DESMOPRESSIN IN THE TREATMENT OF SEVERE NOCTURNAL ENURESIS IN ADOLESCENTS - A 7-YEAR FOLLOW-UP-STUDY

Objectives To evaluate the role of long-term oral desmopressin (over a 7-year follow-up) in refractory enuretics, particularly in assessing the potential curative effect, and to analyse the results for specific types of patient to obtain clues about possible mechanisms of cure, P atients and methods The effect of oral desmopressin was investigated i n 25 adolescents (aged 11-21 years) with severe monosymptomatic noctur nal enuresis. The long-term study consisted of two 12-week treatment p eriods, with the efficacy of the drug assessed as the reduction in the number of wet nights per week, Subsequently, the patients were follow ed-up for up to 7 years. Close contact was maintained with the familie s over this period ('good doctoring' approach), At approximate to 3-, 5- and 7-year intervals after completing the study, patients were asse ssed for dryness, frequency, treatment and sleeping habits, using post al questionnaires and telephone follow-up. Results At the end of the l ong-term study, 35% of the patients remained dry without therapy. With in 2 years of ending treatment, 15 patients were dry, compared with an expected estimate of six by spontaneous resolution, and after 7 years , 19 patients were cured. Nocturia occurred in 75% of the enuretic pat ients but in only 5% of the healthy controls. Conclusions Active treat ment of primary nocturnal enuresis with oral desmopressin has a clinic ally significant effect on the cure rate, which is maintained after ce asing therapy. The cure rate was higher than would be expected from sp ontaneous recovery alone during the first 2 years of the study and the re was a significant further increase in the cure rate 7 years after e nding therapy, again greater than the expected spontaneous cure rate, There also seemed to be a better response to treatment when it was pro longed. Furthermore, this therapy is safe when administered in the lon g-term.