Desmopressin treatment: Current status

Desmopressin has a proven pharmacological effect in most enuretic patients, although a clinical response is not seen in all patients. Numerous questio ns about the current treatment status of desmopressin include the specific anti-enuretic effect of desmopressin, the effect of desmopressin on sleep a nd the use of desmopressin as a possible cure for enuresis. The Swedish Enu resis Trial has produced some very positive results on the long-term use of desmopressin, showing a 61% response rate (> 50% reduction in wet nights). Desmopressin has proven to be highly effective when used in combination wi th other treatments, including the alarm and oxybutinin, and after urothera py. It is suggested that imipramine should not be used to treat enuresis un less the patient has attention deficit hyperactivity disorder. Bladder inst ability is also an important factor to consider when selecting treatment fo r enuresis. Bladder dysfunction (detrusor overactivity) can be the cause of lack of clinical response to either desmopressin or alarm treatment; in su ch cases, following a cystometrogram, patients should be treated with detru sor-relaxing drugs, and urotherapy should be considered as the first treatm ent option. The most effective treatment for enuresis is the treatment chos en by the patient and their families. Desmopressin and urotherapy have had promising results, with desmopressin acting as a bridge until spontaneous o r treatment-induced remission occurs.