Efficacy of Desmopressin Combined with Alarm Therapy for Monosymptomatic Nocturnal Enuresis

Yıl 2020, Cilt: 5 Sayı: 2, 249 - 259, 30.06.2020

Yüksel Bıcılıoğlu , Mustafa Bak Erkin Serdaroğlu

https://doi.org/10.26453/otjhs.560449

Cited By: 1

Öz

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.

Anahtar Kelimeler

enuresis, alarm, desmopressin, combined therapy

Monosemptomatik Nokturnal Enürezis Tedavisinde Desmopressin ile Kombine Edilen Alarm Tedavisinin Etkinliği

Öz

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.

Anahtar Kelimeler

enürezis, alarm, desmopressin, kombine tedavi

Kaynakça

• 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