Monosymptomatic
nocturnal enuresis, a heterogeneous condition, is frequently treated in children aged >5 years. Of the various treatment options,
enuresis alarm has been widely advocated as being effective for treating
nocturnal enuresis, while extracorporeal pelvic floor magnetic stimulation for
overactive bladder,
urge incontinence and urgency-frequency syndrome has not yet been confirmed by controlled studies as primary treatment for monosymptomatic
nocturnal enuresis.
Desmopressin, an
antidiuretic hormone (ADH) analog, or
arginine vasopressin (AVP), can resolve primary
nocturnal enuresis by decreasing night-time urine production. Enuretic children requiring either
desmopressin or
desmopressin plus
oxybutynin to achieve dryness have
polyuria.
Tricyclic antidepressants (i.e.
imipramine) are used successfully in enuretic children. Although tricyclics and
desmopressin are effective in reducing the number of wet nights, most children relapse after discontinuation of active treatment. Combined
therapy (
enuresis alarm, bladder training, motivational
therapy and pelvic floor muscle training) is more effective than each component alone or than
pharmacotherapy. Furthermore,
desmopressin combined with alarm
therapy has a positive effect on
enuresis.
Pharmacotherapy can provide early relief of
enuresis, while behavioral intervention may lead to greater long-term benefits. The positive effect of achieving dry nights with
pharmacotherapy can encourage the child to sustain behavioral
therapy.