‘Frequently recurring’ nocturnal polyuria is predictive of response to desmopressin in monosymptomatic nocturnal enuresis in childhood

Marzuillo, Pierluigi; Marotta, Rosaria; Guarino, Stefano; Fedele, Maria Cristina; Palladino, Federica; Capalbo, Daniela; Vecchia, Nicoletta Della; Giudice, Emanuele Miraglia del; Polito, Cesare; Manna, Angela La

doi:10.1016/j.jpurol.2018.11.004

Cited by 12 publications

(11 citation statements)

References 19 publications

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“…Marzuillo et al conducted a similar study using these three NP definitionsthe ICCS criteria, Rittig's criteria, and Kamperis's criteria 16 (EBC × 100%)in 103 cases of monosymptomatic NE and predictions of DDAVP efficacy. 17 Results of multivariable analysis indicated that the effectiveness of DDAVP was predictable only in patients in whom the diagnosis of NP was based on the ICCS definition when their urine output was measured for at least 4 of 5 days of observation before treatment. On the other hand, when urine output was measured on only 1 of the 5 days of observation, no difference was found in the effectiveness of DDAVP by any of the criteria.…”

Section: Discussionmentioning

confidence: 99%

Evaluating nocturnal polyuria in Japanese children with nocturnal enuresis

Nishizaki

Hara²,

Obinata

et al. 2021

Pediatrics International

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Background: The purpose of this study was to assess whether enuretic Japanese patients with nocturnal polyuria (NP) who met Hoashi's criteria (6-9 years: ≥200 mL; 10 years and older: ≥250 mL) met the International Children's Continence Society (ICCS; expected bladder capacity × 130%) and Rittig's criteria for nocturnal polyuria (> [age+9] × 20 mL). We also compared the effectiveness of 1-desamino-8-D-arginine vasopressin (DDAVP) with the three criteria. Methods: Fifty-four patients who had NP with normal bladder capacity were enrolled: 36 boys (67%); median age, 8 (interquartile range: 7-9). We compared the diagnostic differences between the Hoashi's criteria and international standards (ICCS and Rittig's) for NP and the short-term effects of DDAVP. The patients received DDAVP for 8 weeks; we evaluated the association between each evaluation method and the effects of therapy. Results: Only 17% of the patients met both Hoashi's and ICCS criteria, whereas 26% met both Hoashi's and Rittig's criteria. The therapeutic effect of DDAVP did not differ significantly between these two groups: there was an effective rate of 73% (Hoashi's criteria) versus 50% (ICCS criteria), P = 0.19, and an effective rate of 71% (Hoashi's criteria) versus 62% (Rittig's criteria), P = 0.84. Conclusions: Hoashi's criteria are widely used but, according to both the ICCS and Rittig's criteria, approximately 80% of the patients did not fulfill the definition of NP. However, 8 weeks after the DDAVP treatment began, no significant difference was observed in the therapeutic effect of DDAVP according to each set of criteria. The definition of NP should account for the physical disparities between Japanese people and Westerners.

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Section: Discussionmentioning

confidence: 99%

Evaluating nocturnal polyuria in Japanese children with nocturnal enuresis

Nishizaki

Hara²,

Obinata

et al. 2021

Pediatrics International

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“…Previous studies have shown that several factors, such as larger bladder capacities, nocturnal polyuria, older age and fewer wet nights at baseline, are associated with a better response ( 15 – 17 ). In our study, logistic regression analysis showed that age, sex, body weight, family history, bladder capacity, nocturnal polyuria, and number of wet nights were not predictive factors of the response to dDAVP.…”

Section: Discussionmentioning

confidence: 99%

Exploration of the Optimal Desmopressin Treatment in Children With Monosymptomatic Nocturnal Enuresis: Evidence From a Chinese Cohort

Liu

Miao

et al. 2021

Front. Pediatr.

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Objectives: Nocturnal enuresis (NE) is a common pediatric condition, and desmopressin (dDAVP) is a first-line therapy for NE. The standard initial dosage of dDAVP is 0. 2 mg/day, and most guidelines recommend that the dose should be increased at 0.2 mg increments until dryness is achieved or to the maximal recommended dose. However, previous evidence has shown that this strategy seems insufficient to further improve efficacy and results in unnecessarily high doses for some patients. Our study aimed to assess the efficacy of our modified dDAVP treatment regimen in children with MNE in China and evaluate predictive factors associated with the dDAVP response.Methods: All MNE patients at the Department of Nephrology at Children's Hospital of Fudan University from January to December 2019 were prospectively and consecutively enrolled. dDAVP treatment comprised a dose titration period and a 3-month maintenance period. The efficacy of dDAVP was assessed according to the latest International Children's Continence Society criteria at the end of the study. Predictive factors were evaluated by logistic regression analysis.Results: Overall, 322 MNE patients were enrolled in our study, and 225 (69.9%) completed the study. The intention to treat analysis showed that the overall dDAVP response rate was 69.9%: among these patients 32.3% were complete responders, and 37.6% were partial responders. At the end of the study, 194/225 (86.2%) patients received a final dose of 0.2 mg, 24/225 (10.7%) patients received a final dose of 0.3 mg, and 7/225 (3.1%) patients received a final dose of 0.4 mg. Multivariate analysis showed that patients requiring lower doses to achieve responses were significantly more likely to experience complete response during the maintenance period [odds ratio (OR)=9.683; 95% confidence interval (CI), 2.770–33.846].Conclusions: Our results indicate that the dDAVP treatment regimen provides a comparable efficacy to the international conventional treatment regimen with a lower overall dose. Low-dose responders were likely to achieve a complete response without increasing the dose; in these cases, the maximum dose might not be necessary.

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“…14 They compared the efficacy of DDAVP among 103 patients with monosymptomatic NE (more than four times a week) using three different standards: exceeding 100% of the EBC, exceeding 130% of the EBC (ICCS standard) and Rittig's standard, showing that there was no difference between standards regarding DDAVP efficacy. 14 In the present study, we have additionally compared the Akashi and Hoashi's standard, which accounts for sleeping time. The present study and their previous study together strengthen the conclusion.…”

Section: Discussionmentioning

confidence: 99%

“…However, in the current study and the study of Marzuillo et al, the presence of NP did not affect the efficacy of DDAVP. 14 There are two possible hypotheses to explain the observed equivalent efficacy of DDAVP in NE patients with and without NP. First, on initiation of DDAVP treatment, the patients are instructed thoroughly on the dangers of combining the medication with excessive fluid intake and how this might result in water intoxication with hyponatremia.…”

Section: Discussionmentioning

confidence: 99%

Desmopressin response in nocturnal enuresis without nocturnal polyuria in Japanese children

et al. 2021

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Objectives: To evaluate whether the efficacy of desmopressin differs between patients with and without nocturnal polyuria. Methods: A total of 65 treatment-na€ ıve children with monosymptomatic nocturnal enuresis were enrolled (45 boys; median age 8.9 years). Patients received desmopressin as their first-line treatment. Four different standards were used (Akashi and Hoashi >0.9 mL/kg/ sleeping hour; Hamano >[age + 2] 9 25 9 130% mL; the International Children's Continence Society >[age + 1] 9 30 9 130% mL; and Rittig >[age + 9] 9 20 mL) to assess nocturnal polyuria. The effectiveness of desmopressin was compared between patients with and without nocturnal polyuria according to each standard. A response was defined as a reduction in wet nights of >50%. Results: The desmopressin treatment efficacy rate was 54% for polyuria and 67% for non-polyuria patients (P = 0.20), 45% for polyuria and 68% for non-polyuria patients (P = 0.08), 54% for polyuria and 59% for non-polyuria patients (P = 0.80), and 52% for polyuria and 61% for non-polyuria patients (P = 0.61), for the Akashi and Hoashi's, Hamano's, International Children's Continence Society and Rittig's standards, respectively. Conclusions: No difference was observed in the short-term clinical efficacy of desmopressin regardless of the presence of nocturnal polyuria. Thus, this might be a feasible treatment option for patients with nocturnal enuresis without nocturnal polyuria.

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‘Frequently recurring’ nocturnal polyuria is predictive of response to desmopressin in monosymptomatic nocturnal enuresis in childhood

Cited by 12 publications

References 19 publications

Evaluating nocturnal polyuria in Japanese children with nocturnal enuresis

Evaluating nocturnal polyuria in Japanese children with nocturnal enuresis

Exploration of the Optimal Desmopressin Treatment in Children With Monosymptomatic Nocturnal Enuresis: Evidence From a Chinese Cohort

Desmopressin response in nocturnal enuresis without nocturnal polyuria in Japanese children

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