Desmopressin for nocturnal enuresis: urinary osmolality and response

Objective To measure the effect of intranasal desmopressin (1‐deamino 8‐d‐arginine vasopressin, DDAVP) on urine osmolality in a group of patients with persistent primary enuresis, and to determine whether changes in osmolality can the predict response to treatment. Patients and methods Thirty‐seve...

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Published in:	British Journal of Urology Vol. 80; no. 3; pp. 480 - 484
Main Authors:	FOLWELL, A.J., MACDIARMID, S.A., CROWDER, H.J., LORD, A. DE M., ARNOLD, E.P.
Format:	Journal Article
Language:	English
Published:	Oxford, UK Blackwell Science Ltd 01-09-1997 Blackwell
Subjects:	Administration, Intranasal Adolescent Biological and medical sciences Child continence Cross-Over Studies DDAVP Deamino Arginine Vasopressin - adverse effects Deamino Arginine Vasopressin - therapeutic use desmopressin Double-Blind Method Enuresis Enuresis - drug therapy Enuresis - urine Female Humans Male Medical sciences Osmolar Concentration Pharmacology. Drug treatments Renal Agents - adverse effects Renal Agents - therapeutic use Treatment Outcome Tropical medicine urinary osmolar concentration Urinary system Human Measurement Urine Desmopressin Urinary system disease Night Osmolarity Enuresis Treatment efficiency Result Urinary incontinence Voiding dysfunction Treatment Opotherapy Predictive value
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Summary:	Objective To measure the effect of intranasal desmopressin (1‐deamino 8‐d‐arginine vasopressin, DDAVP) on urine osmolality in a group of patients with persistent primary enuresis, and to determine whether changes in osmolality can the predict response to treatment. Patients and methods Thirty‐seven patients with persistent primary nocturnal enuresis were entered into a double‐blind placebo‐controlled crossover trial of 20 μg intranasal DDAVP spray. Morning urinary osmolality was measured on two occasions during each phase of treatment and the clinical response recorded in a diary. Results Thirty‐one patients (22 males and nine females) were evaluable at the end of the trial period. A good clinical response, defined as enuresis on two nights or fewer each week, occurred in 12 of 31 (39%) patients, but complete continence was attained in only two. The response was better in older patients and in those with less frequent enuresis. The mean and peak urinary osmolality of the morning urine samples were higher while on treatment with DDAVP compared with placebo, but this difference was not statistically significant and the response did not predict a good clinical outcome in improving the enuresis. Conclusions Treatment with DDAVP can produce a socially acceptable level of dryness in some patients with refractory nocturnal enuresis. However, the early morning urinary osmolality, as a reflection of changes in nocturnal osmolality, was not useful in distinguishing this group or in selecting those who will respond to treatment.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-News-3 content type line 23
ISSN:	0007-1331 1464-410X
DOI:	10.1046/j.1464-410X.1997.00360.x