For pediatric nocturnal enuresis, combination treatment bests monotherapy

  • Song P & al.
  • BJU Int
  • 14 Sep 2018

  • curated by Craig Hicks
  • Clinical Essentials
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Takeaway

  • Desmopressin plus anticholinergic agent (AA) and desmopressin plus alarm have better efficacy than monotherapies for treating pediatric monosymptomatic nocturnal enuresis (MNE).

Why this matters

  • MNE affects 15%-20% of children aged 5 years and 1%-2% of adolescents.

Key results

  • Pooled estimates showed the treatment success rate for desmopressin plus AA was higher than that for monotherapy with desmopressin or alarm alone:
    • desmopressin: OR, 0.27 (95% CI, 0.11-0.62); and
    • alarm: OR, 0.29 (95% CI, 0.13-0.61).
  • The success rate for desmopressin plus alarm was higher than for alarm monotherapy:
    • alarm: OR, 0.52 (95% CI, 0.30-0.90).
  • Success rates for desmopressin plus alarm and desmopressin plus AA were not significantly different.

Study design

  • Researchers analyzed 18 randomized controlled trials comparing desmopressin, alarm, desmopressin plus alarm, and desmopressin plus AA (N=1649).
  • Funding: None disclosed.

Limitations

  • MNE has many causes; patients may respond differently to the same treatment.
  • Researchers included 3 AAs (tolterodine [eg, Detrol], oxybutynin [eg, Oxytrol], and propiverine) in the desmopressin plus AA treatment group.

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