Optimizing response to desmopressin in patients with monosymptomatic nocturnal enuresis

Most patients with monosymptomatic nocturnal enuresis can be effectively treated with an enuresis alarm or antidiuretic therapy (desmopressin), depending on the pathophysiology of the condition in the individual patient. Desmopressin is first-line therapy for enuresis caused by nocturnal polyuria, an excessive urine output during the night. However, in a recent study, around one-third of patients thought to be resistant to desmopressin were subsequently treated effectively with desmopressin monotherapy in a specialist centre. The aim of this article is to review best practice in selecting patients for desmopressin treatment, as well as outline eight recommendations for maximizing the chances of treatment success in patients receiving desmopressin. The roles of formulation, dose, timing of administration, food and fluid intake, inter-individual variation in response, body weight, adherence, withdrawal strategies and combination therapies are discussed in light of the most recent research on desmopressin and enuresis. Possible reasons for suboptimal treatment response are explored and strategies to improve outcomes in patients for whom desmopressin is an appropriate therapy are presented. Through optimization of the treatment plan in primary and specialist care centres, the hope is that fewer patients with this distressing and often embarrassing condition will experience unnecessary delays in receiving appropriate care and achieving improvements

Recent advances in managing and understanding enuresis

Enuresis, particularly in children during sleep, can be a debilitating condition, affecting the quality of life of the child and his or her family. The pathophysiology of nocturnal enuresis, though not clear, revolves around the inter-related mechanisms of overactive bladder, excessive nocturnal urine production, and sleep fragmentation. The first mechanism is more related to isolated nocturnal voiding, whereas the latter two are more related to nocturnal enuresis, in which circadian variations in arginine vasopressin hormone play a key role. A successful treatment would depend upon appropriately addressing the key factors precipitating nocturnal enuresis, necessitating an accurate diagnosis. Thus, advancements in diagnostic tools and treatment options play a key role in achieving overall success. This review summarizes recent advances in understanding the pathophysiology of nocturnal enuresis, diagnostic tools, and treatment options which can be explored in the future

Circadian rhythm of water diuresis and salt excretion in treatment naïve children with nocturnal polyuria and the influence on desmopressin response

Nocturnal enuresis is caused by a mismatch between nocturnal diuresis and functional bladder volume. Nocturnal polyuria (nocturnal diuresis > 130% of the expected bladder capacity for age, by ICCS definition) is a known pathophysiological mechanism of bedwetting. Other comorbidities such as constipation, mental health problems, and sleep disorders may play a role in prognosis and/or therapy response. In the prospective study (B670201212) we investigated the correlation of different sleep parameters and neuropsychological findings with specific enuresis characteristics and response to desmopressin treatment in children with nocturnal polyuria. The children participating in this study underwent polysomnography and had a 24-hour urine concentration profile before and 6 months after starting desmopressin. The primary research questions have since been published. Recently, there are indications that, but by analogy with nocturia in adults, not only water diuresis but also disturbed circadian rhythm of osmotic excretion play a role, but especially in treatment-resistant enuresis: The existing database offers the possibility to assess the importance of these factors. evaluate without having to re-study patients Our aim is to perform a post-hoc analysis on the existing anonymized database of the above study, in which we wish to analyze data (urine volumes, electrolytes, osmolarity, creatinine), to determine the renal circadian rhythm of water diuresis and salt and osmotic excretion analyze. In addition, the correlation with nocturnal polyuria and desmopressin response will also be investigated