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Predictive parameters of response to desmopressin in primary nocturnal enuresis

By Charlotte Van Herzeele, Jonathan Evans, Paul Eggert, Henri Lottmann, Jens Peter Norgaard, and Johan Vande Walle

Journal of Pediatric Urology, December 11, 2014, Article in Press

Editor’s comments:
For the clinician it is not only important to inform the child and the parents why the child is bedwetting, but it is also important to “guide” them towards the optimal treatment with the highest success rate. It is known that motivation is probably the most important success factor, but other variables can also be taken into account. This study retrospectively analyzed 936 children from 86 centers in 4 different countries. The authors found that treatment with desmopressin is more successful in older children if the number of wet nights per week are limited and if nocturnal polyuria is present. Therefore, in order to provide an optimal individualized therapy, it is recommended to collect information, such as a frequency and volume chart, before treatment.

Abstract


INTRODUCTION/BACKGROUND

Many recent treatment guidelines have advocated the importance of a full noninvasive medical evaluation. To individualize treatment, special emphasis must be put on recording of the maximum voided volume (MVV) and nocturnal diuresis in a diary or frequency/volume chart.

OBJECTIVE

The aim of this study was to identify any possible predictive factors to desmopressin response.

STUDY DESIGN

This study is a re-analysis of a prospective, open-label, multinational, phase-IV study evaluating ≤6 months of treatment with desmopressin tablets for children with primary nocturnal enuresis. The children were enrolled between April 2002 and December 2004 from 86 centers in four countries: UK, Canada, Germany and France. A total of 936 children were screened; 744 children aged 5-15 years participated in the study. Of these, 471 children completed the study with 6 months follow-up and recording in a frequency/volume chart. All children experienced six or more wet nights during the 14-day screening period. Exclusion criteria were: organic pathology, treatment for enuresis within the past year, previous treatment for enuresis for >4 weeks, diurnal symptoms, renal or central diabetes insipidus and the use of systemic antibiotics or other drugs known to affect desmopressin activity. The predictive value of number of wet nights a week, fluid intake, daytime voiding frequency and diuresis was investigated by performing a multinomial logistic regression.

RESULTS

Of the demographic variables, age was the only significant predictor for response to desmopressin. Controlling for age, the significant predictive variables were: number of wet nights a week, average voided volume daytime, maximum voided volume daytime, total daytime diuresis, nocturnal diuresis (see Figure), maximum voided volume 24 h and total 24 h diuresis. More than 80% of the children had no nocturnal polyuria and a low maximum voided volume.

DISCUSSION

Performing a secondary analysis is a limitation because the original study was not designed for that. A new prospective study is ethically hardly defendable for children if data are available from previous literature [1]; therefore, a re-analysis was the appropriate choice. The study confirms the predictive value of age, number of wet nights a week and nocturnal diuresis [1,2].

CONCLUSIONS

The study demonstrates that desmopressin response rates are higher in children with greater age, limited number of wet nights a week and nocturnal polyuria. Only a minority of a primary nocturnal enuresis population, based on history alone, had nocturnal polyuria. The majority had a low maximum voided volume. The results clearly stress the importance of a frequency/volume chart for individualizing therapy to the characteristics, thereby resulting in elevated success rates. Registration number of clinical trial: Clinical Trials.gov NCT00245479.

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