Desmopressin, Alarm ya da Kombine Tedavi? Primer Monosemptomatik Noktürnal Enürezisli Çocuklarda Etkinlik ve Nüksün Değerlendirilmesi

Year 2025, Volume: 78 Issue: 3, 239 - 243, 30.09.2025

Aykut Akinci , Murat Can Karaburun

https://doi.org/10.65092/autfm.1740446

Abstract

Giriş: Monosemptomatik noktürnal enürezis (MNE), çocuklarda özgüven ve aile düzenini olumsuz etkileyen yaygın bir durumdur. Enürezis alarmı ve desmopressin birinci basamak tedavi seçenekleri arasında yer almakta, ancak etkinlik ve nüks oranları hâlâ tartışılmaktadır.

Amaç: Bu çalışmanın amacı, primer MNE tanılı çocuklarda desmopressin, alarm tedavisi ve kombine tedavinin kısa dönem tedavi sonuçları ile nüks oranlarını karşılaştırmaktır.

Gereç ve Yöntem: Bu retrospektif iki merkezli çalışmaya, Eylül 2022 ile Ocak 2025 tarihleri arasında MNE tanısı alan 202 çocuk dahil edildi. Hastalar desmopressin monoterapisi (n=124), alarm tedavisi (n=45) ve kombine tedavi (n=33) gruplarına ayrıldı. Demografik veriler, tedavi yanıtları ve nüks oranları değerlendirildi.

Bulgular: Tam yanıt oranları desmopressin grubunda %39,5, alarm grubunda %42,2 ve kombine grupta %63,6 idi. Nüks oranı desmopressin grubunda %48,4, alarm grubunda %33,3 ve kombine grupta %30,3 olarak saptandı. Kombine tedavi sayısal olarak daha iyi sonuç verse de fark istatistiksel olarak anlamlı değildi (p>0,05).

Sonuç: Primer MNE tedavisinde desmopressin, alarm tedavisi ve kombine tedavi etkili seçeneklerdir. Kombine tedavi bazı hastalarda ek fayda sağlayabilir, ancak bu çalışmada belirgin bir üstünlük göstermemiştir. Tedavi planı, bireysel faktörler ve aile uyumu göz önünde bulundurularak yapılmalıdır.

Keywords

Monosemptomatik Noktürnal Enürezis , Desmopressin , Enürezis Alarmı

Desmopressin, Alarm, or Both? Evaluating Efficacy and Relapse in Children with Primary Monosymptomatic Nocturnal Enuresis

Abstract

Background: Monosymptomatic nocturnal enuresis (MNE) is a common pediatric condition that affects a child’s self-esteem and daily family life. Both enuresis alarm and desmopressin are recommended as first-line treatment options, but their comparative effectiveness and relapse rates remain subjects of discussion.
Aim: This study aimed to compare the short-term treatment outcomes and relapse rates of desmopressin, alarm therapy, and combination therapy in children with primary MNE.
Materials and Methods:
This retrospective two-center study included 202 children diagnosed with MNE between September 2022 and January 2025. Patients were grouped into desmopressin monotherapy (n=124), alarm therapy (n=45), and combination therapy (n=33). Demographic data, treatment responses, and relapse rates were evaluated.
Results: Complete response rates were 39.5% for desmopressin, 42.2% for alarm therapy, and 63.6% for the combination group. Relapse occurred in 48.4% of the desmopressin group, 33.3% of the alarm group, and 30.3% of the combination group. Although the combination group showed higher response rates and lower relapse rates, these differences were not statistically significant (p>0.05).
Conclusion: Desmopressin, alarm therapy, and their combination are effective options for the treatment of primary MNE. Combination therapy may provide added benefit in selected patients, but no clear superiority was demonstrated in this study. Treatment plans should consider individual factors such as nocturnal urine output and family compliance.

Keywords

Monosymptomatic nocturnal enuresis , Desmopressin , Enuresis alarm

Ethical Statement

This study was approved by the Non-Interventional Clinical Research Ethics Committee of Pamukkale University (Approval No: E-60116787-020-622659, Date: 10.12.2024). The study was conducted in accordance with the principles of the Declaration of Helsinki.

References

• Austin PF, Bauer SB, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the International Children's Continence Society. Neurourol Urodyn. 2016;35(4):471-81.
• Nevéus T, Fonseca E, Franco I, et al. Management and treatment of nocturnal enuresis-an updated standardization document from the International Children's Continence Society. J Pediatr Urol. 2020;16(1):10-9.
• Caldwell PH, Deshpande AV, Von Gontard A. Management of nocturnal enuresis. BMJ. 2013;347:f6259.
• Bayne AP, Skoog SJ. Nocturnal enuresis: an approach to assessment and treatment. Pediatr Rev. 2014;35(8):327-34; quiz 35.
• Purnomo AF, Daryanto B, Nurhadi P. Monosymptomatic Nocturnal Enuresis Treatment Using Alarm-Therapy and Desmopressin: A Meta-analysis Approach. Med Arch. 2021;75(6):431-5.
• Aksakallı T, Cinislioğlu AE, Aksoy Y. The Efficacy of Combined Alarm Therapy Versus Alarm Monotherapy in the Treatment of Monosymptomatic Nocturnal Enuresis: A Review of Current Literature. Eurasian J Med. 2022;54(Suppl1):164-7.
• Kamperis K, Hagstroem S, Rittig S, Djurhuus JC. Combination of the enuresis alarm and desmopressin: second line treatment for nocturnal enuresis. J Urol. 2008;179(3):1128-31.
• Song P, Huang C, Wang Y, et al. Comparison of desmopressin, alarm, desmopressin plus alarm, and desmopressin plus anticholinergic agents in the management of paediatric monosymptomatic nocturnal enuresis: a network meta-analysis. BJU Int. 2019;123(3):388-400.
• Zhai R, Shao S, Lv L, et al. Efficacy of desmopressin and enuresis alarm in the treatment of monosymptomatic nocturnal enuresis: a multicenter prospective randomized controlled study. Pediatr Nephrol. 2025;40(10):3137-3144.
• Mello MF, Locali RF, Araujo RM, et al. A prospective and randomized study comparing the use of alarms, desmopressin and imipramine in the treatment of monosymptomatic nocturnal enuresis. J Pediatr Urol. 2023;19(3):241-6.
• Naitoh Y, Kawauchi A, Yamao Y, et al. Combination therapy with alarm and drugs for monosymptomatic nocturnal enuresis not superior to alarm monotherapy. Urology. 2005;66(3):632-5.