Skip to main content

Advertisement

SpringerLink
Log in

Comparing alarms, desmopressin, and combined treatment in Chinese enuretic children

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

The objective of this multicenter randomized controlled trial was to compare the efficacy of enuresis alarms, oral desmopressin, and combined treatment in Chinese children with monosymptomatic primary nocturnal enuresis. We assigned 105 children aged 7–15 years to receive alarms (group 1, 35 patients), oral desmopressin 400 μg (group 2, 38 patients), or combined therapy (group 3, 32 patients) for 12 weeks; patients were then followed for 12 weeks after treatment. The wetting frequency decreased during treatment by 46%, 52%, and 73% in groups 1, 2, and 3, respectively. In groups 2 and 3, but not in group 1, there was rebound post treatment, but significant improvements persisted at 12 weeks. The complete and partial response rates were 22.9% and 20%, respectively in group 1, 42% and 10.5% in group 2, and 62.5% and 15.6% in group 3. By Kaplan-Meier analysis, group 1 had a significantly poorer response than groups 2 and 3. Of the responders, 20%, 60%, and 40% in groups 1, 2, and 3, respectively, relapsed after stopping treatment. In conclusion, enuresis alarms and/or oral desmopressin were less efficacious in Chinese than in Western societies. Desmopressin produced an immediate effect but relapses were common. Alarms took several weeks to produce a benefit, which was persistent on follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Nijman RJM, Butler R, Van Gool J, Yeung CK, Bauer W, Hjalmas K (2002) Committee 10A. Conservative management of urinary incontinence in childhood. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence. Proceedings of the 2nd International Consultation on Incontinence. Health Publication, Plymouth, pp 513–551

  2. Moffatt MEK (1989) Nocturnal enuresis: psychologic implications of treatment and nontreatment. J Pediatr 114:697–704

    Google Scholar 

  3. Fergusson DM, Horwood LJ (1994) Nocturnal enuresis and behavioral problems in adolescence: a 15-year longitudinal study. Pediatrics 94:662–668

    Google Scholar 

  4. Redsell SA, Collier J (2001) Bedwetting, behaviour and self-esteem: a review of the literature. Child Care Health Dev 27:149–162

    Article  CAS  PubMed  Google Scholar 

  5. Moffatt MEK, Kato C, Pless IB (1987) Improvements in self-concept after treatment of nocturnal enuresis: randomized controlled trial. J Pediatr 110:647–652

    Google Scholar 

  6. Butler RJ, Redfern EJ, Forsythe WI (1990) The child’s construing of nocturnal enuresis: a method of inquiry and prediction of outcome. J Child Psychol Psychiatry 31:447–454

    CAS  PubMed  Google Scholar 

  7. Longstaffe S, Moffatt MEK, Whalen JC (2000) Behavioral and self-concept changes after six months of enuresis treatment: a randomized, controlled trial. Pediatrics 105:935–940

    Google Scholar 

  8. Glazener CMA, Evans JHC (2002) Alarm interventions for nocturnal enuresis in children (Cochrane Review). In: The Cochrane Library, issue 3. Update Software, Oxford

  9. Glazener CMA, Evans JHC (2002) Desmopressin for nocturnal enuresis in children (Cochrane Review). In: The Cochrane Library, issue 3. Update Software, Oxford

  10. Butler R, Holland P, Devitt H, Hiley E, Roberts G, Redfern E (1998) The effectiveness of desmopressin in the treatment of childhood nocturnal enuresis: predicting response using pretreatment variables. Br J Urol [Suppl 81]:29–36

  11. Morison MJ (1998) Family attitudes to bed-wetting and their influence on treatment. Prof Nurse 13:321–325

    CAS  PubMed  Google Scholar 

  12. Moffatt M, Cheang M (1995) Predicting treatment outcome with conditioning alarm. Scand J Urol Nephrol [Suppl] 73:119–122

    Google Scholar 

  13. Yap HK, Chao SM, Tan AS, Murugasu B, Ong EK, Low EH (1998) Efficacy and safety of oral desmopressin in the treatment of primary nocturnal enuresis in Asian children. J Paediatr Child Health 34:151–153

    Article  Google Scholar 

  14. Kanaheswari Y (2003) Epidemiology of childhood nocturnal enuresis in Malaysia. J Paediatr Child Health 39:118–123

    Article  CAS  PubMed  Google Scholar 

  15. Bosson S, Lyth N (2003) Nocturnal enuresis. Clin Evidence 9:407–414

    Google Scholar 

  16. Sukhai RN, Mol J, Harris AS (1989) Combined therapy of enuresis alarm and desmopressin in the treatment of nocturnal enuresis. Eur J Pediatr 148:465–467

    Google Scholar 

  17. Bradbury MG, Meadow SR (1995) Combined treatment with enuresis alarm and desmopressin for nocturnal enuresis. Acta Paediatr 84:1014–1018

    CAS  PubMed  Google Scholar 

  18. Leebeek-Groenewegen A, Blom J, Sukhai R, Van DH (2001) Efficacy of desmopressin combined with alarm therapy for monosymptomatic nocturnal enuresis. J Urol 166:2456–2458

    Article  CAS  PubMed  Google Scholar 

  19. Muller D, Florkowski H, Chavez-Kattau K, Carlsson G, Eggert P (2001) The effect of desmopressin on short-term memory in children with primary nocturnal enuresis. J Urol 166:2432–2434

    Article  CAS  PubMed  Google Scholar 

  20. Butler RJ, Robinson JC (2002) Alarm treatment for childhood nocturnal enuresis: an investigation of within-treatment variables. Scand J Urol Nephrol 36:268–272

    Article  CAS  PubMed  Google Scholar 

  21. Hjalmas K, Hanson E, Hellstrom AL, Kruse S, Sillen U on behalf of the Swedish Enuresis Trial (SWEET) Group (1998) Long-term treatment with desmopressin in children with primary monosymptomatic nocturnal enuresis: an open multicentre study. Br J Urol 82:704–709

    Article  CAS  PubMed  Google Scholar 

  22. Tullus K, Bergstrom R, Fosdal I, Winnergard I, Hjalmas K (1999) Efficacy and safety during long-term treatment of primary monosymptomatic nocturnal enuresis with desmopressin. Swedish Enuresis Trial Group. Acta Paediatr 88:1274–1278

    Article  CAS  PubMed  Google Scholar 

  23. Kruse S, Hellstrom AL, Hanson E, Hjalmas K, Sillen U (2001) Treatment of primary monosymptomatic nocturnal enuresis with desmopressin: predictive factors. BJU Int 88:572–576

    Article  CAS  PubMed  Google Scholar 

  24. Caione P, Arena F, Biraghi H, et al. (1997) Nocturnal enuresis and daytime wetting: a multicentric trial with oxybutynin and desmopressin. Eur Urol 31:459–463

    CAS  PubMed  Google Scholar 

  25. Shu SG, Lii YP, Chi CS (1993) The efficacy of intranasal DDAVP therapy in children with nocturnal enuresis. Chin Med J (Taipei) 52:368–371

    Google Scholar 

  26. Hogg RJ, Husmann D (1993) The role of family history in predicting response to desmopressin in nocturnal enuresis. J Urol 150:444–445

    CAS  PubMed  Google Scholar 

  27. Yeung CK, Sit FK, To LK, Chiu HN, Sihoe JD, Lee E, Wong C (2002) Reduction in nocturnal functional bladder capacity is a common factor in the pathogenesis of refractory nocturnal enuresis. BJU Int 90:302–307

    Article  CAS  PubMed  Google Scholar 

  28. Riccabona M, Oswald J, Glauninger P (1998) Long-term use and tapered dose reduction of intranasal desmopressin in the treatment of enuretic children. Br J Urol 81 [Suppl 3]:24–25

  29. Neveus T (2001) Oxybutynin, desmopressin and enuresis. J Urol 166:2459–2462

    Article  CAS  PubMed  Google Scholar 

  30. Apakama DC, Bleetman A (1999) Hyponatraemic convulsion secondary to desmopressin treatment for primary enuresis. J Accid Emerg Med 16:229–230

    CAS  PubMed  Google Scholar 

  31. Bernstein SA, Williford SL (1997) Intranasal desmopressin-associated hyponatremia: a case report and literature review. J Fam Pract 44:203–208

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This project was sponsored by Hong Kong Paediatric Nephrology Society with a research grant from Ferring Pharmaceuticals Limited. We would like to thank the children and their parents who participated in this study.

Author information

Authors and Affiliations

  1. Department of Pediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China

    Cherry Fai-Ngo Ng

  2. Department of Pediatrics and Adolescent Medicine, Tuen Mun Hospital, Tsing Chung Koon Road, Hong Kong SAR, China

    Sik-Nin Wong

Authors
  1. Cherry Fai-Ngo Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sik-Nin Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

The Hong Kong Childhood Enuresis Study Group

Corresponding author

Correspondence to Sik-Nin Wong.

Additional information

This study was carried out by the Hong Kong Childhood Enuresis Study Group. Other members are: Sonia Chang (Kwai Chung Hospital), Stella Chim (Queen Mary Hospital), Man-Chun Chiu (Princess Margaret Hospital), Kwok-Wai Lee (Queen Elizabeth Hospital), Lettie Leung (Kwong Wah Hospital), Kei-Chiu Tse (Princess Margaret Hospital), Esther Wong (Prince of Wales Hospital), Fai-To Yau (Alice Ho Miu Ling Nethersole Hospital), Chung-Kwong Yeung (Prince of Wales Hospital), and Pa-Shing Yeung (Caritas Medical Center)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fai-Ngo Ng, C., Wong, SN. & The Hong Kong Childhood Enuresis Study Group. Comparing alarms, desmopressin, and combined treatment in Chinese enuretic children. Pediatr Nephrol 20, 163–169 (2005). https://doi.org/10.1007/s00467-004-1708-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-004-1708-5

Keywords

Search

Navigation