Low-dose desmopressin in the treatment of nocturnal urinary incontinence in the exstrophy-epispadias complex

Objective To report our experience of the use of desmopressin to improve no cturnal dryness in patients who have undergone a staged reconstruction of t he exstrophy-epispadias complex (EEC), who although continent by day, have nocturnal incontinence because their nocturnal urinary output exceeds their bladder capacity. Patients and methods Seven children (aged 8-12 years) who had undergone a s taged reconstruction for EEC (six with classical bladder exstrophy, one wit h incontinent epispadias) were treated with intranasal desmopressin for per sistent nocturnal incontinence despite daytime dryness. Previous additional procedures far continence had been self-augmentation in one and periurethr al collagen injection in three others. The criteria for inclusion in the st udy were: normal renal function, no upper tract deterioration, no urinary t ract infections, spontaneous voiding during the day with dry intervals betw een micturitions, a postvoid residual volume of <10% of bladder capacity an d night-time incontinence for 7 nights/week. Desmopressin was administered at bedtime at increasing dosages from 10 to 30 mu g until effective. Body w eight, arterial blood pressure, and serum electrolytes were measured, and a ll patients assessed using renal ultrasonography, a voiding diary and a noc turnal pad-test. Results Desmopressin at doses of 10-30 mu g was successful in keeping all t he patients dry. The nocturnal urinary output was decreased so that it did not exceed bladder capacity. There was only one minor side-effect (nose ble eding). Conclusions In selected patients with EEC, desmopressin is effective in imp roving nocturnal dryness, with no significant side-effects.