DESMOPRESSIN VERSUS INDOMETHACIN TREATMENT IN PRIMARY NOCTURNAL ENURESIS AND THE ROLE OF PROSTAGLANDINS

Objectives. To compare the efficacy of desmopressin and indomethacin a nd also determine the prostaglandin E-2 (PGE(2)) concentrations in the patient and control groups. Methods. Eighty-five children with primar y nocturnal enuresis were followed up for a baseline period of 4 weeks , during which they recorded wet and dry nights. After this period, th e patients were divided into three groups that used desmopressin, Indo methacin, or placebo for 4 weeks. The dosage of desmopressin (group A, n = 31) was 20 mu g/day and the dosage of indomethacin (group B, n = 29) was 100 mg/day. The placebo group (group C) consisted of 25 patien ts. We determined the serum PGE(2) and urine PGE(2) concentrations bef ore and after treatment in the three groups and in a control group. Re sults. Treatment with desmopressin and indomethacin resulted in signif icantly more dry nights during the 4 weeks of observation than did pla cebo (P <0.005). The number of dry nights was also significantly diffe rent in the desmopressin group than in the indomethacin group (P <0.01 ). In the total patient group, the mean serum and urine PGE, concentra tions were significantly different from the control group's serum and urine PGE, concentrations (P < 0.001). There was a significant decreas e in the serum and urine PGE(2) concentrations in group A and group B after the treatment period (P < 0.01). Conclusions. Desmopressin and i ndomethacin were found to be more effective than placebo. We conclude that prostaglandins have an important role in the pathophysiology of p rimary nocturnal enuresis. (C) 1998, Elsevier Science Inc. All rights reserved.