Management of the refractory nocturnal enuresis patient to desmopressin in a pediatric population: Desmopressin + oxybutynin vs. desmopressin + imipramine

• Published in: Journal of pediatric urology 2024-08, Vol.20 (4), p.603.e1-603.e8
• Main Authors: Shain, Spencer, Gitlin, Jordan, Pantazis, Amelia, Fine, Ronnie, Horowitz, Mark, Friedman, Steven, Zelkovic, Paul, Dyer, Lori, Schlussel, Richard, Freyle, Jamie, Fang, Alexander, Sommer, Jessica, Franco, Israel
• Format: Article
• Language: English
• Subjects: Adolescent; Antidiuretic Agents - administration & dosage; Antidiuretic Agents - therapeutic use; Child; DDAVP; Deamino Arginine Vasopressin - administration & dosage; Deamino Arginine Vasopressin - therapeutic use; Desmopressin; Drug Therapy, Combination; Enuresis; Female; Humans; Imipramine; Imipramine - administration & dosage; Imipramine - therapeutic use; Male; Mandelic Acids - administration & dosage; Mandelic Acids - therapeutic use; Nocturnal Enuresis - drug therapy; Oxybutynin; Retrospective Studies; Treatment Outcome
• ISSN: 1477-5131; 1873-4898; 1873-4898
• DOI: 10.1016/j.jpurol.2024.05.024

Desmopressin is well accepted as first-line medical therapy for enuresis. If ineffective, combination therapy of desmopressin + oxybutynin or desmopressin + imipramine has been used. This study assessed the efficacy of adjunct therapy with either imipramine or oxybutynin in the management of enuresis patients who failed desmopressin treatment. A retrospective chart review of our database for patients with enuresis was performed. Patients who were prescribed desmopressin, oxybutynin, and imipramine over 14 years for enuresis were included. Two cohorts of patients were examined; group OXY was treated with desmopressin and oxybutynin, and group IMP received desmopressin and imipramine. Pretreatment measurement of Vancouver Symptom Scores (VSS) were used to compare groups using the VSS question “I wet my bed at night” where 4: every night, 3: 4–5 nights per week, 2: 1–2 nights per week, 1: 3–4 nights per month, and 0: never. International Children's Continence Society (ICCS) criteria for continence success was utilized to determine outcomes. 2521 patients prescribed one of the 3 medications were identified. Among them, 81 patients (mean age: 10.5 ± 2.8 years) received combination therapy. Of which, 55 were male and 26 female. Specifically, 58 were prescribed both desmopressin and imipramine (group IMP), 23 desmopressin and oxybutynin (group OXY), and 4 transitioned from OXY to IMP. Mean pretreatment VSS showed no difference between groups. Both groups experienced minimal drops in wet nights with desmopressin alone. A comparison revealed that group IMP reduced wet nights significantly more than group OXY (VSS wet night score 0.7 ± 1.2 vs. 2.3 ± 1.1 respectively, p