Background:
Enuresis (bed-wetting) is a socially disruptive and stressful condition which affects from 15% to 20% of five year olds, and up to 2% of young adults.
Objectives:
To assess the effects of desmopressin on nocturnal enuresis in children, and to compare desmopressin with other interventions.
Search methods:
We searched the Cochrane Incontinence Group Specialised Trials Register (searched 10 May 2006). The reference list of the original version of this review was also searched.Selection criteria: All randomised controlled trials of desmopressin for nocturnal enuresis in children were included in the review. Trials focused solely on daytime wetting were excluded.
Data collection and analysis:
Two reviewers independently assessed the quality of the eligible trials and extracted data.
Main results:
Forty seven randomised controlled trials involving 3448 children (of whom 2210 received desmopressin) met the inclusion criteria. The quality of many of the trials was poor. Desmopressin was effective in reducing bed-wetting during treatment, compared with placebo (e.g. 20 µg: 1.34 fewer wet nights per week; 95% confidence interval (CI) 1.11 to 1.57), and children were more likely to become dry (e.g. 118/146, 81% versus 140/142, 98% still wet; relative risk (RR) for failure to achieve 14 dry nights with 20 µg was 0.84; 95% CI 0.79 to 0.91). However, there was no difference between the two patient groups after treatment was finished. There was no clear dose-related effect of desmopressin, but the evidence was limited. Data which compared oral and nasal administration were too few to be conclusive.In four small trials, there were no significant differences between desmopressin and alarms during treatment when these were used separately, but the chance of failure or relapse after treatment stopped was lower after an alarm in two small trials (40/62, 65% versus 26/57, 46%; RR 1.42, 95% CI 1.05 to 1.91).Although children had fewer wet nights during treatment when they used desmopressin combined with alarm treatment compared with alarms alone (WMD -0.83, 95% CI -1.11 to -0.55), there were no significant differences either in failure rates during treatment (RR 0.88; 95% CI 0.73 to 1.05) or for relapse after treatment stopped (105/213, 49% versus 118/214, 55%: RR 0.91, 95% CI 0.76 to 1.08).Comparison with some tricyclic drugs (e.g. amitriptyline) suggested that they might be as effective as desmopressin, although in two trials children were less likely to achieve 14 dry nights with imipramine than desmopressin (RR 0.44, 95% CI 0.27 to 0.73) but there was not enough information about subsequent relapse. There were more side effects with the tricyclics. Desmopressin may be better than diclofenac or indomethacin.There was not enough information to evaluate the relative effects of behavioural or complementary treatments against desmopressin.
Authors' conclusions:
Desmopressin rapidly reduced the number of wet nights per week experienced by children, but the limited evidence available suggested that this was not sustained after treatment stopped. Comparison with alternative treatments suggested that desmopressin and tricyclics had similar clinical effects during treatment, but that alarms may produce more sustained benefits. However, based on the available limited evidence, these conclusions are only tentative. Children should be advised not to drink more than 240 ml (8 ounces) of fluid during the evening before desmopressin treatment in order to avoid the possible risk of water intoxication.
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