Desmopressin treatment regimens in monosymptomatic and nonmonosymptomatic enuresis: A review from a clinical perspective

Alloussi, S.; Mürtz, Gerd; Läng, Christoph; Madersbacher, H.; Strugala, Gerhard; Seibold, J.; Schwentner, Christian; Stenzl, Arnulf

doi:10.1016/j.jpurol.2010.04.014

Cited by 36 publications

(23 citation statements)

References 59 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This recommendation was consistent with a recent review by Alloussi et al, 6 which summarized 13 retrospective heterogeneous studies. Despite the low-level evidence available at that time, they recommended against abrupt termination of desmopressin therapy.…”

Section: Figuresupporting

confidence: 88%

“…[18][19][20] According to several literature reviews, desmopressin treatments render immediate response; however, they are associated with high relapse rates after abrupt withdrawal. 5,6 Critical care studies have postulated that suppressed endogenous vasopressin caused by vasopressin infusion and sudden withdrawal may lead to sustained F, female; HS, at bedtime; ITT, intention to treat, total number of subjects per treatment group; M, male; MNE, monosymptomatic nocturnal enuresis; PMNE, primary monosymptomatic nocturnal enuresis; PNE, primary nocturnal enuresis; yo, years old.…”

Section: Discussionmentioning

confidence: 99%

“…5 Treatment results with desmopressin are favorable, with acceptable adverse effects; however, as reported by several studies, the relapse rate is high. 5,6 Therefore, a structured withdrawal (time dependent and dose dependent) of desmopressin therapy was being studied in several retrospective studies. Although these results showed that structured withdrawal is more time consuming and costly, a higher clinical success rate was achieved.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Desmopressin Withdrawal Strategy for Pediatric Enuresis: A Meta-analysis

et al. 2016

View full text Add to dashboard Cite

CONTEXT: A high relapse rate after discontinuation of desmopressin treatment of pediatric enuresis is consistently reported. Structured withdrawal strategies have been used to prevent relapse. OBJECTIVE:To assess the efficacy of a structured withdrawal strategy of desmopressin on the relapse-free rate for desmopressin responder pediatric enuresis.DATA SOURCES: 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. STUDY SELECTION: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. DATA EXTRACTION: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. RESULTS: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). LIMITATIONS:The small number of studies included in meta-analysis represents a major limitation.CONCLUSIONS: Structured withdrawal of desmopressin results in better relapse-free rates. Specifically, the dose-dependent structured withdrawal regimen showed significantly better outcomes.

show abstract

Section: Figuresupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Desmopressin Withdrawal Strategy for Pediatric Enuresis: A Meta-analysis

et al. 2016

View full text Add to dashboard Cite

show abstract

“…In the present study of 160 patients, in which we distinguished between MNE and NMNE patients for appropriate treatment, in can be asserted that the limitations of the previous studies have been addressed. The success rate of the medical treatment of NE patients in the present study was 78.7%, which was similar to that previously reported . We did find a statistically significant difference between the SBO and non‐SBO groups in outcome, with a complete response more likely in children without SBO, although we could not confirm the previously reported effect of the location of SBO .…”

Section: Discussionsupporting

confidence: 77%

Spina bifida occulta: Not to be overlooked in children with nocturnal enuresis

Shin

Lee

et al. 2013

Int J of Urology

View full text Add to dashboard Cite

Abbreviations & AcronymsObjective: Previous reports have suggested that the incidence of spina bifida occulta in patients with nocturnal enuresis is higher than in the general population. However, the effect of spina bifida occulta on the response to nocturnal enuresis treatment is controversial. The purpose of this study was to investigate the relationship between spina bifida occulta and response to treatment of nocturnal enuresis. Methods: Between 2006 and 2009, the records of 160 children with nocturnal enuresis were reviewed. Children with other organic urological disease or symptoms suggestive of spinal dysraphism were excluded. Plain radiography for the kidney-ureterbladder was carried out before the start of the nocturnal enuresis treatment. Response to treatment of children with and without spina bifida occulta was compared. Results: Of 160 children, 53 were girls; the mean age was 7.8 Ϯ 2.06 years. The mean duration of treatment was 8.7 Ϯ 9.29 months. Spina bifida occulta was detected in 43 children (26.9%). Spina bifida occulta affected L4 in four children, L5 in 12 children, S1 in 26 children and S2 in one child. There was a significant difference between the spina bifida occulta and non-spina bifida occulta groups in terms of outcome (P = 0.002), with a complete response more likely in children without spina bifida occulta (P = 0.005). None of the children with primary non-mono symptomatic nocturnal enuresis and spina bifida occulta showed a complete response. Conclusions:The presence of spina bifida occulta significantly affects the response to treatment in patients with nocturnal enuresis. Thus, verifying spina bifida occulta in this patient population can facilitate the prediction of the response to nocturnal enuresis treatment.

show abstract

“…Marschall-Kehrel and Harms proposed structured withdrawal of Desmopressin in order to reduce the relapse rates [19]. Time dependent and dose dependent strategies for structured withdrawal have been introduced [29,30], however the protocol and duration is still elusive. In our study, the treatment period (including withdrawal period) was 5 months, which is quite longer than other studies.…”

Section: Discussionmentioning

confidence: 99%