Excerpt from Mayo Clinic
Nocturnal Enuresis: A Guide to Evaluation and Treatment
(Mayo Clinic – Rochester)
Tofranil (imipramine) Another pharmacologic agent that has been used to treat nocturnal enuresis. It offers two beneficial physiologic effects: a direct anticholinergic action on bladder tone (improvement in bladder capacity) and a decrease in the depth of sleep during the last third of the night. Successful management of nocturnal enuresis with imipramine has been reported to range between 20 and 36%. Unfortunately discontinuation of use of imipramine usually leads to recurrent incontinence, and resolution of nocturnal enuresis does not differ from that in untreated control subjects.
DDAVP (Desmopressin) Desmopressin acetate, an analogue of the ADH arginine vasopressin, is frequently used to treat nocturnal enuresis. The rationale behind its use stems from controversial findings that children with nocturnal enuresis have an altered circadian ADH release. The reported efficacy of desmopressin in the treatment of nocturnal enuresis varies between 10 and 86%. Of note, the type of nocturnal enuresis – that is, monosymptomatic versus polysymptomatic – may distinctly affect the patient’s response to desmopressin. We found that 68% of patients with monosymtomatic nocturnal enuresis had continence while taking this medication in contrast to only 19% of those with polysymptomatic nocturnal enuresis. Unfortunately, after discontinuation of use of this agent, most of the children (those with nonsymptomatic and those with polysymptomatic nocturnal enuresis) had recurrence incontinence. Indeed after a successful 6-month therapeutic trial with desmopressin the percentage of children that retained continence did not differ from an untreated control population – 10% versus 16%, respectively. Thus we recommend use of this agent primarily for symptomatic control of enuresis during special occasions – for example, sleepovers and band trips.
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