Effects of Combined Drug Therapy in the Nocturnal Enuretic Patients

Jung, Jung Yun; Kim, Kwang Myung

Abstract

PURPOSE: Recently there have been arguments about the exact nature of pathophysiology of nocturnal enuresis. Desmopressin and imipramine have been used for drug therapy. Also oxybutynin chloride has been used to treat the children having nocturnal enuresis and diurnal voiding symptoms. Practically most nocturnal enuretic patients who visit outpatient clinic really want to quit their enuretic episode quickly and durably without side effect of drug therapy. We evaluated the effectiveness of combined drug therapy in the primary nocturnal enuretic patients who had 7 times episodes in a week. MATERIALS AND METHODS: In a total of 36 nocturnal enuretic patients(male:female=24:12) whose ages ranged from 4- to 12-year-old(mean; 7.9-year-old), we initially used two or three drugs among oxybutynin chloride(O) t.i.d., imipramine(I) h.s. and desmopressin(D) h.5. for the 24 patients who have urgency and/or daytime enuresis(DE): O+l for 8 patients, O+D for 4,1+D for 4 and 0+1+D for 8. For 12 monosymptomatic enuretic(ME) patients without having diurnal symptoms,0 h.s.+1 h.s.(in 5 patients) or 1 h.s.+D h.s.(in 7 patients) were used. Usual doses in a time are as follows: 2.5mg p.o. for 0,25mg p.o. for 1,20mg intranasally for D or 0.2mg p.o. for 8.
RESULTS
At the first follow-up visit(2 weeks later), 14 patients had up to 3 enuretic episodes in a 2 weeks period(judged as success) in the 24 DE patients. Among the successful patients, 2 used O+l, 2 used O+D, 4 used 1+D and 6 used 0+1+D at the start. In the 12 ME patients,5 had success. Four of the 5 successful patients had used 1+D. At the second visit(6 weeks later from the beginning), 16 patients who had not showed success at the first follow-up visit were analysed. Ten(6 DE and 4 ME) of the 16 patients became success. Five DE and 3 ME patients among the 10 successful patients had newly used D or increased D dose during the second period. Three patients (1+D in 1 DE,0+1+D in 1 DE and 1+D in 1 ME)who had showed success at 2 week visit became worse at 6-week visit after dose reduction in 1(12.5mg).
CONCLUSIONS
From the above data, we think that combined use of imipramine and desmopressin is effective for initial treatment in the enuretic patients regardless of diurnal symptom. To improve success rate, desmopressin dose needs to be increased.