Early Response to Desmopressin in Pediatric Patients with Monosymptomatic Nocturnal Enuresis

Abstract

Aim: The aim of this study was to evaluate the treatment responses of primary monosymptomatic nocturnal enuresis (MNE) patients who were chosen for desmopressin treatment after the family was informed about the pros and cons of alarm and desmopressin therapies.

Material and Methods: Primary MNE patients aged 5–18 years who received desmopressin as first-line treatment between May 2023 and April 2024 were enrolled. Patients' responses to treatment were categorized as complete response, partial response, and non-response.

Results: Fifty-five patients with MNE were included in the study; 37 (67.3%) were male, and the mean age was 8.7±2.7 years. The mean duration of enuresis was 73±33 month, and the frequency of enuresis was 7 nights/week in 45 patients (82%). 35 patients (64%) had a family history of enuresis. After two weeks of treatment with 120 mcg of desmopressin, the complete response rate was 63.6%, the partial response rate was 18.2%, and the non-response rate was 18.2%. Two weeks after increasing the desmopressin dose to 240 mcg in partial responders and non-responders, and after excluding the 10 patients who either declined dose escalation or were lost to follow-up, the overall complete response rate was 84.4% (38/45 patients), the partial response rate was 4.4% (2/45 patients), and the non-response rate was 11.2% (5/45 patients). Age, sex, family history, duration of enuresis, and prior desmopressin use were not significantly associated with complete response.

Conclusion: This study confirms that desmopressin is an effective first-line therapy for primary MNE. When completion of a voiding diary by a family member is not feasible, empiric initiation of desmopressin may be considered as first-line treatment.

Keywords

• Children
• desmopressin
• enuresis
• monosymptomatic nocturnal enuresis

Ethical Statement

The study protocol was approved by the Balıkesir Ataturk City Hospital Scientific Research Ethics Board (2024/05/26). All procedures followed scientific and ethical principles, and all referenced studies are appropriately cited.

Monosemptomatik Enürezis Nokturna Tanılı Çocuklarda Desmopressin Tedavisine Erken Yanıtın Değerlendirilmesi

Abstract

Amaç: Bu çalışmada, alarm ve desmopressin tedavilerinin avantaj ve dezavantajları hakkında aileye bilgilendirme yapıldıktan sonra desmopressin tedavisi tercih edilen primer monosemptomatik enürezis nokturna (MEN) hastalarının tedavi yanıtlarının değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntemler: Mayıs 2023 ile Nisan 2024 tarihleri arasında birinci basamak tedavi olarak desmopressin başlanan, 5–18 yaş aralığındaki primer MEN hastaları çalışmaya dahil edildi. Hastaların tedaviye yanıtları; tam yanıt, kısmi yanıt ve yanıtsızlık olarak sınıflandırıldı.

Bulgular: Çalışmaya MEN tanılı 55 hasta dahil edildi; bunların 37’si (%67,3) erkekti ve ortalama yaş 8,7±2,7 yıl idi. Ortalama enürezis süresi 73±33 ay olup, 45 hastada (%82) enürezis sıklığı haftada 7 gece olarak saptandı. Otuz beş hastanın (%64) ailesinde enürezis öyküsü mevcuttu. 120 mcg desmopressin ile iki haftalık tedavi sonrasında tam yanıt oranı %63,6, kısmi yanıt oranı %18,2 ve yanıtsızlık oranı %18,2 olarak belirlendi. Kısmi yanıt veren ve yanıtsız hastalarda desmopressin dozunun 240 mcg’a artırılmasından iki hafta sonra, ve doz artışını kabul etmeyen veya takibi bırakan 10 hasta dışlandıktan sonra, genel tam yanıt oranı %84,4 (38/45 hasta), kısmi yanıt oranı %4,4 (2/45 hasta) ve yanıtsızlık oranı %11,2 (5/45 hasta) olarak saptandı. Yaş, cinsiyet, aile öyküsü, enürezis süresi ve daha önce desmopressin kullanımı ile tam yanıt arasında istatistiksel olarak anlamlı bir ilişki bulunmadı.

Sonuç: Bu çalışma, desmopressinin primer MEN tedavisinde etkili bir birinci basamak tedavi seçeneği olduğunu doğrulamaktadır. Aile tarafından işeme günlüğünün doldurulmasının mümkün olmadığı durumlarda, desmopressinin ampirik olarak birinci basamak tedavi şeklinde başlanması düşünülebilir.

Keywords

• Çocuk
• desmopressin
• enürezis
• monosemptomatik enürezis nokturna

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