MP70-01: Management of the Refractory Nocturnal Enuresis Patient to Desmopressin in a Pediatric Population: Desmopressin + Oxybutynin vs. Desmopressin + Imipramine
Introduction: Desmopressin (DDAVP) is well accepted as first-line medical therapy for nocturnal enuresis (NE). If DDAVP is ineffective, combination therapy of DDAVP + oxybutynin (Oxy) or DDAVP + imipramine (Imp) has been used. This study assessed the efficacy of adjunct therapy with either Imp or Oxy in the management of NE patients who failed DDAVP treatment. Methods: A retrospective chart review of our database for patients with NE was performed. All patients who were prescribed DDAVP, Oxy, and Imp over 14 years for NE were included. Two cohorts of patients were examined; group A was treated with DDAVP and Oxy, and group B was treated with DDAVP and Imp. Pretreatment measurement of Vancouver Symptom Score (VSS) was used to compare groups as well as the VSS question “I wet my bed at night” with 4: I wet my bed every night, 3: 4-5 nights per week, 2: 1-2 nights per week, 1: 3-4 nights per month, and 0: never. ICCS criteria for continence success was utilized to determine outcomes. Statistical analysis was performed with SPSS. Results: 2521 patients were identified who were prescribed one of the 3 medications. 72 patients with a mean age of 9.8 ± 2.8 years were identified, of which 48 were male and 24 female. Of these patients, 58 were prescribed both DDAVP and Imp (group B), 23 DDAVP and Oxy (group A), and 9 transitioned from group A to group B. Mean pretreatment VSS showed no difference between the groups. Both groups had minimal drops in wet nights with DDAVP alone. When comparing groups, it was found that group B reduced wet nights significantly more than group A (VSS wet night score 0.7 vs 2.3 respectively). Complete response rate was 68% vs 5% (OR= 42.5, p < 0.001) (Imp vs Oxy respectively). Conclusions: A combination of DDAVP and Imp was more effective in reducing wet nights and had a complete response rate that was 42.5 times greater than DDAVP and oxybutynin. SOURCE OF Funding: None.
