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Objective: The objective of this study was to evaluate the response rate of older children to combination
therapy using an anticholinergic agent, Oxybutynin Hydrochloride, and a synthetic analogue of antidiuretic
hormone, desmopressin acetate.
Material and Methods: Children aged 9-18 years, diagnosed as nocturnal enuresis were evaluated
using a questionnaire, history and physical examination. All were begun on, 2.5mg, Oxybutynin HCL and
20ug of desmopressin intranasally at bed time. The response rate was monitored at 2 and 4 weeks, and
then every 3 months by recording dry nights on a calendar or in a dairy. To improve efficacy, the dosage
of medication was adjusted up to 5mg Oxybutynin HCL and 60ug of desmopressin. Upon achieving dryness
and spontaneous awakening to void, medication doses were tapered.
Results: Out of 30 patients, 17(57%) patients were completely dry within 6 months and 7(21%) were dry
at least 80% of nights. Nine patients relapsed during dose tapering and therapy was reinstituted. Eighteen
(60%) patients were off medication (after a mean of 8 months of treatment). Combination therapy failed in
three patients. None experienced untoward side effects from the medications.
Conclusion: Most older children with nocturnal enuresis responded well to combination therapy, these
children require long term follow up and may need medication for up to six months because the relapse
rate is fairly high. Combination therapy appears safe and reliable in treating nocturnal enuresis in older
children who have had no success with other treatment modalities.
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