title: Desmopressin Withdrawal Strategy for Pediatric Enuresis: A Meta-analysis.
abstract: A high relapse rate after discontinuation of desmopressin treatment of pediatric enuresis is consistently reported. Structured withdrawal strategies have been used to prevent relapse.
  
  
  
  To assess the efficacy of a structured withdrawal strategy of desmopressin on the relapse-free rate for desmopressin responder pediatric enuresis.
  
  
  
  Systematic literature search up to November 2015 on Medline, Embase, Ovid, Science Direct, Google Scholar, Wiley Online Library databases, and related references without language restriction.
  
  
  
  Related clinical trials were summarized for systematic review. Randomized controlled trials on the efficacy of structured versus abrupt withdrawal of desmopressin in sustaining relapse-free status in pediatric enuresis were included for meta-analysis.
  
  
  
  Eligible studies were evaluated according to Cochrane Collaboration recommendations. Relapse-free rate was extracted for relative risk (RR) and 95% confidence interval (CI). Effect estimates were pooled via the Mantel-Haenszel method with random effect model.
  
  
  
  Six hundred one abstracts were reviewed. Four randomized controlled trials (total 500 subjects) of adequate methodological quality were included for meta-analysis. Pooled effect estimates compared with the abrupt withdrawal, structured withdrawal results to a significantly better relapse-free rate (pooled RR: 1.38; 95% CI, 1.17-1.63; P = .0001). Subgroup analysis for a dose-dependent structured withdrawal regimen showed a significantly better relapse-free rate (pooled RR: 1.48; 95% CI, 1.21-1.80; P = .0001).
  
  
  
  The small number of studies included in meta-analysis represents a major limitation.
  
  
  
  Structured withdrawal of desmopressin results in better relapse-free rates. Specifically, the dose-dependent structured withdrawal regimen showed significantly better outcomes.
authors.affiliation: Institute of Urology, St Luke's Medical Center, National Capital Region, Philippines; Division of Urology, Taipei Tzu Chi Hospital, Medical Foundation, New Taipei, Taiwan and Buddhist Tzu Chi University, Hualien, Taiwan; Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, Canada urolyang@tzuchi.com.tw.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Chua
authors.affiliation: Institute of Urology, St Luke's Medical Center, National Capital Region, Philippines;
authors.forename: Jan Michael
authors.initials: JM
authors.lastname: Silangcruz
authors.affiliation: Division of Urology, Taipei Tzu Chi Hospital, Medical Foundation, New Taipei, Taiwan and Buddhist Tzu Chi University, Hualien, Taiwan;
authors.forename: Shang-Jen
authors.initials: SJ
authors.lastname: Chang
authors.affiliation: Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Katharine
authors.initials: K
authors.lastname: Williams
authors.affiliation: Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Megan
authors.initials: M
authors.lastname: Saunders
authors.affiliation: Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Roberto Iglesias
authors.initials: RI
authors.lastname: Lopes
authors.affiliation: Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Walid A
authors.initials: WA
authors.lastname: Farhat
authors.affiliation: Division of Urology, Taipei Tzu Chi Hospital, Medical Foundation, New Taipei, Taiwan and Buddhist Tzu Chi University, Hualien, Taiwan;
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Yang
mesh_terms: D050034:Antidiuretic Agents / Q000627:therapeutic use*; D002648:Child; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D004775:Enuresis / Q000188:drug therapy*; D006801:Humans; D012008:Recurrence; D028761:Withholding Treatment
chemical_list: D050034:Antidiuretic Agents; D003894:Deamino Arginine Vasopressin