Comparison of desmopressin and conservative therapy in enüresis nocturna and evaluation of the effects of bladder capacity on the response to therapy

Objectives: The purpose of this research was aimed to compare the response of the patientswith primer enuresis nocturna to the conservative therapy and desmopressin therapy, and inaddition to measure the bladder capacity of the patients to find out the affects of bladdercapacity on the response of patients to the treatments.Material and Methods: 52 PMEN (primer monosymphtomatic enuresis nocturna) patientswere diagnosed for this study and included 52 children with at least two enuretic episodes in aweek. Children with appropriate age and have no enuresis episode were selected as controlgroup. Before treatment patient?s bladder capacities were measured by three differentmethods. All patients collected and measured their daily fluid uptake and urine output.According to daily voiding chart, maximum voided volume accepted as functional bladdercapacity.During the ultrasonography as the patients bladder was full with urine the bladdervolume was measured and after voiding, the residual urine volume was measured again tofind the total capacity. Uroflowmetric measurements of the patients were made byuroflowmetry device and the maximum voided volume accepted to be the bladder capacity.The data are compared with the bladder capacity calculated by Koff formulas (age +2)x30.Corrected capacity was calculated as a percentage of FMK to the capacity ideal for age. Thepatients were divided in to 3 subgroups according to their response to the conservativetherapy and desmopressin therapy.42 patients were given DDAVP 1 x0,2mg one hour before bed time. The affect ofbladder capacities on the response of patients to the desmopressin treatment was searched.SPSS 11.5 programme was preferred for analyses, probability values of p<0.05 in all testswere considered significant.Results: The enuresis risk was higher in the children whose father, father?s relatives andbrother have enuresis (p<0.05). Sleep disorder is the most important predisposing factor forenuresis (p<0.05). Upper airway obstruction was increased in enuresis nocturna populationaccording to control group (p=0,05).The most prescribed drug was imipramin . The decreaseof enuresis episodes with both treatment were significantly high (p<0.05). The patients whorecovered with desmopressin treatment was significantly high (p=0,035).The relapse ofdesmopressin treatment was significantly high too (p<0.0001).The recovery rate of childrenwhom assumed to drink much more fluid was high (p=0.05).The functional bladder capacityand corrected bladder capacity of the patients who did not recovered with desmopressintherapy were significantly low (p<0.02). In addition their bladder capacity measured withUSG and uroflowmetry were lower than the group achieved to be dry over 20 days in a monthwith desmopressin treatment.Conclusions: The most important predisposing factors for enuresis nocturna were found to besleep disorder and genetics. Both therapies were successful, and conservative therapy waseffective in the first step. Desmopressin is successful and safe as a drug therapy but relapserate was significantly high in this study.The functional and corrected bladder capacities are found lower in the group who didnot recover with desmopressin. In conclusion we suggest that the measurement of bladdercapacity before drug therapy to decrease unnecessary prescription of desmopressin.Uroflowmetry and ultrasonography are useful to evaluate the lower urinary system andbladder functions. Functional bladder capacity should be considered as a valuable parameterto guess the response to desmopressin and useful to choice most convenient therapy for thepatient in a short time.Key Words: Enuresis Nocturna, Conservative therapy, Desmopressin, Bladder Capacity.