A Placebo-Controlled Trial of the Effects of Hydrochlorothiazide on Nocturnal Enuresis

Abstract

Objective: To assess the efficacy, tolerability and side effects of the diuretic hydrochlorothiazide (HCTZ) in the management of monosymptomatic nocturnal enuresis by a placebo-controlled double-blind crossover trial. Patients and Methods: Forty patients suffering from nocturnal enuresis were blindly randomized into 2 groups of equal numbers. Group 1 first received placebo for 3 months, and group 2 received oral HCTZ once daily for the same period. Both groups, after a 2-week wash-out period, were crossed over in their medication and continued treatment for another 3 months. The main outcome measure (variable) for the assessment of drug efficacy was taken to represent the average reduction in the percentage of wet nights as compared to the baseline enuresis pattern. Statistical analysis was based on a t test (p ≤ 0.05). A subjective scale was also used to assess patients’ and their parents’ satisfaction. Tolerability and side effects were also documented in the study. Results: Both HCTZ and placebo were statistically effective in reducing the average percentage of wet nights. HCTZ resulted in a significantly better reduction than placebo (41.1 vs. 32.5%; p ≤ 0.023). Overall short-term clinical cure and improvement, on the other hand, were comparable to those of placebo according to the standards of the International Children’s Continence Society. Satisfaction, as a crude measure of success, was expressed more frequently in patients who received HCTZ (20 vs. 9). Both drugs were well-tolerated. Conclusion: The use of HCTZ in the treatment of nocturnal enuresis has never been previously evaluated. The drug, in this pilot study, has a promising statistical superiority to placebo. Its clinical value, however, deserves further definition in future controlled trials.

Therapeutic Efficacy of Hydrochlorothiazide in Primary Monosymptomatic Nocturnal Enuresis in Boys With Idiopathic Hypercalciuria

“…Based on our findings, children who became normocalciuric after receiving HCT had significant PMNE clinical response. The findings of Alawwa et al ( 17 ) and mechanisms explained by Park et al ( 14 ) about the relationship between IHC and NE confirm our results. Due to the low cost, availability, ease of use and minor complications of HCT ( 13 ), it can be an effective drug in the treatment of PMNE in children.…”

“…Our results showed that the improvement of PMNE in children receiving conservative treatment with HCT was more significant than the group receiving conservative treatment alone. Therapeutic efficacy of HCT on NE has been studied in only one study in 2010, by Alawwa et al ( 17 ). In this study, 1 mg/kg/day oral HCT and placebo were used for treatment of 40 patients with NE and clinical responses of the patients were studied for 3 months.…”

Therapeutic Efficacy of Hydrochlorothiazide in the Primary Monosymptomatic Nocturnal Enuresis of Children

“…This study was conducted on 40 children with NE and they used placebo and 1 mg/kg/day oral HCT; clinical responses of children were studied during a period of 3 months. It was observed that HCT reduced episodes of wet night better than placebo, but both of them were statistically effective on reducing the mean of wet nights; the current study also came to the same conclusion (21). Yousefichaijan et al in a study on the therapeutic effect of HCT on PMNE only in males, compared the case (HCT and conservative treatment) and control (conservative treatment) groups.…”

Insight on the Mechanism of the Effects of Hydrochlorothiazide on Nocturnal Enuresis

“…We read with great interest the recent contribution by AlAwwa et al [1] . They showed the beneficial effect of hydrochlorothiazide (HCTZ) on nocturnal enuresis (NE), but did not suggest the possible mechanisms.…”