DESMOPRESSIN FOR NOCTURNAL ENURESIS - URINARY OSMOLALITY AND RESPONSE

Objective To measure the effect, of intranasal desmopressin (1-deamino 8-D-arginine vasopressin, DDAVP) on urine osmolality in a group of pa tients with persistent: primary enuresis, and to determine whether cha nges in osmolality can the predict. response to treatment. Patients an d methods Thirty-seven patients with persistent primary nocturnal enur esis were entered into a double-blind placebo-controlled crossover tri al of 20 mu g intranasal DDAVP spray, Mooting urinary osmolality was m easured on two occasions during each phase of treatment and the clinic al response recorded in a diary. Results Thirty-one patients (22 males and nine females) were evaluable at the end of the trial period. A go od clinical response, defined as enuresis an two nights or fewer each week, occurred in 12 of 31 (39%) patients, but complete continence was attained in only two. The response was better in older patients and i n those with less frequent enuresis. The mean and peak urinary osmolal ity of the morning urine samples were higher while on treatment with D DAVP compared with placebo, but this difference was not statistically significant and the response did not predict a good clinical outcome i n improving the enuresis. Conclusions Treatment with DDAVP can produce a socially acceptable level of dryness in some patients with refracto ry nocturnal enuresis. However, the early morning urinary osmolality, as a reflection of changes in nocturnal osmolality, was not useful in distinguishing this group or in selecting those who will respond to tr eatment.