CURE OF NOCTURNAL ENURESIS - WHY ISNT DESMOPRESSIN VERY EFFECTIVE

Prospective controlled studies on the treatment of enuresis with desmo pressin (DDAVP) indicate that cure rates (complete dryness) while on t herapy are markedly lower than are response rates (decrease in wet nig hts). In an attempt to explain this discrepancy, we analyzed the etiol ogical mechanisms for enuresis and found evidence that most children a re not cured by DDAVP because their nocturnal wetting is not actually caused by the defect which DDAVP therapy aims to cure: low nocturnal v asopressin secretion with high nocturnal urinary output. Our study sug gested that an arrest in the normal development of two separate areas of the central nervous system is necessary for enuresis to occur in ma ny patients, yet cure of enuresis occurs if either developmental delay is eliminated. This hypothesis of a dual developmental delay helps to unify many diverse and often seemingly contradictory scientific obser vations about this condition and to explain why many patients react in consistently to treatment aimed at a single etiology, yet eventually b ecome dry.