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The Outcomes of Long-Term Combined Therapy of Enuresis Alarm and Desmopressin for the Cases Bedwetting Twice or More Every Night
Kenichi Kobayashi, M.D.1, Yasuyuki Naitoh, M.D.2, Akihiro Kawauchi, M.D.1, Kazuyoshi Johnin, M.D.1, Yasuhiro Yamada, M.D.2, Atsuko Fujihara, M.D.2, Koji Okihara, M.D.2, Tsuneharu Miki, M.D.2.
1Shiga University of Medical Science, Otsu City, Japan, 2Kyoto Prefectural University Of Medicine, Kyoto City, Japan.

Introduction: Treatment of nocturnal enuresis in children bedwetting twice or more every night is often difficult. We performed combined therapy that consisted of enuresis alarm and desmopressin (DDAVP), which is categorized as the 2nd line therapy by the International Children’s Continence Society to treat these children as the 1st line therapy. Here, we report the outcomes from the long-term trial.
Material and Methods: The subjects were a total of 34 children [28 males and 6 females, 7 to 13 years old (mean: 9 years)] with monosymptomatic nocturnal enuresis who visited our department from 2009 through 2013. These children bedwetted twice or more per night according to medical interviews or bedwetting records. They received the combined therapy of enuresis alarm and DDAVP as the 1st line therapy.
Results: During the treatment period, when necessary, anticholinergics were included as a part of the tripartite combination therapy that consisted of enuresis alarm, DDAVP and anticholinergics. The average observation period was 17 months. Four out of 34 subjects (12%) dropped out during the treatment period. Before the final evaluation of the treatment outcomes, it was determined that anticholinergics were added to 12 out of 34 subjects. The final treatment outcomes included partial response (17/34; 50%), response (9/34; 26%) and non-response (4/34; 12%). Among the subjects who received anticholinergics, the ratio of nocturnal urine volume (NUV)/maximal voided volumes (MVV) was 2.80 while the ratio was 1.59 in the subjects who did not receive anticholinergics. With cutoff value of NUV/MVV at 2.3, sensitivity, specificity and positive predictive value were 75%, 93% and 90%, respectively.
Conclusion: Total response rate (including response and partial response) after exclusion of the subjects who dropped out was 87% (26 of 30 subjects) in the combined therapy of enuresis alarm and DDAVP with additional anticholinergics when needed. Our results also suggested that the tripartite combination therapy may be appropriate as the 1st line therapy for the children with NUV/MVV of 2.3 or greater.

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