Korean J Urol.
2005 Sep;46(9):909-913.
The Effect of Long-term Use and Tapered Dose Reduction to the Relapse Rate of Enuresis in Children with Primary Nocturnal Enuresis
- Affiliations
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- 1Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. kskim2@amc.seoul.kr
- 2Department of Urology, Ulsan University Hospital, Ulsan, Korea.
Abstract
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PURPOSE: Pharmacotherapy is the mainstay in the treatment of patients with primary nocturnal enuresis. However, as effective as it may be, the high relapse rate after the discontinuation of medicine remains difficult to overcome. Modulation of the duration or discontinuation method of medication was investigated to see if this could reduce the relapse rate.
MATERIALS AND METHODS
Between May 1998 and December 2003, 87 boys and 46 girls (mean age 7.8, range 5-15 year-old) were included in this study. The criteria for inclusion were the enuresis had to be primary and uncomplicated, showing a good and early response to pharmacotherapy, resulting in 90% dry nights within 1 month from the beginning of medication. Patients were treated with desmopressin only and followed up for at least 3 months after discontinuation of medicine. Patients were divided into 4 groups, 3 month medication, 3 month medication with tapered dose reduction, 6 month medication and 6 month medication with tapered dose reduction group. Medication was tapered by reducing the dosage by half every 2 weeks, within a maximum of 2 months. Relapse was defined as the occurrence of more than 4 episodes of enuresis per month. There were no differences in age, sex, frequencies of enuresis before and after the medication between the four groups.
RESULTS
The relapse rate was 54.4% in patients with primary nocturnal enuresis. The rates for relapse were 75.9 and 46.3% in patients with 3 and 6 months of medication, respectively (p<0.001). With respect to the method for reducing the medication dosage, there was a significant difference in the relapse rate between the sudden stop and tapered dose groups, which were 71.3 and 46.2%, respectively (p=0.006). However, there were no significant differences in the relapse rates with respect to the methods for reducing the medication for the same period.
CONCLUSIONS
Gradual dosage reduction for the discontinuation of medicine has a beneficial effect in reducing the relapse rate. For best results, long-term medication with a tapered dose reduction is recommended.
