Predictive parameters of response to desmopressin in primary nocturnal enuresis

Herzeele, Charlotte Van; Evans, Jonathan; Eggert, Paul; Lottmann, Henri; Nørgaard, Jens Peter; Walle, Johan Vande

doi:10.1016/j.jpurol.2015.03.007

Cited by 32 publications

(31 citation statements)

References 19 publications

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“…In the context of using NP as an index for good desmopressin response, then we suggest that nocturnal diuresis of >100 % of EBC might be more appropriate for the clinician [5]. …”

Section: Mne and Its Pathophysiologymentioning

confidence: 99%

“…A post-hoc analysis of the large DRIP [Desmopressin Response in PNE (primary nocturnal enuresis)] study demonstrated the importance of selecting the right treatment for the right patients, based upon a full non-invasive medical evaluation, including a frequency–volume chart [5]. The original DRIP study found that around 40 % of participants experienced ≥50 % reduction in wet nights, a lower than expected response rate [22].…”

Section: Which Patients Can Benefit From Desmopressin?mentioning

confidence: 99%

“…A recent post-hoc analysis investigated parameters that were predictive of response to desmopressin in the DRIP study [5] and found that age was the only significant demographic predictor (increased efficacy with increased age). Younger children are more prone to have a low maximum voided volume (MVV) and/or overactive bladder symptoms which are resistant to antidiuretic therapy [8, 27].…”

Section: Which Patients Can Benefit From Desmopressin?mentioning

confidence: 99%

“…This should include a daytime diary (frequency–volume chart) documenting void volumes and times and fluid intake over a 4-day period, which is sufficient time to allow an evaluation of MVV [29]. Although the ICCS advises the exclusion of the first morning void [1], we recommend that it should be included for the MVV to be predictive of desmopressin response [5, 30]. We recognize that the ICCS standardization recommends the use of 2-day diaries, which represent a compromise between optimal and minimal registration during screening [1].…”

Section: Which Patients Can Benefit From Desmopressin?mentioning

confidence: 99%

“…However, patients must be properly evaluated and diagnosed and therapy must be used appropriately for the treatment to be successful [4]. Data show that proper patient screening can predict treatment response, as well as failure rates [5]. Furthermore, in a recent study of enuresis patients with desmopressin resistance who had been referred to a specialist centre, one-third of children (177/539) subsequently became dry on desmopressin monotherapy under specialist care, once any daytime symptoms had been addressed [6].…”

Section: Introductionmentioning

confidence: 99%

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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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“…In the context of using NP as an index for good desmopressin response, then we suggest that nocturnal diuresis of >100 % of EBC might be more appropriate for the clinician [5]. …”

Section: Mne and Its Pathophysiologymentioning

confidence: 99%

Section: Which Patients Can Benefit From Desmopressin?mentioning

confidence: 99%

Section: Which Patients Can Benefit From Desmopressin?mentioning

confidence: 99%

Section: Which Patients Can Benefit From Desmopressin?mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Optimizing response to desmopressin in patients with monosymptomatic nocturnal enuresis

et al. 2016

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Practical recommendations of the EAU‐ESPU guidelines committee for monosymptomatic enuresis—Bedwetting

Bogaert

Stein

Undre

et al. 2019

Neurourology and Urodynamics

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Background and Aims: The objective of this update of the EAU-ESPU guidelines recommendations for nocturnal enuresis was to review the recent published literature of studies, reviews, guidelines regarding the etiology, diagnosis and treatment options of nocturnal enuresis and transform the information into a practical recommendation strategy for the general practitioner, pediatrician, pediatric urologist and urologist. Material and Methods: Since 2012 a monthly literature search using Scopus® was performed and the relevant literature was reviewed and prospectively registered on the European Urology bedwetting enuresis resource center (http:// bedwetting.europeanurology.com/). In addition, guideline papers and statements of the European Society for Paediatric Urology (ESPU), the European Association of Urology (EAU), the National Institute for Health and Care Excellence (NICE) and the International Children Continence Society (ICCS) were used to update the knowledge and evidence resulting in this practical recommendation strategy.Recommendations have been discussed and agreed within the working group of the EAU-ESPU guidelines committee members. Results:The recommendations focus to place the child and his family in a control position. Pragmatic analysis is made of the bedwetting problem by collecting voiding and drinking habits during the day, measuring nighttime urine production and identification of possible risk factors such as high-volume evening drinking, nighttime overactive bladder, behavioral or psychological problems or sleep disordered breathing. A questionnaire will help to identify those risk factors. Conclusion: Motivation of the child is important for success. Continuous involvement of the child and the family in the treatment will improve treatment compliance, success and patient satisfaction.bedwetting, guidelines, monosymptomatic enuresis, practical recommendations Abbreviations: EAU, the European Association of Urology; ESPU, European Society for Paediatric Urology; UTI, urinary tract infections.

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The pooled analysis evaluates the therapeutic efficacy of desmopressin combined with anticholinergic drugs in the treatment of pediatric nocturnal enuresis

Tang,

Liu,

et al. 2023

Neurourology and Urodynamics

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ObjectiveThis pooled analysis aims to demonstrate the clinical efficacy and safety of combined desmopressin and anticholinergic therapy in the treatment of pediatric nocturnal enuresis (NE).MethodsA systematic search was conducted through PubMed, MEDLINE, EMBASE, ResearchGate, and Cochrane Library to identify all randomized controlled trials (RCTs) comparing monotherapy with desmopressin versus combined therapy with desmopressin and anticholinergic agents for the treatment of NE. Data analysis was performed using RevMan version 5.4.1.ResultsThis study included 8 RCTs involving a total of 659 patients. The frequencies of complete response (CR), partial response (PR), and nonresponse (NR) were computed for both short‐term treatment (1 month) and long‐term treatment (3 months). Additionally, alterations in the mean number of NE episodes, adverse events, and relapse were assessed. Our analysis indicates that, in comparison to the monotherapy group, the combination therapy group plays a pivotal role in augmenting the CR odds and diminishing the NR ratios in both short‐term and long‐term treatments (1 month CR ratio [risk ratio (RR): 1.84; 95% confidence interval (CI): 1.22–2.76; p = 0.003, I2 = 72%]; 3 months CR ratio [RR: 1.48; 95% CI: 1.25–1.76; p < 0.00001, I2 = 0%]; 1 month NR ratio [RR: 0.67; 95% CI: 0.55–0.82; p = 0.0001, I2 = 0%]; 3 months CR ratio [RR: 0.37; 95% CI: 0.19–0.73; p = 0.004, I2 = 0%]). Furthermore, in both short‐term and long‐term treatment, the combined therapy group exhibits a greater magnitude of change in the average number of NE episodes compared to patients receiving monotherapy (1 month, mean difference [MD] = −2.97; 95% CI: −4.23 to −1.71, p < 0.0001; 3 months, MD = −4.30; 95% CI: −7.18 to −1.43, p = 0.003). Moreover, the combination therapy group exhibits a significant reduction in the recurrence rate (RR: 0.36; 95% CI: 0.15–0.86; p = 0.02). There is no significant difference in the incidence of adverse events between the two groups (RR: 1.16; 95% CI: 0.58‐2.31; p = 0.67).ConclusionCombining desmopressin with anticholinergic medications is more effective for NE than desmopressin alone, with lower recurrence and minimal adverse effects.

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Predictive parameters of response to desmopressin in primary nocturnal enuresis

Cited by 32 publications

References 19 publications

Optimizing response to desmopressin in patients with monosymptomatic nocturnal enuresis

Optimizing response to desmopressin in patients with monosymptomatic nocturnal enuresis

Practical recommendations of the EAU‐ESPU guidelines committee for monosymptomatic enuresis—Bedwetting

The pooled analysis evaluates the therapeutic efficacy of desmopressin combined with anticholinergic drugs in the treatment of pediatric nocturnal enuresis

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