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Efficacy of Desmopressin Combined with Alarm Therapy for Monosymptomatic Nocturnal Enuresis

Year 2020, Volume: 5 Issue: 2, 249 - 259, 30.06.2020
https://doi.org/10.26453/otjhs.560449

Abstract

Objective: The aim of the retrospective study was to compare desmopressin, alarm, and combined treatments in nocturnal enuresis.
Materials and Methods: Patients diagnosed with monosymptomatic nocturnal enuresis is retrospectively evaluated. In total 101 patients (67 male/34 female) with desmopressin (33 patients), alarm (34 patients) and combined (34 patients) included to the study. The average age determined as 10.7±2.4 years (5-16 years). Medical history of the patients and family, physical findings, treatments are recorded. The wet night numbers are determined for 1 month before the beginning of the treatment, treatment duration and during the follow-up (monitoring) process for nine weeks after the completion of treatment.  Response rates to the treatment and subsequent relapse rates were detected.
Results: The number of wet nights per month was significantly reduced from before treatment and the last month of treatment in the desmopressin (14.5±5.7 to 4.8±6.5, p<0.001), alarm (14.1±5.9 to 2.9±4.1, p<0.001), and combined treatment (16.2±6.9 to 1.9±2.5, p<0.001) groups. The treatment success (>50% decrease in wet nights) and complete response (100% dry) rates were 79%, 91%, and 97%, and 30%, 27%, and 35% in the desmopressin, alarm, and combined treatment groups, respectively. The relapse rates in successfully treated patients were 67%, 11%, and 22% in the desmopressin, alarm, and combined treatment groups, respectively (p=0.002).
Conclusion: Alarm treatment was the best intervention with low relapse rates and no potential adverse effects in nocturnal enuresis. The desmopressin group has a higher relapse rate.

References

  • 1. Avanoğlu A, Baskın E, Söylemezoğlu O, Tekgül S, Ziylan O, Zorludemir Ü. Türkiye enürezis çalışma grubu. Türkiye Enürezis Tedavi Kılavuzu 2010;1-16.
  • 2. Kahraman A, Dursun H, Hatipoglu S, et al. Non-dipping phenomenon in children with monosymptomatic nocturnal enuresis. Pediatr Nephrol. 2013;28(7):1099–103. doi: https://doi.org/10.1007/s00467-013-2448-1
  • 3. Kwak KW, Lee YS, Park KH, Baek M. Efficacy of desmopressin and enuresis alarm as first and second line treatment for primary monosymptomatic nocturnal enuresis: prospective randomized crossover study. J Urol. 2010;184(6):2521-6 https://doi.org/10.1016/j.juro.2010.08.041
  • 4. Deshpande AV, Caldwell PH. Medical management of nocturnal enuresis. Paediatr Drugs. 2012;14(2):71-7. doi: https://doi.org/10.2165/11594870-000000000-00000
  • 5. Glazener CMA, Evans JHC, Peto RE. Alarm interventions for nocturnal enuresis in children. Cochrane Database Syst Rev 2005;(2):CD002911. doi: https://doi.org/10.1002/14651858.CD002911.pub2
  • 6. Sinha R, Sumantra R. Management of nocturnal enuresis - myths and facts. World J Nephrol. 2016;5(4): 328-38. doi: https://doi.org/10.5527/wjn.v5.i4.328
  • 7. Miller K, Atkin B, Moody ML. Drug therapy for nocturnal enuresis. Current treatment recommendations. Drugs. 1992;44(1):47-56. doi: https://doi.org/10.2165/00003495-199244010-00004
  • 8. Meadow SR. Enuresis. In:Edelmann CM, ed.Pediatric Kidney Disease. 2nd ed. Boston, Brown Company, Inc; 1992:2015-25.
  • 9. Gera T, Seth A, Mathew J. Nocturnal enuresis in children. The Internet Journal of Pediatrics and Neonatology. 2000;12(1):1-12.
  • 10. Gümüş B, Vurgun N, Lekili M, İscan A, Müezzinoğlu T, Büyüksu C. Prevelance of nocturnal enüresis and acompanying foctors in children aged 7-11 years in Turkey. Acta pediatr. 1999; 88(12):1369-72. doi: https://doi.org /10.1080/080352599750030103
  • 11. Oge O, Koçak T, Gemalmaz H. Enuresis:Point prevelence and associated factors among Turkish children. Turk J pediatr. 2001;43(1):38-43.
  • 12. Gür E, Turhan P, Can G, et al. Enüresis: Prevalence,risk,factors and urinary pathology among school children in İstanbul,Turkey. Pediatrics İnternational. 2004;46(1):58. doi: https://doi.org/10.1111/j.1442-200X.2004.01824.x
  • 13. Readett DR, Bomigbode T, Serjeant GR. Nocturnal enüresis in normal Jamaican children implications for therapy. West İndian Med J. 1991;40(4):181-4.
  • 14. Perrin N, Sayer L, While A. The efficacy of alarm therapy versus desmopressin therapy in the treatment of primary mono-symptomatic nocturnal enuresis: a systematic review. Prim Health Care Res Dev. 2015; 16(1): 21–31. doi: https://doi.org/10.1017/S146342361300042X
  • 15. Gıbb S, Nolan T, South M, Noad L. Evidence agaınst a synergistic effect of desmopressin with conditioning ın the treatment of nocturnal enuresis. J Pediatr. 2004;144(3):351-7. doi: https://doi.org/10.1016/j.jpeds.2003.12.019
  • 16. Leebeek-Groenewegen A, Blom J, Sukhaı R, Van Der Heilden B. Effıcacy Of Desmopressin Combined With Alarm Therapy For Monosymptomatıc Nocturnal Enuresis. J Urol. 2001;166(6):2456-58.
  • 17. Fai-Ngo Ng C, Wong S.N. Comparing alarms, desmopressin, and combined treatment in Chinese enuretic children. Pediatr Nephrol. 2005;20(2):163-69. doi: https://doi.org/10.1007/s00467-004-1708-5
  • 18. Ahmed AF, Amin MM, Ali MM, Shalaby EA. Efficacy of an enuresis alarm, desmopressin, and combination therapy in the treatment of saudi children with primary monosymptomatic nocturnal enuresis. Korean J Urol. 2013;54(11):783-90. doi: https://doi.org/10.4111/kju.2013.54.11.783

Monosemptomatik Nokturnal Enürezis Tedavisinde Desmopressin ile Kombine Edilen Alarm Tedavisinin Etkinliği

Year 2020, Volume: 5 Issue: 2, 249 - 259, 30.06.2020
https://doi.org/10.26453/otjhs.560449

Abstract

Amaç: Geriye dönük olarak yapılan çalışmamızda amaç; monosemptomatik nokturnal enürezis tedavisinde kullanılan desmopressin, alarm ve kombine tedavileri karşılaştırmaktır.
Materyal ve Metot: Monosemptomatik noktürnal enürezis tanısı alan hastalar geriye dönük olarak değerlendirildi. Desmopressin (33 hasta), alarm (34 hasta) ve kombine (34 hasta) tedavi başlanan toplam 101 hasta (67 erkek/34 kız) çalışmaya dahil edildi. Yaş ortalaması 10,7±2,4 yıl (5-16 yaş) saptandı. Hastaların tıbbi öyküsü, fizik muayene bulguları, özgeçmiş ve soygeçmişi, verilen tedavi bilgileri kayıt altına alındı. Tedavi başlanmadan 1 ay önceki, tedavi süresi ve tedavi kesildikten sonraki dokuz haftalık izlem süresi boyunca ıslak gece sayıları tespit edildi. Tedaviye yanıt ve sonrasında nüks oranları tespit edildi.
Bulgular: Tedavi öncesi ıslak gecelerin ortalaması ayda 14,9±6,1 gün bulundu. Aylık ıslak gece sayısı tedaviden sonra her üç tedavi grubunda da anlamlı olarak azaldı (desmopressin; 14,5±5,7 ila 4,8±6,5; p<0,001, alarm; 14,1±5,9 ila 2,9±4,1; p<0,001, kombine tedavi;16,2±6,9 ila 1,9±2,5; p<0,001). Tedavi başarısı (ıslak gecelerde>%50 azalma) ve tam yanıt (%100 kuru) oranları desmopresin, alarm ve kombine tedavi gruplarında sırasıyla %79, %91 ve %97, %30 ve %27, %35 idi. Başarılı tedavi edilen hastalarda nüks oranları desmopresin, alarm ve kombine tedavi grubunda sırasıyla % 67, % 11 ve % 22 (p=0,002) saptandı.
Sonuç: Alarm tedavisi, düşük nüks oranları ve yan etki olmaması nedeniyle en iyi tedavi seçeneği olarak karşımıza çıkmaktadır. Desmopressin tedavisinde yüksek oranda nüks saptanmıştır.

References

  • 1. Avanoğlu A, Baskın E, Söylemezoğlu O, Tekgül S, Ziylan O, Zorludemir Ü. Türkiye enürezis çalışma grubu. Türkiye Enürezis Tedavi Kılavuzu 2010;1-16.
  • 2. Kahraman A, Dursun H, Hatipoglu S, et al. Non-dipping phenomenon in children with monosymptomatic nocturnal enuresis. Pediatr Nephrol. 2013;28(7):1099–103. doi: https://doi.org/10.1007/s00467-013-2448-1
  • 3. Kwak KW, Lee YS, Park KH, Baek M. Efficacy of desmopressin and enuresis alarm as first and second line treatment for primary monosymptomatic nocturnal enuresis: prospective randomized crossover study. J Urol. 2010;184(6):2521-6 https://doi.org/10.1016/j.juro.2010.08.041
  • 4. Deshpande AV, Caldwell PH. Medical management of nocturnal enuresis. Paediatr Drugs. 2012;14(2):71-7. doi: https://doi.org/10.2165/11594870-000000000-00000
  • 5. Glazener CMA, Evans JHC, Peto RE. Alarm interventions for nocturnal enuresis in children. Cochrane Database Syst Rev 2005;(2):CD002911. doi: https://doi.org/10.1002/14651858.CD002911.pub2
  • 6. Sinha R, Sumantra R. Management of nocturnal enuresis - myths and facts. World J Nephrol. 2016;5(4): 328-38. doi: https://doi.org/10.5527/wjn.v5.i4.328
  • 7. Miller K, Atkin B, Moody ML. Drug therapy for nocturnal enuresis. Current treatment recommendations. Drugs. 1992;44(1):47-56. doi: https://doi.org/10.2165/00003495-199244010-00004
  • 8. Meadow SR. Enuresis. In:Edelmann CM, ed.Pediatric Kidney Disease. 2nd ed. Boston, Brown Company, Inc; 1992:2015-25.
  • 9. Gera T, Seth A, Mathew J. Nocturnal enuresis in children. The Internet Journal of Pediatrics and Neonatology. 2000;12(1):1-12.
  • 10. Gümüş B, Vurgun N, Lekili M, İscan A, Müezzinoğlu T, Büyüksu C. Prevelance of nocturnal enüresis and acompanying foctors in children aged 7-11 years in Turkey. Acta pediatr. 1999; 88(12):1369-72. doi: https://doi.org /10.1080/080352599750030103
  • 11. Oge O, Koçak T, Gemalmaz H. Enuresis:Point prevelence and associated factors among Turkish children. Turk J pediatr. 2001;43(1):38-43.
  • 12. Gür E, Turhan P, Can G, et al. Enüresis: Prevalence,risk,factors and urinary pathology among school children in İstanbul,Turkey. Pediatrics İnternational. 2004;46(1):58. doi: https://doi.org/10.1111/j.1442-200X.2004.01824.x
  • 13. Readett DR, Bomigbode T, Serjeant GR. Nocturnal enüresis in normal Jamaican children implications for therapy. West İndian Med J. 1991;40(4):181-4.
  • 14. Perrin N, Sayer L, While A. The efficacy of alarm therapy versus desmopressin therapy in the treatment of primary mono-symptomatic nocturnal enuresis: a systematic review. Prim Health Care Res Dev. 2015; 16(1): 21–31. doi: https://doi.org/10.1017/S146342361300042X
  • 15. Gıbb S, Nolan T, South M, Noad L. Evidence agaınst a synergistic effect of desmopressin with conditioning ın the treatment of nocturnal enuresis. J Pediatr. 2004;144(3):351-7. doi: https://doi.org/10.1016/j.jpeds.2003.12.019
  • 16. Leebeek-Groenewegen A, Blom J, Sukhaı R, Van Der Heilden B. Effıcacy Of Desmopressin Combined With Alarm Therapy For Monosymptomatıc Nocturnal Enuresis. J Urol. 2001;166(6):2456-58.
  • 17. Fai-Ngo Ng C, Wong S.N. Comparing alarms, desmopressin, and combined treatment in Chinese enuretic children. Pediatr Nephrol. 2005;20(2):163-69. doi: https://doi.org/10.1007/s00467-004-1708-5
  • 18. Ahmed AF, Amin MM, Ali MM, Shalaby EA. Efficacy of an enuresis alarm, desmopressin, and combination therapy in the treatment of saudi children with primary monosymptomatic nocturnal enuresis. Korean J Urol. 2013;54(11):783-90. doi: https://doi.org/10.4111/kju.2013.54.11.783
There are 18 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research article
Authors

Yüksel Bıcılıoğlu 0000-0003-4531-3978

Mustafa Bak This is me

Erkin Serdaroğlu This is me 0000-0002-5572-532X

Publication Date June 30, 2020
Submission Date May 6, 2019
Acceptance Date March 25, 2020
Published in Issue Year 2020 Volume: 5 Issue: 2

Cite

AMA Bıcılıoğlu Y, Bak M, Serdaroğlu E. Monosemptomatik Nokturnal Enürezis Tedavisinde Desmopressin ile Kombine Edilen Alarm Tedavisinin Etkinliği. OTJHS. June 2020;5(2):249-259. doi:10.26453/otjhs.560449

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