Desmopressin and oxybutynin in monosymptomatic nocturnal enuresis: a randomized,
double-blind, placebo-controlled trial and an assessment of predictive factors.
Author(s): Montaldo P, Tafuro L, Rea M, Narciso V, Iossa AC, Del Gado R.
Affiliation(s): Department of Pediatrics, Second University of Naples, Naples, Italy.
Publication date & source: 2012, BJU Int. , 110(8 Pt B):E381-6
OBJECTIVES: To assess the efficacy of desmopressin plus oxybutynin and compare
two starting dosages of desmopressin (120 and 240 µg) in a randomized,
double-blinded, placebo-controlled trial for children with monosymptomatic
nocturnal enuresis (MNE) resistant to desmopressin. The predictive factors of
children with MNE responsive to desmopressin and combination therapy were also
evaluated.
PATIENTS AND METHODS: Our sample included 206 patients aged between 6 and 13
(mean age 10.6 ± 2.9 years), 117 males. All patients were required to have MNE.
The patients were randomly divided into two groups: the first group was given
oral melt 120 µg and the second group 240 µg, for 2 weeks. All patients who had
experienced failure of treatment with sublingually administered desmopressin
alone were given either desmopressin plus 5 mg oxybutynin or desmopressin plus
placebo in a randomized, double-blinded trial for 4 weeks. As predictive factors,
bladder volume and wall thickness index, nocturnal polyuria and voiding latency
were considered.
RESULTS: There was no significant difference between the 120 µg and 240 µg
patients in terms of response. The oxybutynin group showed a higher rate of full
and partial responses (45% success) compared with the placebo group (17%
success), P < 0.01. The responders to combined oxybutynin and desmopressin had
significantly lower bladder volume and wall thickness index than the other
patients.
CONCLUSIONS: Our findings highlight that anticholinergic agents may play an
important role for a subset of children with enuresis who have a restricted
bladder capacity and thickened bladder wall. Ultrasonography-measured bladder
variables can provide useful predictive clues for MNE. Predictive factors can
help to differentiate treatment subtypes and guide clinical management in primary
nocturnal enuresis.
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