deamino-arginine-vasopressin and Urinary-Bladder--Neurogenic

Topics: Antidiuretic Agents; Behavior Therapy; Child; Deamino Arginine Vasopressin; Diurnal Enuresis; Dose-Response Relationship, Drug; Humans; Nocturnal Enuresis; Physical Examination; Urinary Bladder, Neurogenic; Urodynamics

The current review evaluates the safety and efficacy of desmopressin in patients with multiple sclerosis (MS) who suffer from both daytime and nocturnal voiding frequency and from incontinence.. A literature search was carried out looking for studies published between 1990 and 2003 which evaluated desmopressin in MS patients with bladder dysfunction.. The grand total mean effect sizes show the following estimates of clinical relevant differences: desmopressin has a moderate effect on the number of voids during the day or during the night over a period of 6 h after taking the drug. A large effect associated with the use of desmopressin was detected by the mean difference in urine volume (ml) in 6 h. A small effect was detected in the mean 24-h urine volume. Serum sodium levels were combined with plasma osmolality in some studies and were found to be not significantly affected by desmopressin treatment.

Topics: Adult; Aged; Deamino Arginine Vasopressin; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Osmolar Concentration; Renal Agents; Sodium; Treatment Outcome; Urinary Bladder, Neurogenic; Urination; Water-Electrolyte Balance

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

Neurogenic bladder affects up to 80% of patients with multiple sclerosis (MS) and, in 50% of these patients, it is a significant cause of disability. The current management of neurogenic bladder, based on fluid restriction, anticholinergic agents, intermittent self-catheterization, and, in some cases, surgical intervention, often fails to relieve all symptoms. Furthermore, anticholinergic drugs have significant adverse effects and may be medically contraindicated. Nocturia is a particularly disabling symptom of neurogenic bladder; by disrupting sleep patterns, it aggravates the chronic fatigue of MS, imposes serious demands on caregivers, and can lead to institutionalization. To evaluate a novel approach to the symptomatic management of nocturia in patients with MS, we have conducted a trial of desmopressin acetate (1-desamino-8-D-arginine vasopressin), a synthetic analogue of antidiuretic hormone.. To evaluate the efficacy and short-term safety of desmopressin therapy in the symptomatic treatment of nocturia in patients with MS.. Seventeen patients were enrolled in a double-blind, crossover trial of desmopressin administered at bedtime. Patients with both relapsing-remitting and chronic-progressive forms of MS were admitted. Night time voiding diaries were maintained for the 6 weeks of the trial; similarly, serum electrolyte levels and plasma osmolality were measured twice weekly and urinalyses and urine cultures were performed weekly during the trial.. Desmopressin reduced the percentage of nights with nocturia in patients from 97% to 66%. The average number of episodes of nocturia per night in patients decreased from 2.35 to 1.09 and the maximum hours of sleep uninterrupted by nocturia increased from 3.74 to 5.77. These results were highly significant. Four of the 17 patients discontinued participation in the study after developing asymptomatic or minimally symptomatic hyponatremia.. Desmopressin was found effective; no tolerance and only minimal adverse effects have been observed. Our results suggest that desmopressin, either alone or in combination with other therapeutic modalities, is effective in the symptomatic management of nocturia in patients with MS. The only adverse effect attributed to desmopressin was hyponatremia, which occurred in 4 of 17 patients and appeared to be dose related.

Topics: Adult; Aged; Cross-Over Studies; Deamino Arginine Vasopressin; Double-Blind Method; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Renal Agents; Urinary Bladder, Neurogenic; Urination Disorders

Thirteen patients with advanced multiple sclerosis and urge urinary incontinence were treated with desmopressin--a synthetic analogue of antidiuretic hormone--in a double-blind cross-over study. The micturition frequency decreased significantly (p less than 0.05). Less leakage was considered valuable for daily life. Peroral medication was favourable in these patients with muscular dysfunction. Side-effects were few.

Topics: Administration, Oral; Deamino Arginine Vasopressin; Double-Blind Method; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Randomized Controlled Trials as Topic; Urinary Bladder, Neurogenic; Urinary Incontinence

Multiple sclerosis (MS) is the commonest progressive neurological disease affecting young people. With advancing disease, management of neurogenic detrusor overactivity (NDO) based on antimuscarinics may prove inadequate and if based on botulinum toxin, may necessitate clean intermittent self-catheterization. The aim of the study was to evaluate the effectiveness of combined mirabegron and desmopressin administration in the treatment of NDO in patients with MS.. Sixty patients diagnosed with MS and NDO were evaluated. All had received treatment with solifenacin 10 mg/daily for 3 months and were displeased with the results. Patients were divided in four groups. In Group A (n = 15) patients continued receiving solifenacin 10 mg/daily; in Group B (n = 15) patients received mirabegron 50 mg/daily; in Group C (n = 15) patients received desmopressin 120 mcg/daily and in Group D (n = 15) patients received mirabegron 50 mg/daily and desmopressin 120 mcg/daily. All patients were assessed with a 3 day bladder diary at the beginning and at the end of the treatment.. All patients in Groups A, B and C did not demonstrate statistically significant changes at the end of the treatment period in their 3 day bladder diary and in the presence of urinary infections. In Group D, a statistically significant improvement was noted in the mean change from baseline to end of treatment in micturition episodes (3.5 +/- 0.4 micturition/24h), in urgency episodes (2.3 +/- 0.2) and mean number of urinary incontinence (1.0 +/- 0.2 episodes/24h).. Treatment with mirabegron and desmopressin revealed both effectiveness and safety in patients with NDO and MS.

Topics: Acetanilides; Adrenergic beta-3 Receptor Agonists; Adult; Antidiuretic Agents; Deamino Arginine Vasopressin; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Muscarinic Antagonists; Retreatment; Solifenacin Succinate; Thiazoles; Urinary Bladder, Neurogenic; Urinary Bladder, Overactive; Urinary Incontinence; Urination

Topics: Antidiuretic Agents; Child; Chromosomes, Human, Pair 4; Deamino Arginine Vasopressin; Diabetes Insipidus; Family Health; Female; Hearing Loss, Sensorineural; Homozygote; Humans; Hydronephrosis; Membrane Proteins; Mothers; Mutation; Treatment Outcome; Uniparental Disomy; Urinary Bladder, Neurogenic; Wolfram Syndrome

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

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

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