title: Combination therapy with alarm and drugs for monosymptomatic nocturnal enuresis not superior to alarm monotherapy.
abstract: OBJECTIVE
  To evaluate the effectiveness of alarm-based combination therapy using desmopressin and imipramine for primary monosymptomatic nocturnal enuresis.
  
  
  METHODS
  Of the 105 patients, 37 were treated with alarm monotherapy (monotherapy group), 35 were treated with desmopressin combined with an alarm (desmopressin group), and 33 were treated with imipramine combined with an alarm (imipramine group). The therapeutic effects were evaluated at 3 and 6 months. The relapse rates and predictive factors of the therapies were also studied.
  
  
  RESULTS
  No significant differences were found in the changes in the frequency of wet nights among the three groups, although the frequencies in all three groups decreased significantly with the therapeutic duration. Although the improvement rates at 3 months did not differ among the three groups, the improvement rate of 80% in the desmopressin group and 79% in the imipramine group at 6 months were greater than the 59% rate in the monotherapy group. After cure, no patients relapsed in the monotherapy group, and 3 (43%) each did so in the desmopressin and imipramine groups. In comparing the improved cases in each group, no significant differences were found in background factors.
  
  
  CONCLUSIONS
  Desmopressin and imipramine combined with an alarm was no more effective than alarm monotherapy. As for alarm monotherapy, other therapeutic modalities should be considered if it has not proved effective after 3 months. In such a situation, combination therapy may be effective as a second choice. No predictive factors for the therapeutic effects in the three modalities were found.
authors.affiliation: Department of Urology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Naitoh
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kawauchi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yamao
authors.forename: Hideo
authors.initials: H
authors.lastname: Seki
authors.forename: Jintetsu
authors.initials: J
authors.lastname: Soh
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Yoneda
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Mizutani
authors.forename: Tsuneharu
authors.initials: T
authors.lastname: Miki
mesh_terms: D000293:Adolescent; D002648:Child; D003131:Combined Modality Therapy; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D004775:Enuresis / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D007099:Imipramine / Q000627:therapeutic use*; D008297:Male; D011379:Prognosis
chemical_list: D003894:Deamino Arginine Vasopressin; D007099:Imipramine