Monosemptomatik Nokturnal Enürezisli Çocuklarda Desmopressin ve Oksibutinin Kombine Tedavi Etkinliğinin Değerlendirilmesi

Abstract

Amaç: Bu çalışma, primer monosemptomatik nokturnal enürezis (MNE) tanılı, desmopressin tedavisine yanıtsız veya kısmi yanıtlı çocuklarda antikolinerjik eklenerek yapılan kombine tedavinin etkinliğini ve etkileyen faktörleri araştırmayı amaçlamaktadır. Gereç ve Yöntemler: Ocak 2022-Aralık 2024 arasında Çocuk Nefroloji polikliniğinde takip edilen, 5-16 yaş arası desmopressine yanıtsız veya kısmi yanıtlı MNE’li çocuklar retrospektif incelendi. Demografik veriler, alt ıslatma durumu ve tedavi yanıtları kaydedildi. Desmopressin tedavisinden en az 1 ay sonra yanıt alınamazsa tedaviye oksibutinin eklendi. Bulgular: Çalışmaya yaş ortalaması 9,27±2,34 yıl olan 77 çocuk (31 kız, 46 erkek) dahil edildi. Hastaların %93,5’i her gün, %28,6’sı gecede birden fazla idrar kaçırıyordu. 'Antikolinerjik eklenen 77 hastadan 48'inin kombine tedavi sonrası takibi mevcuttu ve %52’si desmopressine kısmi yanıtlı, %48’i yanıtsızdı. Kombine tedavi ile takibi yapılan 48 hastada; %62,5 tam yanıt, %14,6 kısmi yanıt, %22,9 yanıtsızlık gözlendi. Tam yanıt ile yaş arasında pozitif korelasyon bulundu (r=0,332, p=0,021). Sonuç: Desmopressine tam yanıt alınamayan MNE olgularında antikolinerjik eklenmesi kombine tedavinin etkin ve güvenilir bir seçenek olduğunu göstermektedir.

Keywords

• Çocuk
• Desmopressin
• Nokturnal Enürezis
• Oksibutinin

Evaluation of Effectiveness of Combined Treatment with Desmopressin and Oxybutynine in Children with Monosymptomatic Nocturnal Enuresis

Abstract

Aim: This study aims to investigate the efficacy and influencing factors of combined treatment with an anticholinergic in children with primary monosymptomatic nocturnal enuresis (MNE) who were unresponsive or partially responsive to desmopressin treatment. Materials and Methods: A retrospective review was conducted on children aged 5 to 16 years with MNE who were unresponsive or partially responsive to desmopressin and followed in the Pediatric Nephrology Outpatient Clinic between January 2022 and December 2024. Demographic data, bedwetting status, and treatment responses were recorded. If no response was observed after at least 1 month of desmopressin treatment, oxybutynin was added to the treatment. Results: The study included 77 children (31 girls, 46 boys) with a mean age of 9.27±2.34 years. Ninety-three percent of the patients had daily urine leakage, and 28.6% had more than one urine leakage per night. Forty-eight of the 77 patients who received anticholinergic therapy were followed up after combination therapy, and 52% showed a partial response to desmopressin and 48% no response. Of the 48 patients who received combination therapy, 62.5% had a complete response, 14.6% a partial response, and 22.9% no response. A positive correlation was found between complete response and age (r=0.332, p=0.021). Conclusion: In patients with MNE who do not fully respond to desmopressin, the addition of an anticholinergic demonstrates that combination therapy is an effective and reliable option.

Keywords

• Child
• Desmopressin
• Nocturnal Enuresis
• Oxybutynin

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