COMBINATION THERAPY IN THE TREATMENT OF NOCTURNAL ENURESIS IN OLDER CHILDREN

Abstract

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.