Desmopressin and oxybutynin in monosymptomatic nocturnal enuresis: a randomized, double-blind, placebo-controlled trial and an assessment of predictive factors
| Autor: | Roberto Del Gado, Lucia Tafuro, Paolo Montaldo, Azzurra Concetta Iossa, Valeria Narciso, Monica Rea |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
business.industry Urology Placebo-controlled study Anticholinergic agents Placebo medicine.disease law.invention Randomized controlled trial Overactive bladder Enuresis law Anesthesia medicine medicine.symptom Desmopressin business Oxybutynin hormones hormone substitutes and hormone antagonists medicine.drug |
| Zdroj: | BJU International. 110:E381-E386 |
| ISSN: | 1464-4096 |
| DOI: | 10.1111/j.1464-410x.2011.10918.x |
| Popis: | BJU Int 2012; 110: E381–E386. Objectives: To assess the efficacy of desmopressin plus oxybutynin and compare two starting dosages of desmopressin (120 and 240 g) in a randomized, double-blinded, placebo-controlled trial for children with monosymptomatic nocturnal enuresis (MNE) resistant to desmopressin. The predictive factors of children with MNE responsive to desmopressin and combination therapy were also evaluated. Patients and Methods: Our sample included 206 patients aged between 6 and 13 (mean age 10.6 2.9 years), 117 males. All patients were required to have MNE. The patients were randomly divided into two groups: the first group was given oral melt 120 g and the second group 240 g, for 2 weeks. All patients who had experienced failure of treatment with sublingually administered desmopressin alone were given either desmopressin plus 5 mg oxybutynin or desmopressin plus placebo in a randomized, double-blinded trial for 4 weeks. As predictive factors, bladder volume and wall thickness index, nocturnal polyuria and voiding latency were considered. Results: There was no significant difference between the 120 g and 240 g patients in terms of response. The oxybutynin group showed a higher rate of full and partial responses (45% success) compared with the placebo group (17% success), P 0.01. The responders to combined oxybutynin and desmopressin had significantly lower bladder volume and wall thickness index than the other patients. Conclusions: Our findings highlight that anticholinergic agents may play an important role for a subset of children with enuresis who have a restricted bladder capacity and thickened bladder wall. Ultrasonographymeasured bladder variables can provide useful predictive clues for MNE. Predictive factors can help to differentiate treatment subtypes and guide clinical management in primary nocturnal enuresis. Editorial Comment: This study reviews 206 patients with MNE, and their responses to 2 different doses of desmopressin and a combination of desmopressin and oxybutynin. Despite seemingly homogeneous presenting symptoms, children who responded best to desmopressin had greater nocturnal urine production. Those who responded best to a combination of oxybutynin and desmopressin had lower bladder volume wall indices (defined by maximum measured bladder volume divided by measured mean bladder wall thickness). This study provides an algorithm that helps guide the management of the large volume of pediatric MNE cases we see, which at first glance appear homogeneous but may in fact represent 2 groups, ie 1 with higher nighttime urine production and 1 with a tendency toward overactive bladder. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|