Nocturnal enuresis and daytime wetting: a multicentric trial with oxybutynin and desmopressin.
OBJECTIVE
Different etiopathological mechanisms of enuresis are today under study, and different therapies and drugs have been proposed. The Italian Multicentric Trial was undertaken in twelve pediatric and urological centers in order to assess the efficacy of two of the most popular drugs, desmopressin (DDAVP) and oxybutynin.


METHODS
114 enuretic patients were enrolled in the study. After a 2-week observation period, 66 patients with primary monosymptomatic enuresis were treated with DDAVP, 30 micrograms/day intranasally, for 6 weeks, 48 patients with enuresis and voiding dysfunction were randomly assigned to a protocol with oxybutynin alone or oxybutynin plus DDAVP. The efficacy of the two drugs was measured in terms of reduction of wet nights per week during the 6-week treatment period and a 2-week follow-up period. Children with 0-3 dry nights/week were considered as nonresponders.


RESULTS
Patients with monosymptomatic enuresis treated with DDAVP reported a significantly lower number of wet night during treatment than during the baseline period, with 79% showing a 'good' (6-7 dry nights/week) or 'intermediate' response (4-5 dry nights/week). Of the patients with diurnal voiding disturbances and enuresis, those treated with oxybutynin alone had a 54% success rate. The patients treated with both oxybutynin and DDAVP showed a better response, with a 71% rate of success.


CONCLUSIONS
The efficacy of the two drugs is confirmed in patients carefully selected on the clinical basis of voiding disturbances. In patients with enuresis and voiding dysfunction, the reduced urinary output and the lower bladder filling rate due to DDAVP can reduce uninhibited bladder contractions, thus enhancing the oxybutynin action.
Caione
P
P
Division of Pediatric Urology, Bambino Gesù' Children's Hospital, Rome, Italy.
Arena
F
F
Biraghi
M
M
Cigna
R M
RM
Chendi
D
D
Chiozza
M L
ML
De Lisa
A
A
De Grazia
E
E
Fano
M
M
Formica
P
P
Garofalo
S
S
Gramenzi
R
R
von Heland
M
M
Lanza
P
P
Lanza
T
T
Maffei
S
S
Manieri
C
C
Merlini
E
E
Miano
L
L
Nappo
S
S
Pagliarulo
A
A
Paolini Paoletti
F
F
Pau
A C
AC
Porru
D
D
Artibani
W
W
D000281:Administration, Intranasal; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D002940:Circadian Rhythm; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004775:Enuresis / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008333:Mandelic Acids / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D010276:Parasympatholytics / Q000008:administration & dosage / Q000627:therapeutic use*; D012076:Renal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D008333:Mandelic Acids; D010276:Parasympatholytics; D012076:Renal Agents; D003894:Deamino Arginine Vasopressin; C005419:oxybutynin