency, frequency, daytime wetting or urinary tract infection may indicate the presence of a hyperactive, unstable bladder. In these cases, desmopressin in combination with an anticholinergic drug (i.e. oxybutynin; Ditropan) given at bedtime, or desmopressin and a bed alarm, will increase the number of patients with dry nights. This therapy can now be offered not only by pediatricians but also by general practitioners.

Topics: Child; Cholinergic Antagonists; Cues; Deamino Arginine Vasopressin; Enuresis; Humans; Renal Agents; Self Concept; Stress, Psychological

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Epilepsy, Tonic-Clonic; Female; Humans; Medication Errors; Renal Agents

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Hyponatremia; Male; Renal Agents; Seizures

The aim was to compare responders and nonresponders to antienuretic treatment with desmopressin with respect to pharmacokinetics and renal effects of the drug.. Twelve children, aged 7.6 to 16.2 years, with nocturnal enuresis were examined. Six patients were nonresponders and 6 were responders to desmopressin treatment. The children were given 2 mg of desmopressin intravenously and plasma concentrations of the drug were monitored overnight. Urine parameters were followed for 24 hours after desmopressin administration. Ten patients also underwent a thirst provocation test.. Desmopressin pharmacokinetics did not differ between the groups. Neither nocturnal urine production nor morning urine osmolality after desmopressin injection differed between responders and nonresponders, whereas the responders produced significantly larger amounts of significantly less concentrated urine during the day after the injection compared with the nonresponders (urine production, 2.02 +/- 0.84 and 0.77 +/- 0.20 mL/kg/h; urine osmolality, 558 +/- 271 and 883 +/- 134 mOsm/kg). Nonresponders voided with smaller bladder volumes (2.43 +/- 0.68 mL/kg body weight) than responders (4.70 +/- 1.21 mL/kg). The responders produced significantly less concentrated urine than the nonresponders during the thirst provocation test (607 +/- 185 and 922 +/- 217 mOsm/kg, respectively).. Intravenous desmopressin pharmacokinetics and desmopressin renal effects did not differ between responders and nonresponders to desmopressin treatment. Nonresponders had a smaller spontaneous bladder capacity and responders produced less concentrated urine.

Topics: Adolescent; Arginine Vasopressin; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Kidney; Male; Osmolar Concentration; Urinary Bladder; Urine; Water-Electrolyte Balance

Treatment of primary nocturnal enuresis using 1-deamino-8-D-arginine-vasopressin is based on the hypothesis that antidiuretic hormone (arginine vasopressin [AVP]) secretion is insufficient during the night. Persisting doubts about the theoretical background of this treatment and first results pointing to a different AVP regulation in children with nocturnal enuresis were the motives for the present study.. To determine if children with primary nocturnal enuresis have different AVP levels during fluid restriction when compared with normal controls.. Twenty-three children with nocturnal enuresis (median age, 11 years) were compared with a corresponding control group of 18 healthy children. Plasma osmolality, urine osmolality, and plasma AVP concentrations were determined before and after a defined fluid restriction.. Regarding plasma and urine osmolality, no differences were found between the two groups. AVP levels after fluid restriction, however, showed significant differences. To maintain osmolality, the plasma AVP concentrations of the controls rose to a median value of 5.7 pg/mL (range: 0.9-29.0 pg/mL) in comparison to a median of 14.0 pg/mL (range: 3.5-64.0 pg/mL, P =. 015) for the enuretic children.. The results are consistent with the established fact that AVP secretion is a function of plasma osmolality. They contradict the hypothesis that enuretic children have a AVP deficiency that has to be supplemented. Rather, the results point to a defect at the AVP receptor level or of the signal transduction pathway.

Topics: Adolescent; Arginine Vasopressin; Child; Circadian Rhythm; Deamino Arginine Vasopressin; Drinking; Enuresis; Female; Humans; Male; Osmolar Concentration; Renal Agents

Bedwetting is the most common form of incontinence in children. Research in recent years suggests that there can be many different factors responsible for the problem of bed wetting, one of which is bladder dysfunction. The aim of this pilot study was to identify infrequent voiding ("hold pattern") and to investigate whether increasing the number of micturitions during the day can improve the nocturnal enuresis in children with several failed treatment attempts.. Twenty-two children with severe bedwetting were treated. Twelve of them had had no other treatment than increasing the number of regular micturitions during the day, while 10 patients had had enuresis alarm or desmopressin added.. The number of wet nights after 1 month of treatment decreased in all children and the improvement continued in most of the children during the follow-up period.. This study suggests that bladder training by increasing the number of micturitions during the day can be valuable in the treatment of nocturnal enuresis.

Topics: Adolescent; Child; Circadian Rhythm; Combined Modality Therapy; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Pilot Projects; Renal Agents; Statistics, Nonparametric; Time Factors; Urinary Bladder; Urination; Urodynamics

The case of a 6 year old child who presented with convulsions and coma after unsupervised self administration of intranasal desmopressin (DDAVP) for nocturnal enuresis is presented. Children with enuresis can be embarassed by their condition and may believe that multiple doses of their nasal spray may bring about a rapid resolution. Water intoxication is an uncommon but serious adverse effect of treatment with intranasal DDAVP. These patients may present with seizure, mental state changes, or both. Basic management consists of stopping the drug, fluid restriction, and suppressive treatment for seizures. Recovery is usually rapid and complete. Administration of the nasal spray in children should be supervised by parents to prevent highly motivated children from accidental overdose. The risks of high fluid intake need to be carefully explained to both parents and children.

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Hyponatremia; Male; Renal Agents; Seizures

To evaluate relationships between bladder voiding and sleep in children with enuresis.. Polysomnographic recordings were obtained from 25 children, aged 7 to 17 years, with monosymptomatic nocturnal enuresis. During 52 recorded nights, 37 enuretic events were detected. Responders (n = 7) and nonresponders (n = 16) to desmopressin treatment were compared.. The mean latency between sleep onset and the first bladder voiding was 3 hours 20 minutes (SD = 2 hours 5 minutes). The number of voidings were 19, 7, 10, and 1 occurring during stages 2, 3, and 4, and rapid-eye movement sleep, respectively. Desmopressin responders were found to void during the early or late part of the night, whereas the voidings of the nonresponders were dispersed evenly throughout the night (chi2 = 8.09).. The enuretic event is a predominantly non-rapid eye movement sleep phenomenon. Responders and nonresponders to desmopressin treatment void during different parts of the night.

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Polysomnography; Renal Agents; Sleep, REM; Treatment Outcome; Urodynamics

The aim of this study was to determine whether nocturnal enuresis (NE) can be caused by absorptive hypercalciuria.. From 1981 to 1995, 406 patients with primary monosymptomatic nocturnal enuresis were studied. Up to 1989 (Group 1), urinary electrolytes and urinary creatinine were not evaluated, but since 1990 (Group 2) these tests have been performed routinely. In doing so, we noticed that in 8 patients in Group 2 and in 13 patients in Group 1 with persistent NE the urinary calcium and the urinary calcium/creatinine ratios were significantly high (p < 0.001). These patients were submitted to Pak's test and parathyroid hormone (PTH) and antidiuretic hormone (ADH) measurements.. In all 21 patients, PTH and ADH levels were normal, while the Pak's test showed absorptive hypercalciuria. They were given an appropriate diet. After 3 months, NE had ceased completely in 4 patients (19%); bedwetting episodes diminished and calciuria levels were found to be borderline in the remaining 17. A new urodynamic evaluation showed normal patterns in 12 and detrusor instability (DI) in 5. Patients with DI received oxybutinine: enuresis disappeared in all. The remaining 12 children with persistent NE and normal urodynamic findings and the child with DI and persistent NE empirically received DDAVP; enuresis ceased in all of them within 1 month and calciuria stabilized at normal levels.. This study revealed that absorptive hypercalciuria can be responsible for NE and can be treated with the combination of diet and DDAVP.

Topics: Calcium; Calcium, Dietary; Case-Control Studies; Child; Deamino Arginine Vasopressin; Diet, Sodium-Restricted; Enuresis; Female; Humans; Male; Renal Agents; Urodynamics

The case of an 8 year old boy with both nocturnal enuresis and nephrogenic diabetes insipidus is presented. Diagnosis of nephrogenic diabetes insipidus was based on a typical medical history, the characteristic result of a fluid restriction test, the lack of an effect of 1-desamino-8-D-arginine (DDAVP) on both urine osmolality and plasma coagulation factors and, finally, the detection of a hemizygous missense mutation within the arginine vasopressin (AVP) receptor gene. Hydrochlorothiazide treatment and dietary measures reduced the patient's urine volume to one third of its original volume. However, this had no effect on enuresis. The daily intranasal application of DDAVP did not further reduce urine output but dramatically decreased the frequency of bed wetting. This observation contradicts the common notion that the therapeutic effect of DDAVP in nocturnal enuresis is the result of compensation for a nocturnal AVP deficit. Rather, it points to a different mode of action of DDAVP in patients with enuresis. It is hypothesised that central AVP receptors are a target of DDAVP and that they might play an important role in the pathogenesis of nocturnal enuresis.

Topics: Child; Circadian Rhythm; Deamino Arginine Vasopressin; Diabetes Insipidus, Nephrogenic; Enuresis; Humans; Male; Renal Agents

We studied bladder dysfunction in children with significant primary nocturnal enuresis refractory to treatment.. We evaluated 33 Chinese boys and 8 girls with a mean age of 10.4 years, who had significant monosymptomatic primary nocturnal enuresis (3 or more wet nights weekly) after desmopressin treatment with or without an enuretic alarm failed. Daytime cystometry, continuous nighttime cystometry and electroencephalography monitoring during sleep, and detailed recording of daytime and nighttime urinary output were performed.. We recognized 5 patterns of bladder dysfunction and its association with sleep-arousal status. Pattern 1 was normal daytime urodynamics with significant bladder instability at night with normal volume voiding precipitated by unstable detrusor contractions in 14 boys (34%). Pattern 2 was normal daytime urodynamics with frequent small volume voiding at night, probably representing latent bladder instability, in 4 boys (10%). Pattern 3 involved abnormal daytime urodynamics with small bladder capacity, a discoordinated daytime voiding pattern and marked nighttime bladder instability associated with poor sleep in 6 boys (15%). Pattern 4 was abnormal daytime urodynamics with an obstructive pattern, and marked daytime and nighttime detrusor hypercontractility (mean maximum detrusor pressure 178 cm. water) in 8 boys (20%). Pattern 5 was abnormal daytime urodynamics with a dysfunctional daytime voiding pattern and frequent small volume nighttime voiding in 8 girls and 1 boy (22%). In all patients functional bladder capacity was smaller than expected for age and the majority had no nocturnal polyuria. Despite underlying bladder dysfunction a 4-week course of 400 microg. desmopressin orally at bedtime still produced a significant response with a greater than 50% decrease in the number of wet nights during treatment in 47% of the patients, although enuretic symptoms immediately relapsed on cessation of therapy in all. Notably cystourethroscopy in 7 of the 8 boys with pattern 4 dysfunction revealed bladder trabeculations and abnormal urethral lesions, including congenital obstructive posterior urethral membranes in 4, Moormann's ring in 2 and irregular scarring at the bulbous urethra in 1.. Abnormal bladder function, including small functional capacity, instability during sleep and marked detrusor hypercontractility, was common in our enuretic children in whom treatment failed. More importantly, nocturnal enuresis may be the only presenting symptom and there may be a response to desmopressin with a decreased number of wet nights even in cases of significant underlying bladder dysfunction. These findings may have important implications for our management strategy for monosymptomatic primary nocturnal enuresis.

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Renal Agents; Treatment Failure; Urinary Bladder Diseases

Since most of the children observed in our Centre present enuresis with voiding disturbance, we carried out a study where these patients were treated with the DDAVP + Oxybutinin association.. We have treated 89 children with enuresis and voiding disturbances (urge incontinence, voiding urgency, urinated > 7 times a day), administering a drugs combination of desmopressin (20 micrograms/daily) and oxybutinin (0.3-0.6 mg/kg/bid or tid) for a variable period, depending on response to the treatment.. The results demonstrate the efficacy of this association: we have observed a reduction in average bed wetting nights from 23.4 nights/month to 6.4 wet nights after 1 month, to 3.8 ad 2.9 respectively after 3 and 6 months from the beginning. Moreover we obtained a recovery of all daily voiding disturbances after 3 months. Fifty percent of children were cured after 4 months of therapy and finally 93.2% recovered at 6 months. On the other hand, 2 children were no-responders to the therapy even after 9 months of combined drugs administration.. Based on these results we can affirm that children with nocturnal enuresis and voiding disturbance can be treated with this combined therapy. Actually, the reduction of urinary output and thus lower bladder filling, due to the desmopressin, decreases the onset of uninhibited bladder contractions and enhances oxybutinin activity.

Topics: Adolescent; Child; Child, Preschool; Cholinergic Antagonists; Deamino Arginine Vasopressin; Drug Therapy, Combination; Enuresis; Female; Follow-Up Studies; Humans; Male; Time Factors; Urinary Incontinence

Topics: Ambulatory Care; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Monitoring, Physiologic; Risk Factors; Urodynamics

Monosymptomatic nocturnal enuresis (MNE) in children is partly the result of inadequate reduction in the rate of urine output at night. This nocturnal polyuria is due to the lack of a rise in the anti-diuretic hormone, arginine vasopressin (AVP), and can be reduced or eliminated by treatment with desmopressin at bedtime. Since there is a 1% incidence of MNE among adults, this study investigated the circadian pattern of solute and water balance in nine young adult enuretics before and during desmopressin therapy and compared the results with nine-age- and sex-matched, healthy controls. Before treatment, enuretics and controls had similar total fluid intake, urine output, urine osmolality, plasma osmolality, plasma total protein, mean arterial pressure and plasma AVP. The circadian pattern of fluid intake was also normal in enuretics. This abnormality could not be attributed to a deficiency of plasma AVP or an increase in solute excretion, since both variables were similar to controls. Rather, their nocturnal polyuria appeared to be due to a marked nocturnal reduction in renal sensitivity to the antidiuretic effect of vasopressin. In seven enuretics, restudied during treatment with desmopressin (10-30 micrograms o.d.), circadian urine output was normal and enuresis was absent. These results indicate that: (i) The circadian pattern of urine output in healthy adults is largely due to a nocturnal decrease in solute excretion rather than a rise in plasma AVP; (ii) The subset of adults with persistent MNE also have nocturnal polyuria as a result of insensitivity to the antidiuretic action of AVP; (iii) These defects can be corrected by treatment with desmopressin.

Topics: Adult; Arginine Vasopressin; Child; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Kidney Concentrating Ability; Male; Renal Agents; Treatment Outcome; Urodynamics

Renal function was studied in 62 children with primary nocturnal enuresis (PNE) and in 20 healthy children aged 6-15 years. During the night, children with PNE exhibited an increase in diuresis, free water reabsorption and solute excretion (including sodium and magnesium) in comparison to controls. Intranasal administration of Adiuretin-SD (10.5-24.5 micrograms) in the evening reduced diuresis and ion excretion to normal levels. During the treatment, 61% of the children became completely dry and, in 24% of the children, the number of wet nights was reduced by 50%. It is suggested that in the pathogenesis of PNE, the decrease in ion reabsorption in the thick ascending Henle's loop--resulting in a greater load of tubular fluid in the collecting ducts, an elevation of diuresis and increases in free water reabsorption and solute excretion--plays the leading role in disturbing renal function. Treatment of PNE with desmopressin is pathogenically justified, as it eliminates the principal defect of renal tubular function.

Topics: Administration, Intranasal; Adolescent; Child; Circadian Rhythm; Deamino Arginine Vasopressin; Diuresis; Enuresis; Female; Humans; Kidney Concentrating Ability; Kidney Function Tests; Male; Reference Values; Renal Agents; Urodynamics; Water-Electrolyte Balance

Desmopressin responders tend to have a large volume of urine production at night, in contrast to desmopressin refractory patients who often produce normal volumes of urine. Controls and adolescent/adult primary monosymptomatic nocturnal enuretics were included in a study measuring urine volume and plasma vasopressin levels before and during a 24-hour water deprivation test. The results indicate a significantly higher urine production in desmopressin responders when compared with controls and non-responders. Before fluid deprivation, only the nocturnal polyuric patients showed a urine osmolality significantly lower than that of controls and desmopressin non-responders. A significant decrease in the clearance of osmols was evident in the desmopressin refractory group from day to night. All three groups showed a significant increase in plasma vasopressin during fluid deprivation, with polyuric, desmopressin-responding patients showing a lower increase that the non-responders and controls. Plasma vasopressin levels were normal in adolescent and adult enuretics regardless of their response to desmopressin. Moreover, response to fluid deprivation in both polyuric and enuretic patients resulted in a significant decrease in urine output from the first to the second night.

Topics: Administration, Intranasal; Adolescent; Adult; Arginine Vasopressin; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Polyuria; Renal Agents; Treatment Outcome; Urodynamics; Water Deprivation

Topics: Adolescent; Child; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Infusions, Intravenous; Male; Renal Agents; Urodynamics; Water-Electrolyte Balance

Topics: Adult; Biological Availability; Child; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Humans; Renal Agents; Treatment Outcome; Urodynamics

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Renal Agents; Self-Help Devices; Urinary Bladder

After allergic disorders, nocturnal enuresis is the most common chronic childhood condition. Recent research has yielded abundant new knowledge about the condition, especially about its aetiology and pathophysiology, and the psychological consequences. A hereditary background has been substantiated by the identification in genetic linkage studies of areas in chromosomes 12 and 13 that are manifestly associated with bedwetting, though genotype expression in the phenotype appears to be complex and heterogeneous. Pathophysiologically, findings in current intensive research suggest three interactive factors to be involved: (i) relative nocturnal polyuria, due to insufficient antidiuretic hormone release during sleep in pre-teenagers, and due to renal tubular dysfunction in adolescents and adults; (ii) reduced nocturnal bladder capacity, especially in the 33 per cent of cases which do not respond to desmopressin treatment; and (iii) the patient's inability to waken in response to signals from a full bladder. Recent findings have also confirmed previous reports that with very few exceptions bedwetting is not caused by psychological factors. On the contrary, the condition causes psychological problems manifested in reduced self-esteem, shame and guilt, though self-esteem is restored by successful treatment. Active treatment should be started as soon as the child is ready to receive it, the main options being an enuresis alarm, desmopressin, or a combination of the two. If reduced bladder capacity is suspected, treatment with a detrusor relaxant should be included.

Topics: Adolescent; Adult; Child; Circadian Rhythm; Deamino Arginine Vasopressin; Depression; Enuresis; Female; Humans; Male; Self Concept

Intranasal desmopressin has been used extensively to treat primary nocturnal enuresis. While it has proven to be a safe, effective agent for many who are affected by this condition, the potential for complications exists.. To report a case of severe hyponatremia associated with a generalized tonic-clonic seizure in a 10-year-old boy who had been receiving intranasal desmopressin nightly for nocturnal enuresis and to briefly review therapeutic options for nocturnal enuresis; and to present the role of desmopressin.. Georgetown University Medical Center, Washington, DC.. Fluid restriction and intravenous isotonic saline solution with 5% dextrose was administered to raise the serum sodium level.. Prevention of further seizures with normalization of serum sodium levels without any obvious neurological sequelae.. This case illustrates the importance of weighing the benefits and risks of intranasal desmopressin therapy.

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Epilepsy, Tonic-Clonic; Humans; Hyponatremia; Male; Renal Agents

In the last 2 years, 29 children with nocturnal enuresis were treated in the outpatient departments of the Departments of Urology and Pediatric Surgery of the Aristotle University, Thessaloniki. There were 22 boys and 7 girls aged 7 to 12 years. The clinical examination was normal in all cases. All children had undergone various treatments with no beneficial effect, and relapses had occurred. The patients were given desmopressin (DDAVP) nasal drops in combination with bladder physiotherapy; 77% were cured after 12 months. Physiotherapy improves the percentage of cures as the functional capacity of the bladder increases.

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Physical Therapy Modalities; Treatment Outcome; Urinary Bladder; Urodynamics

More than 700 children aged between 5 and 15 years were treated at the University of Vienna Department of Urology during the last 10 years. The therapeutic approach was based on a complex diagnostic scheme to define the individual problem of each enuretic child. Generally speaking the enuresis problem turned out to be a symptom of delayed maturation of fine motor control [1] or sleep and hormone secretion rhythm during day and night hours. In a high percentage of enuretic children, no major physical problem or disease could be found, but the possibility of a physical problem, especially a neurourological problem, should not be ignored. Nonneurogenic discoordinated voiding in children can be treated by cognitive flow-triggered feedback training [2, 3] while overproduction of urine during sleep is reduced by antidiuretic hormone therapy with desmopressin (DDAVP; 1-deamino-8-D-arginine-vasopressin), a synthetic analogue of antidiuretic hormone.

Topics: Adolescent; Austria; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Renal Agents; Retrospective Studies; Syndrome; Toilet Training; Treatment Outcome

Twenty children with primary nocturnal enuresis and 20 healthy children of the same age and sex were studied. Natural urination was used for the 24-h urine collection. It was found that urine osmolality and free water reabsorption during the night did not differ statistically significantly between the enuretic children and the healthy. The increased diuresis in the enuretic children was caused by a higher excretion of the osmotically active solutes, including sodium. Use of desmopressin reduced diuresis and natriuresis to normal levels. It is suggested that the main role in the pathogenesis of the studied form of nocturnal enuresis is played by a decrease in ion reabsorption, probably in the thick ascending Henle loop, which facilitates the increase in diuresis and occurrence of nocturnal enuresis.

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Diuresis; Enuresis; Female; Glomerular Filtration Rate; Humans; Kidney; Male; Natriuresis; Water-Electrolyte Balance

To determine the time taken to achieve complete dryness, the management of desmopressin dosage to reduce the relapse rate, the mean dosage in those responding and any side effects of long-term treatment.. Enuretic children (155, 68% boys and 32% girls, mean age 8 years, range 5-19) were treated with desmopressin and assessed. Treatment (intranasal spray) was started with 20 microg desmopressin and titrated to 40 microg (maximum 50 microg) after 2 days if the child did not become dry within 48 h. The maximum dosage was maintained for at least 4-6 weeks. After 4 weeks of complete dryness, the dosage was reduced by 10 microg initially, and after each additional 4 dry weeks, by a further 10 microg; medication was stopped only after 4 dry weeks at 10 microg.. Of the children, 85% responded to intranasal desmopressin therapy; 71% achieved complete dryness with no relapses, remaining dry with no further treatment, 7% achieved dryness after relapses during or after therapy, 7% improved (no more than two wet nights per week) and 15% did not respond to therapy or improved only slightly (> 2 wet nights per week). The mean duration of therapy was 28 weeks, the mean dose of desmopressin was 30 microg and the median follow-up 18 months. There were no significant side-effects.. This study indicates that rapid titration until dryness within 1-3 days, a long maintenance therapy of at least 4-6 weeks and a slow stepwise reduction of dose decreases the frequency of relapse and improves the outcome.

Topics: Administration, Inhalation; Adolescent; Adult; Child; Child, Preschool; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Enuresis; Female; Humans; Long-Term Care; Male; Recurrence; Renal Agents; Treatment Outcome

To evaluate the role of long-term oral desmopressin (over a 7-year follow-up) in refractory enuretics, particularly in assessing the potential curative effect, and to analyse the results for specific types of patient to obtain clues about possible mechanisms of cure.. The effect of oral desmopressin was investigated in 25 adolescents (aged 11-21 years) with severe monosymptomatic nocturnal enuresis. The long-term study consisted of two 12-week treatment periods, with the efficacy of the drug assessed as the reduction in the number of wet nights per week. Subsequently, the patients were followed-up for up to 7 years. Close contact was maintained with the families over this period ('good doctoring' approach). At 3-, 5- and 7-year intervals after completing the study, patients were assessed for dryness, frequency, treatment and sleeping habits, using postal questionnaires and telephone follow-up.. At the end of the long-term study, 35% of the patients remained dry without therapy. Within 2 years of ending treatment, 15 patients were dry, compared with an expected estimate of six by spontaneous resolution, and after 7 years, 19 patients were cured. Nocturia occurred in 75% of the enuretic patients but in only 5% of the healthy controls.. Active treatment of primary nocturnal enuresis with oral desmopressin has a clinically significant effect on the cure rate, which is maintained after ceasing therapy. The cure rate was higher than would be expected from spontaneous recovery alone during the first 2 years of the study and there was a significant further increase in the cure rate 7 years after ending therapy, again greater than the expected spontaneous cure rate. There also seemed to be a better response to treatment when it was prolonged. Furthermore, this therapy is safe when administered in the long-term.

Topics: Administration, Oral; Adolescent; Adult; Child; Deamino Arginine Vasopressin; Enuresis; Female; Follow-Up Studies; Humans; Long-Term Care; Male; Renal Agents; Sleep; Surveys and Questionnaires; Treatment Outcome; Urinary Bladder Diseases

To evaluate, in a retrospective study, the response rate of older children to combination therapy using a sustained-release anticholinergic agent, hyoscyamine, and a synthetic analogue of antidiuretic hormone, desmopressin acetate.. Twenty-eight patients (20 males and eight females, aged 9-18 years) diagnosed with nocturnal enuresis were evaluated using a questionnaire, history and physical examination. None had success with single-agent pharmacological therapy. All were begun on 0.375 mg of hyoscyamine and 20 microg of desmopressin intranasally at bedtime. The response rate was monitored at 2 and 4 weeks, and then every 3 months by recording dry nights on a calendar. To improve efficacy, the dosage of medication was adjusted up to 0.750 mg of hyoscyamine and 60 microg of desmopressin. Upon achieving dryness and spontaneous awakening to void, medication doses were tapered.. Within 6 months 16 (57%) patients were completely dry and six (21%) were dry at least 80% of nights. Nine patients relapsed during dose tapering and therapy was reinstituted. Presently, 17 (60%) patients are off medication (after a mean of 8 months of medication). Eight patients are still on medication and are dry at least 80% of nights. Combination therapy failed in three patients and they have transferred to a different regimen. None experienced untoward side-effects from the medications.. Most older children with nocturnal enuresis responded to combination therapy. These children require long-term follow-up and may need medication for up to 6 months because the relapse rate is fairly high. Combination therapy appears safe and reliable in treating nocturnal enuresis in older children who have had no success with other treatment modalities.

Topics: Adolescent; Adult; Atropine; Child; Deamino Arginine Vasopressin; Delayed-Action Preparations; Dose-Response Relationship, Drug; Drug Therapy, Combination; Enuresis; Female; Follow-Up Studies; Humans; Male; Muscarinic Antagonists; Renal Agents; Retrospective Studies; Treatment Outcome

To determine the factors that predict the effectiveness of desmopressin in the treatment of childhood nocturnal enuresis.. Sixty-six children with monosymptomatic nocturnal enuresis were treated with intranasal or oral desmopressin for a 4-week period. starting with a standard dose of 20 microg (0.2 mg oral) and increasing after 2 weeks where no progress was apparent to 40 microg (0.4 mg oral). Before treatment a range of variables (demographic, situational, enuretic history, physiological, parental attitude and child) were recorded. Three parameters of success acted as dependent variables, with stepwise linear regression models used to determine pretreatment predictors of success with desmopressin.. Each outcome variable produced a very similar model of predictors. Success, as assessed by the most dry nights over a 14-night period, was associated with less severe enuresis before treatment, a parental belief that the child's enuresis was unstable and higher birthweight.. From the analysis, a model of arginine vasopressin release is proposed and the clinical implications of the findings addressed.

Topics: Administration, Intranasal; Administration, Oral; Adolescent; Attitude to Health; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Life Style; Male; Parents; Renal Agents; Self Concept; Stress, Psychological; Treatment Outcome

To evaluate the 24-h diuresis, urinary osmolality, plasma arginine vasopressin (AVP) and urinary prostaglandin E2 (PGE2) before and during desmopressin treatment in patients with monosymptomatic primary enuresis (MPE), and to investigate the possible depressor effect of desmopressin on the detrusor in such patients with urodynamically confirmed bladder instability.. Seven healthy children (control group) and 11 consecutive patients with MPE (mean age 10.4 years, range 7-15) were assessed using laboratory tests, renal and bladder ultrasonography, and video-urodynamic investigations. A 24-h inpatient assessment with a controlled water intake of 20 mL/kg per day included determinations of diuresis, urinary osmolality, AVP and PGE2 in both normal children and those with MPE. After 30 days of treatment at optimal doses of desmopressin, all children were hospitalized and re-evaluated during desmopressin treatment; all completed 3 months of treatment at optimal doses. At the end of this period, patients whose symptoms improved by > or = 80% were defined as 'responders' while those in whom they did not were defined as 'non-responders'.. After treatment, six of the 11 patients with MPE were 'responders' and five 'non-responders'. Urodynamic evaluation showed bladder instability in seven of the 11 patients with MPE but in those with bladder dysfunction, urodynamic studies carried out during desmopressin treatment showed no changes in detrusor activity. There were significant differences in the morning values of AVP between normal children and responders (P < 0.03), and between responders and non-responders (P < 0.02); none of the non-responders had AVP levels of < 2.5 pg/mL, while none of the responders exceeded this value. At midnight, responders had the lowest mean AVP and non-responders the highest; this correlated with the highest PGE2 value in the nonresponders at 00.00-08.00 hours. Non-responders had an overnight mean PGE2 level greater than that in normal subjects or responders.. Polyuria occurred in all patients with MPE, independently of the response to desmopressin. Responders had the lowest AVP values over the 24 h; the morning AVP levels differentiated normal subjects from enuretic patients and responders from non-responders. In patients with MPE, clinically undetected bladder instability was unrelated to the results of treatment and there were no urodynamic changes during desmopressin treatment. The differences between enuretic patients suggested a different aetiology of MPE, probably related to an increase in PGE2 concentration and an antagonistic mechanism of action of AVP or desmopressin.

Topics: Administration, Oral; Adolescent; Arginine Vasopressin; Child; Deamino Arginine Vasopressin; Dinoprostone; Enuresis; Female; Humans; Male; Osmolar Concentration; Recurrence; Renal Agents; Treatment Failure; Urination; Urine

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: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Hyponatremia; Male; Renal Agents; Seizures

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Hyponatremia; Male; Renal Agents; Seizures

Desmopressin may be a useful treatment in some, but not all, patients with nocturnal enuresis. We have evaluated a relation between nocturnal urine output in patients with primary monosymptomatic nocturnal enuresis and the treatment response to synthetic vasopressin.. Adolescent or adult enuretics and normal subjects were enrolled in the study and admitted to hospital for a 24 hour investigation of the diurnal variation in urine output, plasma vasopressin (AVP) and plasma atrial natriuretic peptide (ANP). The enuretics were characterized prior to investigation as either 1-desamino-8-D-arginine vasopressin (DDAVP) responders or non-responders. During admission the fluid intake was restricted to 25 ml/kg per day.. Twenty-four patients (15-37 years) with primary monosymptomatic nocturnal enuresis and 9 normal subjects (24-31 years).. Circulating levels of AVP, ANP, plasma electrolytes and plasma osmolality were measured (1400, 2000, 2300, 0200, 0500 and 0800 hours) together with urine volume, urine osmolality and urine electrolytes during daytime and nighttime. Tubular reabsorptive capacity for water, osmoles and creatinine were assessed as well as urinary and fractional excretion rates of sodium and potassium.. Controls and DDAVP non-responders had a significant decrease in urine output at night concomitant with a significant plasma AVP amplitude in peak/nadir values although both groups lacked a significant nocturnal increase in AVP. In contrast, in DDAVP responders there was no circadian variation in urine output and thus a nocturnal polyuria together with no oscillation in plasma AVP. The DDAVP responding group had a nocturnal urine production significantly larger than the two other groups. However, the mean 24 hour AVP levels were similar in all groups. The excessive urine production at night in DDAVP responders was accompanied by nocturnal natriuresis due to an increased fractional excretion of sodium. In contrast, nocturnal antidiuresis in controls and DDAVP non-responding enuretics coincided with diminished sodium excretion. Average ANP levels were elevated in both enuretic groups compared to normals, whereas a circadian variation was detected only in the latter.. It is concluded that DDAVP responsiveness is linked to the nocturnal urine production and that no pathophysiological role can be ascribed to AVP or ANP in DDAVP refractory adolescent and adult enuretics. Moreover, it is suggested that an abnormal tubular handling of sodium may contribute to the nocturnal polyuria seen in DDAVP responders.

Topics: Adolescent; Adult; Analysis of Variance; Atrial Natriuretic Factor; Case-Control Studies; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Osmolar Concentration; Renal Agents; Sodium; Treatment Outcome; Urination

We report on a girl with the Prader-Willi syndrome who received desmopressin for nocturnal enuresis, and water intoxication developed after she ingested a large amount of fluid.. The patient received 10 mg. desmopressin at bedtime for enuresis. She was hospitalized when a major motor seizure and coma (Glasgow coma scale 8) occurred after ingesting 48 ounces of fluid. Treatment included 3% saline, followed by 5% dextrose in water and sodium chloride given intravenously.. Serum sodium increased to 128 mEq./l. and serum glucose remained normal. Computerized tomography and magnetic resonance imaging of the head were normal and revealed no evidence of cerebral pontine myelinosis. Patient consciousness returned to normal by day 5 after the seizure.. In patients treated with desmopressin the risk of a seizure or altered level of consciousness can be minimized by not ingesting large quantities of fluid. We recommend that patients drink no more than 8 ounces of fluid on any evening that desmopressin is administered.

Topics: Adolescent; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Prader-Willi Syndrome; Renal Agents; Water Intoxication

Topics: Child; Coma; Deamino Arginine Vasopressin; Drug Therapy, Combination; Enuresis; Humans; Hyponatremia; Male; Seizures

Water intoxication is a serious condition which may be caused by desmopressin overdose, with reversible or irreversible neurological complications. In the past, desmopressin was used in endocrinological centers for the treatment of antidiuretic hormone deficiency (central diabetes insipidus). Indications for hormone treatment have since widened, especially as an effective solution for nocturnal enuresis. It is now often prescribed in community clinics, and its use has been encouraged by extensive promotion. We describe a 15-year-old boy with primary nocturnal enuresis who started treatment with desmopressin 1 year prior to admission. He was allowed to use the drug without supervision, and drank excessively. The result was water intoxication which required admission for intensive care because of loss of consciousness and convulsions for 36 hours.

Topics: Adolescent; Critical Care; Deamino Arginine Vasopressin; Drug Overdose; Enuresis; Humans; Male; Renal Agents; Water Intoxication

Plasma arginine vasopressin (AVP) levels, urinary flow and urine osmolality were investigated in a group of adolescents (20 boys and 5 girls), aged 11-21 y, with severe monosymptomatic nocturnal enuresis and a control group of healthy adolescents (16M and 4F) with similar age- and sex-distribution. Half of the control group was investigated twice, with an interval of 6 months. AVP samples were taken every fourth hour in all adolescents and half of the control group were also investigated every second hour to achieve more samples during controlled sleep. After the study the enuretic group were put on long-term oral desmopressin (DDAVP). The difference between day and night values of AVP was significant for both groups, but there was no difference in the day/night ratios of plasma-AVP. All the adolescents produced less urine while asleep, but the controls produced significantly more urine than the enuretics during day. The controls also had a significantly larger nocturnal elevation of urine osmolality than the enuretics, thus a tendency towards polyuria was found. We could not find any significant difference between responders to DDAVP treatment and non-responders in any of the parameters studied. AVP is secreted in a pulsatile fashion and with point hormone samples taken every fourth or second hour we were unable to find any difference in the diurnal AVP secretion between enuretics and normal controls.

Topics: Adolescent; Adult; Analysis of Variance; Case-Control Studies; Child; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Kidney Concentrating Ability; Longitudinal Studies; Male; Renal Agents; Urine; Vasopressins

A 7-year-old boy had a left-sided cerebrovascular accident 48 hours after beginning intranasal desmopressin acetate (DDAVP) therapy for persistent secondary nocturnal enuresis and approximately 2 weeks after varicella infection. A possible connection between desmopressin therapy or varicella infection (or both) and the patients neurologic symptoms is discussed, as is the relationship of desmopressin with hypercoagulability, Suggestions for patient/parent education, medical history taking, and patient surveillance are offered to prescribing physicians.

Topics: Cerebrovascular Disorders; Chickenpox; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Male; Renal Agents; Tomography, X-Ray Computed

Topics: Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Hyponatremia; Infant; Infant, Newborn; Male; Renal Agents; Seizures; Water Intoxication

Voiding problems, and in particular nocturnal enuresis, can usually be evaluated and managed without resorting to complex procedures or invasive tests. A good history with attention to toilet habits and the possible presence of infection can help distinguish patients who may have significant organic pathologic conditions who require further investigation. Wetting alarms are effective with a low recidivism rate but are noisy. DDAVP is effective, works rapidly, and is discrete but has a higher recidivism rate. Treatment is aimed at correcting any poor toilet habits and using the appropriate alarm device or medication.

Topics: Behavior Therapy; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Renal Agents; Urinary Bladder, Neurogenic; Urinary Tract Infections; Urination Disorders; Urodynamics

To clarify the relationship between nocturnal urine production and the occurrence of both wet and dry nights in patients with nocturnal enuresis and to estimate the effect on nocturnal urine production of treatment with the antidiuretic hormone desmopressin in a group of enuretics with none or only a partial reduction in the number of wet nights in response to desmopressin treatment.. The nocturnal urine production of 60 children with monosymptomatic nocturnal enuresis was measured for 14 nights with no treatment (baseline) and for 14 nights with desmopressin treatment. Sixteen children having both wet and dry nights in the two periods were chosen for the subsequent analysis.. There was significantly less nocturnal urine production during desmopressin treatment (202 mL/night) than during the baseline period (279 mL/night; P < 0.001) and a corresponding decrease in the number of wet nights, from 10 during baseline to five during desmopressin treatment. When expressed as mL/kg body weight per hour, the urine production during baseline was 0.89 on wet and 0.625 on dry nights (P < 0.001), and during desmopressin treatment was 0.716 and 0.535, respectively (P < 0.01).. In this group of enuretics there was a clear reduction in the number of wet nights and in nocturnal urine production during desmopressin treatment, even though none became totally dry on desmopressin. There was a markedly higher nocturnal urine production on wet nights during both the baseline period and during desmopressin treatment. The higher urine production on wet nights could explain the enuretic episode, with urine production exceeding bladder capacity.

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Renal Agents; Treatment Outcome; Urination; Urine

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

Based on several intervention programmes, a strategy for the treatment of nocturnal enuresis has recently been developed by an expert committee in the Netherlands. It consists of three parts. First, two structured interviews are given: one to differentiate between enuresis and incontinence and one to detect associated problems such as diurnal enuresis, constipation or behavioural problems. Secondly, a medical examination is made, confined to the inspection of the external genitalia and lower back, palpation of the abdomen and urine examination. Thirdly, the following guidelines for treatment at different age levels are applied: up to the age of 6 years no intervention is needed; between the ages of 6 and 8 years, lifting out of bed and/or the calendar method; between the ages of 8 and 12 years, enuresis alarm (if not successful, medication with desmopressin is prescribed for a restricted period of time), and ambulatory dry-bed training in a group setting may follow; over 13 years of age, clinical dry-bed training according to the Messer/Azrin method is advised. According to the expert committee, these guidelines offer sufficient possibilities to deal with the problem of nocturnal enuresis.

Topics: Adolescent; Child; Child, Preschool; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Guidelines as Topic; Humans; Netherlands; Treatment Outcome; Vasopressins

Nocturnal enuresis is characterized by nocturnal urine volumes exceeding bladder capacity and by inability to wake up to the stimulus of a full bladder. Desmopressin (DDAVP) is believed to be efficient in treating nocturnal enuresis by reducing nocturnal urine production. However, clinical observations indicate an additional mode of action since the drug appears to modify sleep architecture, apparently improving the patient's ability to awaken to the stimulus of a full bladder. Because of this, a possible arousing effect of DDAVP was studied.. The tentative ability of DDAVP and the endogenous hormone vasopressin (AVP) to produce locomotor stimulation in resting rats after both intracerebroventricular and subcutaneous administration was used as an animal model of arousal. In addition brain monoamine biochemistry was analyzed.. The intracerebroventricular injection of AVP (0.1 and 1 microgram.) and the intracerebroventricular (0.1, 1, 10 and 100 microgram.) and subcutaneous (90 and 180 microgram.) injections of DDAVP were both associated with a significant increase in the locomotor activity of the animals compared with controls. The biochemical analysis of cerebral monoamines indicated that DDAVP lowers brain dopamine levels after both types of administration.. These results suggest that DDAVP exerts a stimulatory effect in the CNS, which is also observed after peripheral administration. There are also indications for an increase in central dopamine turnover which could explain the registered increase in locomotor activity.

Topics: Animals; Brain; Deamino Arginine Vasopressin; Dopamine; Enuresis; Injections, Intraventricular; Injections, Subcutaneous; Motor Activity; Rats; Rats, Sprague-Dawley; Renal Agents; Vasopressins

Topics: Akathisia, Drug-Induced; Blood-Brain Barrier; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Panic Disorder; Vomiting

Desmopressin (DDAVP) is frequently used in the treatment of primary isolated enuresis nocturna if other approaches have failed. We report a further case of hyponatraemia and cerebral convulsion due to water intoxication after intranasal DDAVP application by a 6 year-old boy with enuresis.. Although adverse reactions in DDAVP (e.g. hyponatraemia) are rare, it should not be considered as the first choice treatment of enuresis nocturna and only be used with caution.

Topics: Child; Deamino Arginine Vasopressin; Diseases in Twins; Enuresis; Humans; Hyponatremia; Male; Renal Agents; Seizures; Water Intoxication

Topics: Amitriptyline; Antidepressive Agents, Tricyclic; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Renal Agents

Topics: Adult; Bipolar Disorder; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Drug Administration Schedule; Enuresis; Female; Humans

We assessed the outcome of the use of an enuretic alarm and desmopressin according to conventional guidelines and investigated the reasons for resistance to desmopressin. Children were given a 4 month course using an enuretic alarm if they had not previously used one; 12 out of 21 were dry (57%) after 4 months and one relapsed 1 month later. Those who had previously failed with an alarm or were considered poorly motivated to use it, were given a 4 month course of intranasal desmopressin. Of these 26 children, 10 (38%) were dry at the end of 4 months but only two (7%) remained dry after this was withdrawn. After the initial treatment with alarm or desmopressin, 27 children were still enuretic and attending the clinic. They were shown how to use the alarm and eight also used the dry bed training technique: 15 had become dry after a further 6 months. Of the 12 children who made no response to intranasal desmopressin, nine were given this medication under supervision in hospital; seven of these children still wet the bed despite producing small amounts of concentrated urine overnight. They also had small measured diurnal bladder capacities. We conclude that if a 4 month course with an enuretic alarm is unsuccessful, rather than using desmopressin, the alarm should be continued with relearning and consideration given to additional use of the dry bed training technique. The major factor causing nocturnal enuresis in children is likely to be a small nocturnal bladder capacity.

Topics: Administration, Intranasal; Adolescent; Behavior Therapy; Child; Combined Modality Therapy; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male

Plasma membrane fluidity of platelets (PLT) obtained from subjects with primary nocturnal enuresis (PNE) and healthy controls was investigated before and after addition of desmopressin (DDAVP). Membrane fluidity was studied by measuring steady-state fluorescence anisotropy of 1-(4-trimethylammoniumphenyl)-6-phenyl-1,3, 5-hexatriene incorporated into PLT plasma membrane. Our results show an increase in membrane fluidity at the surface level of PLT from subjects with PNE. Moreover, the addition of DDAVP induces a stable and significant decrease of membrane fluidity in both groups. These results suggest alterations of the lipid order in the exterior part of the PLT plasma membrane from patients with PNE.

Topics: Adolescent; Adult; Anisotropy; Blood Platelets; Cell Membrane; Child; Cholesterol; Deamino Arginine Vasopressin; Diphenylhexatriene; Enuresis; Female; Fluorescent Dyes; Humans; Male; Membrane Fluidity; Phospholipids; Renal Agents; Triglycerides

Topics: Aged; Deamino Arginine Vasopressin; Enuresis; Heart Failure; Humans; Renal Agents; Time Factors; Urinary Incontinence

Peculiarities of the excretion of ions (Na, K, Ca, Mg) and water were studied in healthy children and children with the nocturnal enuresis, aged 6-15 years. A greater diuresis in the enuretic children is due to an increased excretion of the osmotically active substances including Na and Mg; excretion of K and Ca does nor differ from the control. A new formula is proposed for the quantitative evaluation of the role of different substances in the osmolar clearance. A high correlation is found between the sodium and magnesium excretion and the osmotic free water reabsorption. A single intranasal administration of 1-deamino-8-D-arginine-vasopressin (DDAVP) to the children before their going to bed returned to the norm the sodium and magnesium excretion in the enuretic children. It is suggested that the defect peculiar to this particular pathology is associated with a decrease in the ion reabsorption in the thick ascending Henle loop. The normal level of the ion transport is restored after stimulation of V2-receptors by DDAVP. An explanation is suggested of the mechanism of the increase of diuresis with a simultaneous rise in the osmotically free water reabsorption in children with enuresis.

Topics: Administration, Intranasal; Adolescent; Child; Circadian Rhythm; Deamino Arginine Vasopressin; Electrolytes; Enuresis; Female; Humans; Kidney; Male; Osmolar Concentration; Renal Agents; Urodynamics

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Osmolar Concentration; Renal Agents; Specific Gravity

Topics: Adolescent; Adult; Antidepressive Agents; Behavior Therapy; Child; Combined Modality Therapy; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Renal Agents; Risk Factors

The pharmacokinetics of desmopressin (1-desamino-8-D-arginine vasopressin) were investigated in 8 patients with nocturnal enuresis, of whom 4 were known to respond completely to desmopressin and 4 were nonresponders. A decrease in urine production was confirmed in responders after the administration of desmopressin while the drug did not cause antidiuresis in nonresponders. Absorption and excretion of desmopressin were identical in each group. Results indicate at least 2 pathophysiological mechanisms in nocturnal enuresis, including insufficient nocturnal production of arginine vasopressin and impaired renal sensitivity to arginine vasopressin and desmopressin. Each type results in high nocturnal urine production.

Topics: Adolescent; Adult; Arginine Vasopressin; Child; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Urine

The efficacy of desmopressin, a drug that reduces nocturnal urine volume with no side effects, was evaluated in a group of 21 patients.. 20 boys and 1 girl with primary nocturnal enuresis were treated with intranasal desmopressin (DDAVP) for a period of 12 weeks.. An improvement in 80.95% was achieved. Following treatment enuresis recurred, but to a lesser degree than before therapy.. DDAVP is useful in the treatment of primary nocturnal enuresis whose etiology is not organic or functional.

Topics: Adolescent; Child; Chronic Disease; Deamino Arginine Vasopressin; Drug Evaluation; Enuresis; Female; Humans; Male; Recurrence; Time Factors

Topics: Adult; Clozapine; Deamino Arginine Vasopressin; Enuresis; Humans; Male; Psychotic Disorders

Treatment of primary nocturnal enuresis using DDAVP is based upon the hypothesis that antidiuretic hormone (ADH) secretion is insufficient at night. The known efficacy of the treatment on the one hand, and persisting doubts about its theoretical basis on the other, formed the background of the present study. Ten children (mean age 10.5 years) with primary nocturnal enuresis were compared with a corresponding control group of eight patients. Diurnal and nocturnal urine production, ADH secretion, and plasma osmolality were determined. No differences between the two groups were found for urine production, ADH levels during day and night, or plasma osmolality. However, in order to regulate plasma osmolality the enuretic children required a markedly greater output of ADH: 2.87 (95% confidence interval 0.091 to 40.35) pg/ml/mmol/kg v 0.56 (0.08 to 1.03) in the controls (p < 0.01). The results are consistent with the established fact that ADH secretion is a function of plasma osmolality, and they contradict the hypothesis that urine production is increased at night in enuretics because of lower ADH secretion. The findings do not solve the uncertainties in the pathogenesis of enuresis but they suggest there might be a difference between enuretic children and controls at the ADH receptor level.

Topics: Child; Circadian Rhythm; Deamino Arginine Vasopressin; Diuresis; Enuresis; Female; Humans; Male; Osmolar Concentration; Prospective Studies; Single-Blind Method; Vasopressins

Topics: Child; Deamino Arginine Vasopressin; Drug Resistance; Enuresis; Female; Humans; Male; Renal Agents; Urinary Bladder

Topics: Adolescent; Adult; Arousal; Deamino Arginine Vasopressin; Enuresis; Humans; Polysomnography; Renal Agents; Sleep

Topics: Central Nervous System; Child; Child, Preschool; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Humans; Polyuria; Renal Agents; Treatment Failure; Urination; Urodynamics; Vasopressins

Nowadays enuresis is a problem that pediatric urologists are often called to treat, since it affects 15 to 30% of school-age children. In 85% of affected children bedwetting is monosymptomatic, not accompanied by other voiding disorders or daytime incontinence. Treatment of choice is still highly controversial, as the physiopathology is not yet fully understood and the pathogenesis is multifactorial: genetic and psychological factors, sleep disorders, urinary reservoir abnormalities, urine production disorders can all play a part. Behavioural treatments (psychotherapy, bladder training and biofeedback, electric alarm) and pharmacological therapy (tricyclic antidepressants, anticholinergics, DDAVP) have been used with variable results. In our 1 year experience (54 enuretic children) DDAVP proved to be effective in reducing the number of wet nights per week in 79% of cases. Acupuncture, which we have been using for many years, also gave good results in 55% of treated patients. Long term success of DDAVP and acupuncture was respectively 50 and 40%. We discuss the probable pathophysiology and present our own results and those reported in the literature. It has to be stressed that an accurate diagnostic selection of patients and a better understanding of physiopathology are the basis of effective treatment of enuresis.

Topics: Acupuncture Therapy; Adolescent; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Psychotherapy

The purpose of this study is to determine the efficacy of desmopressin (DDAVP), a synthetic analogue of antidiuretic hormone, as an alternative therapy in the management of spinal cord injured (SCI) patients with neurogenic bladder dysfunction unresponsive to conventional therapy. Seven SCI patients (three men and four women) were treated with DDAVP after urodynamic evaluation. Despite treatment with anticholinergic agents, urodynamic evaluation demonstrated uninhibited detrusor contractions exceeding 30 cm H2O pressure at less than 300 ml cystometric capacity in all seven patients. Three patients had been managed with intermittent self-catheterization, but had socially unacceptable short intervals between catheterizations. Two women with incomplete injury were afflicted with significant nocturia (> 3 episodes/night). The remaining two patients managed with intermittent self-catheterization were troubled with nocturnal enuresis. The patients received 10 micrograms intranasal DDAVP once every 24 hours. Prior to DDAVP administration, the four patients who used DDAVP nightly experienced a median of four episodes of nocturia. After one month of DDAVP treatment, two patients had only one episode of nocturia per night and in the other two patients, nocturnal enuresis was completely eliminated. Three patients used daytime DDAVP administration at work to avoid frequent catheterization. The median period between bladder catheterizations increased from 2.5 hours before DDAVP to 6 hours while using DDAVP. Symptomatic improvement persisted during the follow-up period of 6-20 months (mean = 12). Side effects were infrequent; only one patient complained of transient headaches. Neither hyponatremia nor serum electrolyte abnormalities occurred. Our preliminary results suggest that DDAVP is safe and effective in the symptomatic management of complicated neurogenic bladder dysfunction in selected SCI patients.

Topics: Administration, Intranasal; Adult; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Drug Administration Schedule; Enuresis; Female; Humans; Male; Middle Aged; Spinal Cord Injuries; Urinary Bladder, Neurogenic; Urodynamics

Topics: Bedding and Linens; Behavior Therapy; Child; Cost of Illness; Costs and Cost Analysis; Deamino Arginine Vasopressin; Denmark; Enuresis; Female; Humans; Male

Topics: Adolescent; Adult; Behavior Therapy; Child; Deamino Arginine Vasopressin; Enuresis; Humans

Topics: Child; Deamino Arginine Vasopressin; Drug Industry; Enuresis; Hotlines; Humans

Topics: Child; Confidentiality; Deamino Arginine Vasopressin; Enuresis; Hotlines; Humans; New Zealand

Topics: Child; Deamino Arginine Vasopressin; Drug Industry; Enuresis; Hotlines; Humans

The health economic consequences of treating nocturnal enuresis with a buzzer alarm is compared to treatment with Desmopressin. Based on age specific prevalence estimates and reported effects of the two treatments a cost-effectiveness analysis (CEA) was performed. The analysis showed a considerable difference between the costs of the two alternative treatments. A treatment based upon the buzzer alarm could result in a net saving to society of 19.2 million DKK, while a treatment based upon Desmopressin could result in expenses for society of 44.8 million DKK. A treatment based on a combination of the two will be economically neutral to the society. Treatment with a buzzer alarm or a combined treatment is therefore from a health economic point of view preferable. The health economic consequences of the introduction of new treatments are discussed, and it is recommended that health economic analyses are performed before the introduction of new treatments.

Topics: Adolescent; Child; Child, Preschool; Cost of Illness; Cost-Benefit Analysis; Cues; Deamino Arginine Vasopressin; Denmark; Enuresis; Humans; Monitoring, Physiologic

Topics: Adult; Clozapine; Deamino Arginine Vasopressin; Enuresis; Humans; Male; Schizophrenia

Topics: Child; Deamino Arginine Vasopressin; Drug Approval; Enuresis; Humans; United States; United States Food and Drug Administration; Vasopressins

A 4-year-old boy was treated with oxybutinine and desmopressine because of bladder instability associated with secondary enuresis. He was admitted with obnubilation, vomiting and experienced two seizure episodes concomitantly with hyponatremia and hypoosmolality. The child healed promptly under water restriction and intravenous administration of sodium chloride. This case report suggests that desmopressine may be responsible for severe side-effects. This drug should not be widely used and its indications should be restricted to patients with proven antidiuretic hormone secretion abnormalities.

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Male; Water Intoxication

Topics: Administration, Intranasal; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Hyponatremia; Male

This prospective self-controlled study was designed to evaluate the safety and efficacy of Desmopressin (DDAVP) in the treatment of childhood primary nocturnal enuresis (PNE) and the diurnal variation of ADH secretion and urine excretion/concentration in these children. Twenty-three children (15M,8F), aged 5-16 years, who wet their beds at least 3 nights per week were enrolled in the study. After a four-week observation period, they were hospitalized for one day to monitor intake, output, renal sonography, plasma ADH, urine and serum osmolality. Intranasal DDAVP treatment at a dose of 15-30 micrograms at bedtime was started with a 4-week titration period followed by a 3 to 6-month full dose treatment period. Subsequently the dose was tapered off for one to two months, and the patients were followed for at least two months to observe any recurrence. The results showed no diurnal difference of ADH level in these children (p > 0.05); serum osmolality decreased slightly during sleep (p < 0.01); urine production decreased, and urine osmolality increased, during sleep. Seventeen children (81%) responded with a more than 50% reduction in frequency of enuresis: 11 were excellent responders, 6 were partial responders, while 4 failed. After completion of therapy, four (19%) remained dry and were considered cured; the rest had much less frequent recurrence. There were no subjective complaints other than mild local discomfort; laboratory test results remained normal. It was concluded that intranasal DDAVP is a safe and effective treatment for PNE which usually works promptly. Given the spontaneous annual remission rate of 14%, the cure rate of 19% in this study was not satisfactory.

Topics: Administration, Intranasal; Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Drug Evaluation; Enuresis; Female; Humans; Male; Osmolar Concentration; Prospective Studies; Remission Induction; Vasopressins

The response to desmopressin in 71 children with nocturnal enuresis was evaluated to determine whether a family history of nocturnal enuresis could be helpful in predicting which patients would respond. The overall response rate to desmopressin (53 of 71 patients, 75%) was comparable to previous studies. A poor response was associated with a negative family history of nocturnal enuresis (1 of 14 patients, 7%), whereas the response in those with a positive family history was excellent (52 of 57 patients, 91%). We conclude from this preliminary retrospective study that a high rate of success may be predicted when desmopressin is used in patients with familial nocturnal enuresis, whereas less optimism is warranted when no family history of nocturnal enuresis can be elicited. This observation should be validated in a larger, prospective clinical study.

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Retrospective Studies

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Urinary Bladder

Topics: Administration, Intranasal; Behavior Therapy; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Voluntary Health Agencies

Nocturnal enuresis, commonly known as bedwetting, is described in documents dating from 1550 BC. Derived from the Greek word enourein, meaning "in urine" or "inability to control urination," it occurs in 15 to 20 per cent of five year olds and is twice as common in boys as girls. Indeed, no cure has yet been found and thousands of children and their families live with the distress the condition causes. Among affected children, this often includes behavioral problems and low self-esteem.

Topics: Adolescent; Child; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male

Topics: Deamino Arginine Vasopressin; Enuresis; Humans; Hyponatremia; Time Factors

Topics: Administration, Intranasal; Child; Deamino Arginine Vasopressin; Enuresis; Epilepsy, Tonic-Clonic; Female; Humans

Topics: Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Middle Aged; Treatment Failure

Topics: Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Humans

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans

We report a case of hyponatremia associated with a grand mal seizure in a 28 month-old child after intra-nasal desmopressin administration for high fluid intake with nocturnal enuresis. In view of the temporary symptomatic action and the seriousness of certain side-effects of desmopressin we recommend that desmopressin be used with caution in childhood enuresis.

Topics: Administration, Intranasal; Aerosols; Child, Preschool; Deamino Arginine Vasopressin; Drinking; Enuresis; Epilepsy, Tonic-Clonic; Humans; Hyponatremia; Male; Water Intoxication

Topics: Child; Deamino Arginine Vasopressin; Drinking; Electrolytes; Enuresis; Humans; Hyponatremia; Male; Osmolar Concentration; Seizures; Water Intoxication

A five-year experience with the vasopressin analogue desmopressin acetate (DDAVP) for nocturnal enuresis is described in 59 children. The initial starting dose of 5 micrograms at bedtime is lower than that reported in other series. Eighty-one percent of patients required 10 micrograms or less to achieve improvement or resolution of bedwetting.

Topics: Adolescent; Adult; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Treatment Outcome

Topics: Adolescent; Child; Child, Preschool; Cost-Benefit Analysis; Deamino Arginine Vasopressin; Enuresis; Humans; Imipramine; Risk; Treatment Outcome

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans

Topics: Administration, Intranasal; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Humans; Hyponatremia; Male; Seizures

Topics: Child; Child, Preschool; Combined Modality Therapy; Deamino Arginine Vasopressin; Enuresis; Humans; Imipramine; Mental Disorders; Patient Education as Topic

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Vasopressins

Eight patients with monosymptomatic nocturnal enuresis (age 11-24 years) were investigated prior to and after 24 weeks of desmopressin treatment in order to evaluate the impact on the endogenous vasopressin secretion and urinary output. No effect on plasma vasopressin, diurnal urinary volume, and urinary osmolality were found after this long-term treatment. Overall no changes in either body weight, blood pressure, or hematological variables were demonstrated. This supports previous findings that the treatment appears to be well tolerated and free of side effects in longer term.

Topics: Adolescent; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Female; Follow-Up Studies; Humans; Male; Time Factors; Urine; Vasopressins

Topics: Child; Combined Modality Therapy; Conditioning, Psychological; Deamino Arginine Vasopressin; Enuresis; Humans

Topics: Administration, Intranasal; Adolescent; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Vasopressins

Topics: Deamino Arginine Vasopressin; Enuresis; Humans

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans

Topics: Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Humans; Recurrence

Topics: Administration, Intranasal; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Hyponatremia; Male

A group of 7 patients with refractory primary nocturnal enuresis on long-term DDAVP therapy (mean 13 months) were submitted to a standard water deprivation test in conjunction with a hormone profile and routine haematological and biochemical investigations. No abnormalities were demonstrated, which suggests that the drug is safe in this clinical situation.

Topics: Adolescent; Adult; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Pituitary-Adrenal System; Safety; Time Factors

Enuresis affects 5 to 10% of primary-school age children. Nocturnal enuresis, or bedwetting, is often familial and boys are mainly concerned; daytime micturitions are normal, without urine loss or urinary tract infection. Hygienic rules associated with desmopressin or, in some cases, tricyclic antidepressant agents, alarm procedures or psychotherapy, result in a 70% success rate after 1 year. Bladder instability consists of diurnal and nocturnal disturbances, mainly in girls with recurrent urinary tract infections; affected children experience pollakiuria, urine loss and voiding emergencies. Urodynamic assessment of daytime enuresis is of major interest, mainly when dysuria is present. The treatment of non complicated bladder instability needs reeducation, i.e. biofeedback and/or administration of oxybutynin chlorhydrate.

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Parasympatholytics; Surveys and Questionnaires; Urination Disorders; Urodynamics

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Diuresis; Enuresis; Humans; Sleep Stages; Urethra; Urinary Bladder; Urodynamics

Topics: Administration, Intranasal; Adolescent; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Recurrence; Time Factors

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Imipramine

Topics: Adolescent; Deamino Arginine Vasopressin; Enuresis; Humans; Male; Military Personnel; United States

Topics: Adolescent; Adult; Child; Deamino Arginine Vasopressin; Drug Evaluation; Enuresis; Female; Humans; Male; Urinary Bladder

Topics: Administration, Intranasal; Adolescent; Arginine Vasopressin; Child; Deamino Arginine Vasopressin; Enuresis; Humans

Topics: Adolescent; Arginine Vasopressin; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male

Topics: Administration, Intranasal; Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male

Topics: Adolescent; Arginine Vasopressin; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male

Topics: Adolescent; Arginine Vasopressin; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male

Topics: Administration, Intranasal; Adolescent; Child; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Vasopressins

Topics: Adult; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Enuresis; Humans; Kidney; Kidney Concentrating Ability; Vasopressins