Desmopressin and oxybutynin in monosymptomatic nocturnal enuresis: a randomized, double-blind, placebo-controlled trial and an assessment of predictive factors

作者：Montaldo Paolo; Tafuro Lucia; Rea Monica; Narciso Valeria; Iossa Azzurra C; Del Gado Roberto^*

来源：BJU International, 2012, 110(8B): E381-E386.

DOI：10.1111/j.1464-410X.2011.10918.x

• desmopressin
• nocturnal enuresis
• oxybutynin

OBJECTIVES %26lt;br%26gt;To assess the efficacy of desmopressin plus oxybutynin and compare two starting dosages of desmopressin (120 and 240 mu g) in a randomized, double-blinded, placebo-controlled trial for children with monosymptomatic nocturnal enuresis (MNE) resistant to desmopressin. %26lt;br%26gt;The predictive factors of children with MNE responsive to desmopressin and combination therapy were also evaluated. %26lt;br%26gt;PATIENTS AND METHODS %26lt;br%26gt;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. %26lt;br%26gt;The patients were randomly divided into two groups: the first group was given oral melt 120 mu g and the second group 240 mu g, for 2 weeks. %26lt;br%26gt;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. %26lt;br%26gt;As predictive factors, bladder volume and wall thickness index, nocturnal polyuria and voiding latency were considered. %26lt;br%26gt;RESULTS %26lt;br%26gt;There was no significant difference between the 120 mu g and 240 mu g patients in terms of response. %26lt;br%26gt;The oxybutynin group showed a higher rate of full and partial responses (45% success) compared with the placebo group (17% success), P %26lt; 0.01. %26lt;br%26gt;The responders to combined oxybutynin and desmopressin had significantly lower bladder volume and wall thickness index than the other patients. %26lt;br%26gt;CONCLUSIONS %26lt;br%26gt;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. %26lt;br%26gt;Ultrasonography-measured bladder variables can provide useful predictive clues for MNE. %26lt;br%26gt;Predictive factors can help to differentiate treatment subtypes and guide clinical management in primary nocturnal enuresis.

• 出版日期2012-10