Comparison of Long-Term Efficacy of Desmopressin Lyophilisate and Enuretic Alarm for Monosymptomatic Enuresis and Assessment of Predictive Factors for Success: A Randomized Prospective Trial

Önol, Fikret Fatih; Güzel, Rasim; Tahra, Ahmet; Kaya, Cevdet; Boylu, Uğur

doi:10.1016/j.juro.2014.08.088

Cited by 35 publications

(30 citation statements)

References 11 publications

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“…Önol et al . showed that NE severity is an independent predictor of CR . In the present study, on multivariate analysis of data from patients who completed treatment, NE frequency was an independent risk factor for predicting CR (OR, 2.111; 95%CI: 1.316–3.387).…”

Section: Discussionsupporting

confidence: 49%

Effect of traditional Chinese and Western medicine on nocturnal enuresis in children and indicators of treatment success: Randomized controlled trial

Liu

Shen

2017

Pediatrics International

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Section: Discussionsupporting

confidence: 49%

Effect of traditional Chinese and Western medicine on nocturnal enuresis in children and indicators of treatment success: Randomized controlled trial

Liu

Shen

2017

Pediatrics International

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“…Reported response rates vary, only 41% of patients achieved ≥ 50% reduction in wet nights in the study by Lottman et al (5), but 77% achieved > 90% reduction in the study by Onol et al (6). It depends on the type of patients selected, suboptimal adherence rates, administration methods and doses and formulations used (7).…”

Section: Discussionmentioning

confidence: 97%

Desmopressin 120 mcg, 180 mcg, 240 mcg: The right treatment for the right patient

Ferrara

Vescovo

Ianniello

et al. 2018

Arch Ital Urol Androl

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Background: The first-line drug therapy for patients with nocturnal enuresis (NE) associated with nocturnal polyuria and normal bladder function is desmopressin (dDAVP). Objective: To evaluate if increasing dose of oral desmopressin lyophilisate (MELT) can improve response rates to dDAVP and is useful in enuretic children. Materials and methods: We enrolled a total of 260 children all diagnosed with NE. Enuretic children were treated with increasing MELT at a dose of 120, 180 and 240 mcg a day. Results. We included in our study a total of 237 children, 164 males (69.2%) and 73 females (30.8%) aged between 5 and 18 years (mean age 10.32 ± 2.52 years). Of the 237 patients enrolled in the study and treated with MELT 120 mcg, a full response was achieved in 135 (56.9%). A partial response was achieved in 21 (8.9%) patients, therefore the dose was increased up to 180 mcg, with further improving symptoms (14.3%) or full response (9.5%), and up to 240 mcg, without usefulness. Conclusions: MELT at the dose of 120 mcg resulted efficacy and safety; the increased dose up to 180 mcg resulted poorly efficacy; finally, the further increase up to 240 mcg did not improve the symptoms with the increased risk of side effects.KEY WORDS: Desmopressin; Nocturnal enuresis. ated with nocturnal polyuria and normal bladder function is desmopressin (dDAVP) for a period of 3 months following by withdrawal. dDAVP is associated with a response rate of about 40-60%, however its effect may not be maintained on discontinuing treatment, and symptoms have been found to recur in about 50-80% after stopping treatment (3). The different formulations of dDAVP are an intranasal solution, an oral tablet formulation and the recent oral sublingual lyophilisate (MELT). The aim of this study is to evaluate if increasing dose of MELT (120, 180, 240 mcg/day) can improve response rates to dDAVP in enuretic children. MATERIALS AND METHODSWe enrolled a total of 260 children all diagnosed with NE, between April 2014 and April 2017, at the Paediatric Service of Campus Bio-Medico Hospital in Rome. Inclusion criteria were: age > 5 years and a diagnosis of primary MNE (PMNE) without NE treatment in the last 3 months. Exclusion criteria were the presence of secondary NE, any provided story of urinary infection, nephrogenic diabetes or congenital genitourinary anomalies. The children and their families were asked to participate in the study. This study was conducted in accordance with the regulatory standards of Good Clinical Practice and the Declaration of Helsinki. We carefully evaluated each patients with medical history and physical examination, including monitoring blood pressure, possible sign of spinal dysraphism or polythelia, neurological reflexes and genital examination. During the period of treatment, all patients and their parents were asked to keep a NE calendar depicting the wet and the dry nights and in addition, we educated both child and parents with dietary advices (4). During the follow-up, families were called to verify their adherence and respons...

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“…The alarm’s mechanism of effect is not fully understood, but an increase in bladder storage capacities is reported with its use [15, 16]. Despite good efficacy when used appropriately and consistently, alarm treatment can present a significant burden to the family, and discontinuation rates are high [17]. …”

Section: Mne and Its Pathophysiologymentioning

confidence: 99%

“…Reported response rates vary (e.g. only 41 % of patients achieved ≥50 % reduction in wet nights in the study by Lottman et al [22], but 77 % achieved >90 % reduction in the study by Onol and colleagues [17]), likely affected by the type of patients selected, suboptimal adherence rates, administration methods and doses and formulations used. In general, it is estimated that around 30 % of children with enuresis are full responders to desmopressin and that 40 % have a partial response to this AVP analogue [2].…”

Section: Desmopressin Profilementioning

confidence: 99%

Optimizing response to desmopressin in patients with monosymptomatic nocturnal enuresis

et al. 2016

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Most patients with monosymptomatic nocturnal enuresis can be effectively treated with an enuresis alarm or antidiuretic therapy (desmopressin), depending on the pathophysiology of the condition in the individual patient. Desmopressin is first-line therapy for enuresis caused by nocturnal polyuria, an excessive urine output during the night. However, in a recent study, around one-third of patients thought to be resistant to desmopressin were subsequently treated effectively with desmopressin monotherapy in a specialist centre. The aim of this article is to review best practice in selecting patients for desmopressin treatment, as well as outline eight recommendations for maximizing the chances of treatment success in patients receiving desmopressin. The roles of formulation, dose, timing of administration, food and fluid intake, inter-individual variation in response, body weight, adherence, withdrawal strategies and combination therapies are discussed in light of the most recent research on desmopressin and enuresis. Possible reasons for suboptimal treatment response are explored and strategies to improve outcomes in patients for whom desmopressin is an appropriate therapy are presented. Through optimization of the treatment plan in primary and specialist care centres, the hope is that fewer patients with this distressing and often embarrassing condition will experience unnecessary delays in receiving appropriate care and achieving improvements.

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Comparison of Long-Term Efficacy of Desmopressin Lyophilisate and Enuretic Alarm for Monosymptomatic Enuresis and Assessment of Predictive Factors for Success: A Randomized Prospective Trial

Cited by 35 publications

References 11 publications

Effect of traditional Chinese and Western medicine on nocturnal enuresis in children and indicators of treatment success: Randomized controlled trial

Effect of traditional Chinese and Western medicine on nocturnal enuresis in children and indicators of treatment success: Randomized controlled trial

Desmopressin 120 mcg, 180 mcg, 240 mcg: The right treatment for the right patient

Optimizing response to desmopressin in patients with monosymptomatic nocturnal enuresis

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