title: The role of bladder capacity in antidiuretic and anticholinergic treatment for nocturnal enuresis.
abstract: OBJECTIVE
  We evaluated combination treatment with desmopressin and oxybutynin in patients with enuresis who did not respond to desmopressin monotherapy. Furthermore, we compared 2 methods of estimating bladder capacity and evaluated the ability of these methods to predict the response to desmopressin and oxybutynin.
  
  
  METHODS
  A total of 60 children with a mean age +/- SD of 10.6 +/- 3.0 years who had monosymptomatic nocturnal enuresis completed the study. After a 2-week observation period maximal voided volume during free access to fluid intake was determined by a 2-day frequency-volume chart and maximal voided volume after water load was determined on a separate day. Patients then received 20 mug desmopressin intranasally at bedtime during 2 weeks. In nonresponders to desmopressin with less than a 50% decrease in wet nights 5 mg oxybutynin twice daily was added for another 2 weeks.
  
  
  RESULTS
  Of the patients 41 (68%) showed more than 50% decrease in wet nights during the 2-week desmopressin treatment period (4.6 +/- 1.6 to 0.7 +/- 0.8, p <0.001). In desmopressin nonresponders combined treatment with desmopressin and oxybutynin resulted in a further decrease in wet nights (4.0 +/- 1.2 to 1.7 +/- 1.4, p <0.001). Maximal voided volume during free access to fluid intake was significantly higher in desmopressin responders than in nonresponders (244 +/- 111 vs 160 +/- 65 ml, p <0.001). In contrast, maximal voided volume after water load was not significantly different between desmopressin responders and nonresponders.
  
  
  CONCLUSIONS
  The study indicates a role for oxybutynin in combination with desmopressin in children who are not responding to desmopressin monotherapy. Maximal voided volume during free access to fluid intake is a clinically useful predictor of the response to desmopressin but not to oxybutynin.
authors.affiliation: Department of Pediatrics, Comenius University Medical School, Bratislava, Slovakia.
authors.forename: Eva
authors.initials: E
authors.lastname: Radvanska
authors.forename: László
authors.initials: L
authors.lastname: Kovács
authors.forename: Søren
authors.initials: S
authors.lastname: Rittig
mesh_terms: D050034:Antidiuretic Agents / Q000627:therapeutic use*; D002648:Child; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004775:Enuresis / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D008333:Mandelic Acids / Q000627:therapeutic use*; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D001743:Urinary Bladder / Q000187:drug effects* / Q000503:physiopathology*
chemical_list: D050034:Antidiuretic Agents; D008333:Mandelic Acids; D018727:Muscarinic Antagonists; D003894:Deamino Arginine Vasopressin; C005419:oxybutynin