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Combination treatment of nocturnal enuresis with desmopressin and indomethacin

Kamperis K, Hagstroem S, Faerch M, Mahler B, Rittig S, Djurhuus JC

Pediatr Nephrol. 2016 Oct 27. [Epub ahead of print]

Commentary by the Editors

This is a study concerning a highly selected cohort of children with monosymptomatic nocturnal enuresis, nocturnal polyuria evident on home recordings normal reservoir function during daytime and inadequate effect of desmopressin on the nocturnal urine output.

Such children who are to be encountered in all clinical settings represent a challenging population as the very often are refractory to standard therapy. In this study a treatment approach comprising desmopressin and indomethacin was tested in a randomized placebo controlled fashion.

Twenty-three children were recruited. The authors were able to demonstrate that addition of indomethacin to desmopressin further reduces the nocturnal urine output in the majority of the participants. Despite that, this approach did not lead to significantly more dry nights. This dissociation between the antidiuretic effect and the antienuretic effect may be the result of reduced bladder capacities during sleep at least on some of the participating children.

There are two main messages conveyed by this paper. The combination of desmopressin and indomethacin can further reduce the urine output in children with inadequate antidiuretic effect of desmopressin. Secondly and perhaps most importantly that even children with nocturnal polyuria may suffer from nocturnal bladder reservoir dysfunction. Homer recordings during treatment may give important information to the clinicians treating thee children.

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Consensus Guidelines

Practical consensus guidelines for the management of enuresis. 
Evaluation and management of enuresis, a common condition, is not a priority in training programs for medical doctors (MDs), despite being a common condition. 

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Diagnosis and Treatment of Nocturnal Enuresis developed by the Working Group of Nocturnal Enuresis Belgium.