International Urology and Nephrology

, Volume 37, Issue 4, pp 751–757 | Cite as

The Role of Urine Osmolality and Ions in the Pathogenesis of Primary Enuresis Nocturna and in the Prediction of Responses to Desmopressin and Conditioning Therapies

  • Tolga Ünüvar
  • Ferah Sönmez


Aim of the study was to determine the role of nocturnal and daytime urine volume, osmolality and ion excretions in the pathogenesis of primary monosymptomatic enuresis nocturna (PMEN) and in the prediction of response to desmopressin and conditioning therapies. Fifty-five children with PMEN between the ages 5 and 15 years were included to the study. The patients were randomly divided into three groups Group 1: Twenty enuretics having intranasal desmopressin 1× 20 μg treatment for 2 months Group 2: Twenty enuretics having conditioning therapy for 2 months. Group 3: Fifteen enuretics having intranasal izotonic solutions as placebo. The control group consisted of 15 healthy children. Urine osmolality, sodium, potassium, chloride, magnesium and creatinine levels were investigated in both daytime and nighttime urines. Fractional sodium, potassium, magnesium, chloride excretions were calculated. Wilcoxon, Mann–Whitney U, Kruskal–Wallis, Chi-square, Student’s t and Pearson correlation tests were performed. The ratio of night/daytime urine osmolality was significantly decreased in enuretic children. In addition, the ratio of night/daytime urine Cl and K excretions were also significantly decreased in enuretics. Response rate to desmopressin and conditioning treatments were statistically higher than placebo control. The difference between response rates of desmopressin and conditioning therapies was not found statistically significant. Pretreatment values of urine volume osmolality and ions were not observed as predictive factors in response to desmopressin or conditioning therapy. In conclusion, nightly decreased potassium and chloride excretions were found to have a role in the pathogenesis of primary enuresis nocturna. Urine volume, osmolality and ion excretions are not suggested to be used in the prediction of response to desmopressin and conditioning therapies.


Conditioning therapy Desmopressin Osmolality Primary enuresis nocturna Urinary ion excretion Urine volume 


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  1. 1.
    Rushton, HG. 1992EnüresisKelalis, PRing, LBelman, B eds. Clinical Pediatric UrologyW.B. Saunders CompanyPhiladelphia365379Google Scholar
  2. 2.
    Koff SA. Enuresis. In: Walsh-Retik-Stamey-Vaughan Campbell’s Urology, 7th ed., Vol. 2. Philadelphia: W.B. Saunders Company, 1993: 2055–2068Google Scholar
  3. 3.
    Roth, JA, Atala, A. 2001Childhood enuresisRakel, RE eds. Conn’s Current TherapyW.B. Saunders CompanyPhiladelphia658660Google Scholar
  4. 4.
    Rushton, HG. 1992EnuresisKher, KKMakker, SP eds. Clinical Pediatric NephrologyMcGraw IncNew York399419Google Scholar
  5. 5.
    Yuri, VN, Kuznetsova, A. 1999Defect of osmoregulatory renal function in nocturnal enuresisScand J Urol Nephrol334044Google Scholar
  6. 6.
    Lackgren, G, Lilja, B, Neveus, T,  et al. 1998Desmopressin in the treatment of severe nocturnal enuresis in adolescents – a 7 year follow-up studyBr J Urol31723Google Scholar
  7. 7.
    Neveus, T, Lackgren, G, Tuvemo, T,  et al. 1999Osmoregulation and desmopressin pharmacokinetics in enuretic childrenAm Acad Pediatr1036470Google Scholar
  8. 8.
    Sonmez F, Unuvar T. The prevalence and the factors having influence on nocturnal enuresis among Turkish children. Proceedings of the 6thBantao Congress of Nephrology Varna, Bulgaria: 2003: 96–97.Google Scholar
  9. 9.
    Butler, R, Holland, P, Devitt, H. 1998The effectiveness of desmopressin in the treatment of childhood nocturnal enuresis: predicting response using pretreatment variablesBr J Urol812936PubMedGoogle Scholar
  10. 10.
    Douglas, AE, Yves, LH, Paul, F. 1997Spot urine osmolality, age and bladder capacity as predictors of response to desmopressin in nocturnal enuresisScand J Urol Nephrol1834145Google Scholar
  11. 11.
    Folwell, AJ, Macdiarmid, HJ. 1997Desmopressin for nocturnal enuresis: urinary osmolality and responseBJU80480484PubMedGoogle Scholar
  12. 12.
    Medel, R, Dieguez, S, Brindo, M. 1998Monosymptomatic primary enuresis; differences between patient responding or not responding to oral desmopressinBJU814649PubMedGoogle Scholar
  13. 13.
    Bak M, Serdaroğlu E, Çalkavur Ş. Primer monosemptomatik enürezis nokturnada desmopressin tedavisi ve nokturnal poliüri. PGM Pediatr 2001: e15Google Scholar
  14. 14.
    Riccabona, M, Oswald, J, Glauninger, P. 1998Long term use and tapered dose reduction of intranasal desmopressin in the treatment of enuretic childrenBr J Urol812425PubMedGoogle Scholar
  15. 15.
    Hunsballe, JM, Hansen, TK, Rittig, S,  et al. 1998The efficacy of DDAVP is related to the circadian rhythm of urine output in patients with persisting nocturnal enuresisClin Endocrinol49793801CrossRefGoogle Scholar
  16. 16.
    Moffatt, ME, Harlos, S, Kirshen, AJ,  et al. 1993Desmopressin acetate and nocturnal enuresis: how much do we know?Pediatrics92420425PubMedGoogle Scholar
  17. 17.
    Rushton, HG, Belman, AB, Zaontz, M,  et al. 1995Response to desmopressin as a function of urine osmolality in the treatment of monosymptomatic nocturnal enuresis: a double-blind prospective studyJ Urol154749753PubMedGoogle Scholar
  18. 18.
    Bradbury, MG, Meadow, SR. 1995Combined treatment with enuresis alarm and desmopressin for nocturnal enuresisActa Paediatr8410141018PubMedGoogle Scholar
  19. 19.
    Rittig S, Schaumburg H, Schmidt F. Long term home studies of water balance in patients in nocturnal enuresis. Scand J Urol Nephrol 1997: 25–27Google Scholar
  20. 20.
    Monda, JM, Douglas, AD. 1995Primary nocturnal enuresis: a comparison between observation imipramine, desmopressin acetate and bed-wetting alarm systemsThe J Urol154745748Google Scholar
  21. 21.
    Yap, HK, Chao, SM, Tan, AY. 1998Efficacy and safety of oral desmopressin in the treatment of primary nocturnal enuresis in Asian childrenJ Paediatr Child Health34151153CrossRefPubMedGoogle Scholar
  22. 22.
    Wille, S. 1986Comparison of desmopressin and enuresis alarm for nocturnal enuresisArch Dis Child613033PubMedGoogle Scholar
  23. 23.
    Norgaard, J, Rittig, S, Djurhuus, JC. 1989Nocturnal enuresis: an approach to treatment based on pathogenesisJ Pediatri114705710Google Scholar
  24. 24.
    Hjalmas, K, Hanson, E, Hellström, AL. 1998Long-term treatment with desmopressin in children with primary monosymptomatic nocturnal enuresis: an open multicentre studyBr J Urol82704709PubMedGoogle Scholar
  25. 25.
    Kawauchi, A, Watanabe, H, Miyoshi, K. 1996Early morning urine osmolality in nonenuretic and enuretic childrenPediatr Nephrol10696698CrossRefPubMedGoogle Scholar
  26. 26.
    Eggert, P, Kuhn, B. 1995ADH regulation in patients with primary nocturnal enuresisArch Dis Child.73508511PubMedCrossRefGoogle Scholar
  27. 27.
    Steffens, J, Netzer, M, Isenberg, E,  et al. 1993Vasopressin deficiency in primary nocturnal enuresisEur Urol24366370PubMedGoogle Scholar
  28. 28.
    Fjellestad, A, Wille, S, Harris, AS. 1987Comparison of intranasal and oral desmopressin for nocturnal enuresisArch Dis Child62674677Google Scholar
  29. 29.
    Natochin, YV, Kuznetsova, AA. 2000Nocturnal enuresis: correction of renal function by desmopressin and diclofenacPediatr Nephrol144247CrossRefPubMedGoogle Scholar
  30. 30.
    Eggert, P, Muller-Schluter, K, Muller, D. 1999Regulation of Arginine Vasopressin in Enuretic Children Under Fluid RestrictionAm Acad Pediatr103452454Google Scholar
  31. 31.
    Hogg, RJ, Husmann, D. 1993The role of family history in predicting response to desmopressin in nocturnal enuresisJ Urol150444445PubMedGoogle Scholar
  32. 32.
    Djurhuus, JC, Rittig, S. 1998Current trends, diagnosis and treatment of enuresisEur Urol333033CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  1. 1.Department of Pediatric Nephrology, Medical FacultyAdnan Menderes UniversityAydinTürkiye

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