|
Back to 2015 Joint Annual Meeting
Urine: Using High Dose Anticholinergics For Refractory Patients In Combination With Desmopressin For Nocturnal Enuresis
Pamela I Ellsworth, Jackie Pires, Aaron Berkenwald
UMassMemorial Medical Center/University of Massachusetts Medical School, Worcester, MA
Introduction: Desmopressin (DDAVP) is the most common pharmacologic therapy for nocturnal enuresis. Combination therapy, DDAVP plus fixed dose anticholinergic therapy improves symptoms in some patients who fail DDAVP monotherapy. We evaluated treatment response of high dose (advanced) anticholinergic plus DDAVP in prior DDAVP monotherapy failures.
Methods: An IRB approved retrospective review was performed of children treated from November 2013 through December 2014 with DDAVP monotherapy and combination therapy (DDAVP plus anticholinergic) with at least one visit after treatment initiation/change and who satisfied study inclusion/exclusion criteria. Factors evaluated included age, sex, BMI, history of alarm failure, ADD/ADHD, family history nocturnal enuresis, constipation, dysfunctional voiding, oaveractive bladder, treatment with psychotropics, postvoid residual.
Results:
Of the 63 patients, 36 (57%) responded to monotherapy DDAVP. 25/27 nonresponders received combination therapy, 68% responding to low dose combination therapy DDAVP + Oxybutynin 5mg. Of the 8 low dose combination therapy nonresponders , 6 (75%) responded to combination therapy of DDAVP + Oxybutynin (7.5-10mg).
Discussion: Titrating the dose of oxybutynin (5-10mg) in DDAVP monotherapy nonresponders allowed for 92% to become dry at night. Failure of prior alarm therapy was more common in all nonresponders, whereas coexistent ADHD, dysfunctional voiding and OAB were more common in monotherapy nonresponders. Males were more likely to require high-dose combination therapy than females.
Results| Therapy (number treated) | Age years (ave) | Sex M/F | BMI (ave) | Alarm | ADD/ADHD | Fam Hx | Constipation | Dysfunctional voiding | OAB | | Monotherapy responder (36) | 11.9 | 61.1%/38.9% | 22.3 | 11.1% | 16.7% | 30.6% | 36.1% | 19.4% | 0% | | Monotherapy nonresponders (27) | 11.2 | 63%/37% | 21.3 | 25.9% | 40.7% | 18.5% | 33.3% | 48.2% | 29.6% | | | | | | | | | | | | Low dose combination therapy responders (17) | 11.2 | 47.1%/52.9% | 21.1 | 0% | 41.2% | 23.5% | 35.3% | 47.1% | 23.5% | | Low dose combination therapy nonresponders (8) | 11.3 | 87.5%/12.5% | 21.9 | 75% | 37.5% | 12.5% | 25% | 50% | 37.5% | | | | | | | | | | | | High dose combination therapy responders (6) | 10.8 | 83.3%/16.7% | 21.2 | 66.7% | 50% | 0% | 33.3% | 50% | 33.3% | | High dose combination therapy nonresponders (2) | 12.5 | 100% | 24.2 | 100% | 0% | 50% | 0% | 50% | 50% |
Back to 2015 Joint Annual Meeting
|
