title: Does structured withdrawal of desmopressin improve relapse rates in patients with monosymptomatic enuresis?
abstract: OBJECTIVE
  Relapse after cessation of desmopressin is an important problem in treating patients with enuresis. Structured withdrawal of desmopressin tablets has been shown to decrease relapse rates. However, scientific data are lacking on the structured withdrawal of the fast melting oral formulation of desmopressin. We compared relapse rates of structured withdrawal using placebo and direct cessation in a population of patients with enuresis who were desmopressin responders.
  
  
  METHODS
  Patients diagnosed with enuresis and responding to desmopressin from 13 different centers were involved in the study. Patients were randomized into 4 groups. Two different structured withdrawal strategies were compared to placebo and direct withdrawal. Sample size was estimated as 240 (60 patients in each group), with a power of 0.80 and an effect size of 30%. Randomization was performed using NCSS statistical software (NCSS, Kaysville, Utah) from a single center. The relapse rates of the groups were compared using chi-square testing. Logistic regression analysis was performed to define the independent factors having an effect on relapse rates.
  
  
  RESULTS
  Desmopressin treatment was initiated in 421 patients, and 259 patients were eligible for randomization. Relapse rates were 39 (1%) and 42 (4%) for the structured withdrawal groups, which were significantly less than for direct withdrawal (55, 3%) and placebo (53, 1%). Logistic regression analysis revealed that initial effective dose of 240 μcg, greater number of wet nights before treatment and nonstructured withdrawal were associated with higher relapse rates.
  
  
  CONCLUSIONS
  We found that structured withdrawal with the fast melting oral formulation of desmopressin results in decreased relapse rates. Application of a structured withdrawal program was also an independent factor associated with reduced relapse rates, together with lower initial effective dose and number of wet nights per week. Relapse after cessation of desmopressin is an important problem, and in this study structured withdrawal was observed to be associated with decreased relapse rates compared to placebo and direct withdrawal.
authors: Department of Urology, Ankara University School of Medicine, Ankara, Turkey. Electronic address: migokce@yahoo.com.
authors: Mehmet İlker
authors: Mİ
authors: Gökçe
authors: Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
authors: Parviz
authors: P
authors: Hajıyev
authors: Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
authors: Evren
authors: E
authors: Süer
authors: Department of Urology, Gülhane Military Medical School, Ankara, Turkey.
authors: Yusuf
authors: Y
authors: Kibar
authors: Department of Pediatric Urology, Bezmi Alem School of Medicine, Istanbul, Turkey.
authors: Mesrur Selçuk
authors: MS
authors: Sılay
authors: Department of Pediatric Urology, Gazi University School of Medicine, Ankara, Turkey.
authors: Serhat
authors: S
authors: Gürocak
authors: Department of Pediatric Urology, Hacettepe University School of Medicine, Ankara, Turkey.
authors: Hasan Serkan
authors: HS
authors: Doğan
authors: Department of Urology, Gülhane Military Medical School, Ankara, Turkey.
authors: Hasan Cem
authors: HC
authors: Irkılata
authors: Department of Pediatric Urology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
authors: Tayfun
authors: T
authors: Oktar
authors: Department of Pediatric Urology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey.
authors: Bülent
authors: B
authors: Önal
authors: Department of Urology, Mersin University School of Medicine, Mersin, Turkey.
authors: Erim
authors: E
authors: Erdem
authors: Department of Urology, Başkent University School of Medicine, Ankara, Turkey.
authors: Yüksel Cem
authors: YC
authors: Aygün
authors: Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey.
authors: Can
authors: C
authors: Balcı
authors: Department of Urology, Haydarpaşa Education and Research Hospital, Istanbul, Turkey.
authors: Ahmet Rüknettin
authors: AR
authors: Arslan
authors: Department of Urology, Haydarpaşa Education and Research Hospital, Istanbul, Turkey.
authors: Cevdet
authors: C
authors: Kaya
authors: Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey.
authors: Tarkan
authors: T
authors: Soygür
authors: Department of Pediatric Urology, Samsun University School of Medicine, Samsun, Turkey.
authors: Saban
authors: S
authors: Sarıkaya
authors: Department of Pediatric Urology, Hacettepe University School of Medicine, Ankara, Turkey.
authors: Serdar
authors: S
authors: Tekgül
authors: Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey.
authors: Berk
authors: B
authors: Burgu
mesh_terms: D050034:Antidiuretic Agents / Q000008:administration & dosage*; D002648:Child; D002908:Chronic Disease; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage*; D004775:Enuresis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D055502:Secondary Prevention; D016037:Single-Blind Method
chemical_list: D050034:Antidiuretic Agents; D003894:Deamino Arginine Vasopressin
keywords: deamino arginine vasopressin; enuresis; recurrence