Combination therapy with desmopressin and an anticholinergic medication for nonresponders to desmopressin for monosymptomatic nocturnal enuresis: a randomized, double-blind, placebo-controlled trial.
OBJECTIVE
Desmopressin is an approved medical therapy for the treatment of monosymptomatic primary nocturnal enuresis. In cases of limited response to desmopressin, we have added anticholinergic therapy to desmopressin (combination therapy). To evaluate this treatment strategy, we examined the efficacy of combination therapy for primary nocturnal enuresis in desmopressin-nonresponders.


METHODS
Only patients with primary nocturnal enuresis refractory to the maximal dosage of desmopressin were enrolled. Children with lower urinary tract symptoms or bowel dysfunction were excluded, on the basis of a 3-day, 24-hour, frequency-volume chart and elimination record. Children continued to take desmopressin and were assigned randomly, in a double-blind manner, to receive either extended-release anticholinergic medication or placebo. Patients were reassessed after 1 month of therapy, with a 1-week nocturnal record.


RESULTS
Forty-one desmopressin-nonresponders were enrolled, and 7 patients were excluded because of noncompliance. The treatment groups were equally matched with respect to age, gender, functional bladder capacity, and number of wet nights per week. After 1 month of treatment, there was a significant reduction in the mean number of wet nights in the combination therapy group, compared with the placebo group. With a generalized estimating equation approach, there was a significant 66% decrease in the risk of a wet episode, compared with the placebo group.


CONCLUSIONS
This study represents the first prospective, placebo-controlled trial examining the effect of desmopressin in combination with long-acting, anticholinergic, bladder-relaxing therapy for monosymptomatic primary nocturnal enuresis.
Austin
Paul F
PF
Division of Urology, Washington University School of Medicine, St Louis Children's Hospital, St Louis, Missouri, USA. austinp@wustl.edu
Ferguson
Genoa
G
Yan
Yan
Y
Campigotto
Mary J
MJ
Royer
Michele E
ME
Coplen
Douglas E
DE
D000293:Adolescent; D050034:Antidiuretic Agents / Q000008:administration & dosage*; D001559:Benzhydryl Compounds / Q000008:administration & dosage*; D002214:Capsules; D002648:Child; D003408:Cresols / Q000008:administration & dosage*; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D018727:Muscarinic Antagonists / Q000008:administration & dosage*; D053206:Nocturnal Enuresis / Q000188:drug therapy*; D010665:Phenylpropanolamine / Q000008:administration & dosage*; D011446:Prospective Studies; D000068737:Tolterodine Tartrate; D017211:Treatment Failure; D016896:Treatment Outcome
D050034:Antidiuretic Agents; D001559:Benzhydryl Compounds; D002214:Capsules; D003408:Cresols; D018727:Muscarinic Antagonists; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate; D003894:Deamino Arginine Vasopressin