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Cai T, Yao Y, Sun W, Lei P. Desmopressin in combination with anticholinergic agents in the treatment of nocturnal enuresis: a systematic review and meta-analysis. Front Pediatr 2023; 11:1242777. [PMID: 37928358 PMCID: PMC10620680 DOI: 10.3389/fped.2023.1242777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023] Open
Abstract
Background The desmopressin combined with anticholinergic agents for the treatment of nocturnal enuresis (NE) remains controversial. This meta-analysis assesses the efficacy and safety of desmopressin compared with desmopressin plus anticholinergic agents for the treatment of NE. Methods We searched MEDLINE, Embase, and Cochrane Controlled Trials Register databases for RCTs published for the treatment of NE. Systematic review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. This meta-analysis used RevMan v.5.1.0 to analyze data. Results Eight studies involving 600 patients (293 in the combination group and 307 in the desmopressin group) contained meaningful data. The results were as follows: after one month of treatment, compared with the desmopressin monotherapy group, the combination group was significantly better in treating NE in FR (full responders, P = 0.003), FR + PR (partial responders) (P < 0.0001), and the mean number of wet nights (P = 0.004); also, the combination group had a better effect in FR (P < 0.00001), FR + PR (P = 0.02) and the mean number of wet nights (P = 0.04) after 3 months' treatment. For side effects, combination therapy does not cause more adverse events in treating NE (P = 0.42). Conclusions This study elucidates that desmopressin combined with the anticholinergic agent was demonstrated to be more effective in treating NE than desmopressin monotherapy, and the anticholinergic agent does not increase the risk of adverse events (AEs).
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Affiliation(s)
- Tong Cai
- Department of Urology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Yi Yao
- Department of Paediatrics, Yantai Yuhuangding Hospital, Yantai, China
| | - Weigui Sun
- Department of Urology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Peipei Lei
- Department of Endocrinology, Yantai Yuhuangding Hospital, Yantai, China
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Alqannad EM, Alharbi AS, Almansour RA, Alghamdi MS. Alarm Therapy in the Treatment of Enuresis in Children: Types and Efficacy Review. Cureus 2021; 13:e17358. [PMID: 34567898 PMCID: PMC8453315 DOI: 10.7759/cureus.17358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 11/17/2022] Open
Abstract
Enuresis is defined as bedwetting in children aged five years and older when organic reasons have been ruled out. It can result in substantial psychological repercussions and uncomfortable circumstances for both the child and the family. Medical (desmopressin, tricyclic antidepressants [TCAs]) and behavioral treatment are the basis for the treatment of enuresis. Alarm therapy is considered the first treatment modality of choice for enuresis with almost 50% cure rates are in the long term. Cooperation and compliance from parents and children are the cornerstones of the effectiveness of alarm therapy. Multiple factors, such as technical issues, might slow down the therapeutic response time. The objective of this study is to review the role of alarm therapy in the treatment of enuresis, its types, and its efficacy and to explore the factors that may increase or decrease its efficacy.
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Ghanavati PM, Khazaeli D, Amjadzadeh M. A comparison of the efficacy and tolerability of treating primary nocturnal enuresis with Solifenacin Plus Desmopressin, Tolterodine Plus Desmopressin, and Desmopressin alone: a randomized controlled clinical trial. Int Braz J Urol 2021; 47:73-81. [PMID: 32840337 PMCID: PMC7712704 DOI: 10.1590/s1677-5538.ibju.2019.0448] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/08/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Nocturnal enuresis (enuresis) is one of the most common developmental problems of childhood, which has often a familial basis, causes mental and psychological damage to the child and disrupts family solace. OBJECTIVES In this study, we compared therapeutic efficacy and tolerability of treating primary nocturnal enuresis (PNE) with solifenacin plus desmopressin, tolterodine plus desmopressin, and desmopressin alone. Because we don't have enough information about this comparison especially about solifenacin plus desmopressin. PATIENTS AND METHODS This clinical trial study was performed on 62 patients with enuresis aged 5-15 years who referred to the urology clinic of Imam Khomeini Hospital in Ahwaz in 2017-2018. Patients were randomly assigned to one of the three different therapeutic protocols and any participants were given a specific code. After that, we compared the therapeutic response and the level of satisfaction of each therapeutic group in different months. Data were analyzed using SPSS 22 software and descriptive and analytical statistics. RESULTS The mean age of patients was 8.70±66 years. In the therapeutic group with desmopressin and solifenacin, 19 of 20 patients (95%) achieved complete remission (1) after a 3-month treatment in comparison with monotherapy group in which 14 of 22 patients (63.63%) achieved complete remission; and in the combination therapy group of desmopressin and tolterodine, in the study and the evaluation of the consequences of 3-month treatment of this group, it was found that 17 of 20 patients (85%) had complete remission. Overall, the therapeutic response in combination therapy groups of desmopressin plus anticholinergic was higher than the monotherapy group of desmopressin alone. CONCLUSION Our results demonstrate that the combination of desmopressin and an anticholinergic agent is highly effective in treatment of children with PMNE. Although desmopressin has long been a first - line treatment for PMNE, desmopressin monotherapy often fails to achieve a successful response in patients with PMNE.
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Affiliation(s)
| | - Dinyar Khazaeli
- Ahvaz Jundishapur UniversityTehranIranAhvaz Jundishapur University, Ahvaz, Khuzestan, Iran, Tehran, Republic of Islamic
| | - Mohammadreza Amjadzadeh
- Ahvaz Jundishapur UniversityTehranIranAhvaz Jundishapur University, Ahvaz, Khuzestan, Iran, Tehran, Republic of Islamic
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Middleton T, Ellsworth P. Pharmacologic therapies for the management of non-neurogenic urinary incontinence in children. Expert Opin Pharmacother 2019; 20:2335-2352. [PMID: 31644331 DOI: 10.1080/14656566.2019.1674282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Introduction: Non-neurogenic urinary incontinence in children is a common condition that affects the quality of life for both patients and parents. Symptoms may occur in the daytime, nighttime, or both and may be the result of structural and functional anomalies. Evaluation and management of associated co-morbidities, such as constipation is critical to management. Behavioral therapy is a fist line therapy in most cases of non-neurogenic urinary incontinence and pharmacologic therapy a second-line therapy.Areas covered: In this review, the authors cover the pharmacologic agents, FDA approved and commonly used non-FDA approved, available for the treatment of four non-structural etiologies of non-neurogenic urinary incontinence in children. These include nocturnal enuresis, overactive bladder, giggle incontinence, and dysfunctional voiding.Expert opinion: Non-neurogenic causes of urinary incontinence in children represent a complicated medical condition that requires both pharmacologic and non-pharmacologic management. Limited FDA-approved therapies as well as suboptimal results with approved therapies due to a lack in the understanding of the underlying pathophysiology and patient selection may lead to the use of alternative non-FDA approved therapies.
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Affiliation(s)
- Tiernan Middleton
- Class of 2020, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Pamela Ellsworth
- Pediatric Urology, Nemours Children's Hospital, Orlando, FL, USA.,Urology, Central Florida College of Medicine, Orlando, FL, USA
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Cui H, Yu W, Yan H, Zhou Z, Wu J, Cui Y. The efficacy of electrical stimulation in treating children with nocturnal enuresis: A systematic review and meta-analysis. Neurourol Urodyn 2019; 38:2288-2295. [PMID: 31397008 DOI: 10.1002/nau.24136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/20/2019] [Indexed: 11/05/2022]
Abstract
AIM We performed a systematic review and meta-analysis to evaluate the efficacy of electrical stimulation (ES) in treating children with nocturnal enuresis (NE). METHODS Randomized controlled trials (RCTs) of the use of ES for the treatment of NE in children were searched using EMBASE, MEDLINE, and the Cochrane Controlled Trials Register. The references of related articles were also searched. The systematic review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. RESULTS Four RCTs involving 171 patients were studied. We found that there was statistically significant difference in the wet nights per week (mean difference [MD], -0.70; 95% confidence interval [CI], -0.89 to -0.51; P < .00001), the number of patients with clinical response (MD, 26.88; 95% CI, 11.16 to 64.74; P < .00001), and bladder capacity (MD, -0.70; 95% CI -0.89 to -0.51; P < .00001) in the ES group compared with the placebo group with the exception of maximum voided volume (MVV) (MD, 19.48; 95% CI, -9.18 to 48.14; P = .18). CONCLUSIONS The study provides a significant improvement in statistics in the wet nights per week, the number of patients with clinical response and bladder capacity for children with NE compared with the placebo group with the exception of MVV.
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Affiliation(s)
- Huanqin Cui
- Department of Pediatrics, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Wentao Yu
- Department of Pediatrics, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China.,Department of General Surgery, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Huilei Yan
- Department of Urology, Liaocheng People's Hospital, Liaocheng, China
| | - Zhongbao Zhou
- Department of Urology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Jitao Wu
- Department of Urology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Yuanshan Cui
- Department of Urology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
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Trajanovska M, King S, Goldfeld S, Gibb S. A novel method of rapid appraisal of clinical practice guidelines for children with enuresis. J Pediatr Urol 2019; 15:333.e1-333.e9. [PMID: 31217085 DOI: 10.1016/j.jpurol.2019.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 05/16/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Enuresis (bedwetting) is a common but variably managed pediatric condition. Despite an abundance of published documents which provide recommendations for clinical evaluation and management of enuresis, no formal appraisal of their methodological quality has been undertaken. OBJECTIVE The objective of the study is to evaluate the quality of current pediatric guidelines for enuresis (bedwetting) using a novel method of appraisal. STUDY DESIGN A comprehensive gray literature search was undertaken to identify guideline documents that provided recommendations for management of enuresis in children and adolescents. The search strategy included guideline databases, targeted websites, Google search engines, and MEDLINE. Guideline documents included clinical practice guidelines, consensus documents, position statements, and other clinical review documents. Each document underwent basic appraisal by two independent assessors using the International Centre for Allied Health Evidence (iCAHE) Guideline Quality Checklist. Those documents which (1) had an iCAHE quality score of ≥10; (2) used a systematic search strategy; and (3) linked evidence to their recommendations underwent further detailed appraisal using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. RESULTS Eighteen documents were shortlisted for basic appraisal. The iCAHE highlighted a lack of information regarding underlying evidence and dates (mean score 36% and 41%, respectively). Only three documents met basic quality criteria and progressed to detailed appraisal using the AGREE II. These included guidelines produced by the Paediatric Society of New Zealand and National Clinical Guideline Centre and a position statement from the Canadian Paediatric Society. All three guidelines presented clear and unambiguous recommendations (mean score 80%). However, information regarding stakeholder involvement was lacking (mean score 50%). CONCLUSIONS Several guidelines exist for the evaluation and management of children with enuresis, but many lack appropriate methodological quality standards. The guideline produced by the National Clinical Guideline Centre achieved the highest quality rating and is recommended for future adaptation and implementation in relevant clinical settings.
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Affiliation(s)
- M Trajanovska
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia 3052
| | - S King
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, 3052, Australia; Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, 3052, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, 3052, Australia
| | - S Goldfeld
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia 3052; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, 3052, Australia; Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, 3052, Australia
| | - S Gibb
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, 3052, Australia; Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, 3052, Australia.
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Girisgen I, Avcı E, Yüksel S. Assessment of serum levels of copeptin and corticotropin-releasing factor in children with monosymptomatic and non-monosymptomatic nocturnal enuresis. J Pediatr Urol 2019; 15:393-398. [PMID: 31256952 DOI: 10.1016/j.jpurol.2019.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/14/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nocturnal enuresis is defined as bed-wetting in children from the age of five years that occurs during sleep; if untreated, the condition can result in social and psychological problems both for the children and their parents. Nocturnal enuresis is a complicated disease that includes multiple pathogenetic factors. Nocturnal enuresis is divided into two subgroups: monosymptomatic and non-monosymptomatic. The role of some biomarkers in patients with monosymptomatic enuresis has been reported in a small number of the studies. OBJECTIVE The aim of this research was to evaluate the serum levels of copeptin and corticotropin-releasing factor (CRF) in monosymptomatic and non-monosymptomatic nocturnal enuresis cases. Although these markers were previously examined in children with monosymptomatic enuresis, there is no study that has evaluated these markers in non-monosymptomatic children. STUDY DESIGN One hundred nineteen children with nocturnal enuresis (5-16 years) and forty healthy children (5-17 years) were enrolled to the study. Of the nocturnal enuresis group, forty-nine were monosymptomatic and seventy were non-monosymptomatic. Copeptin and CRF were measured by a competitive inhibition method with enzyme-linked immunosorbent assay. RESULTS The serum copeptin levels were significantly lower in children with monosymptomatic and non-monosymptomatic nocturnal enuresis than in the controls.(median, 34.7 [interquartile range (IQR): 34 pg/ml], 39.8 [IQR: 29 pg/ml] vs 52.1 [IQR: 14 pg/ml], respectively, P < 0.05). The serum CRF levels were significantly lower in children with monosymptomatic and non-monosymptomatic nocturnal enuresis than in the controls (median, 35.1 [IQR: 19 pg/ml], 34.05 [IQR: 24 pg/ml] vs 78.3 [IQR: 39 pg/ml], respectively, P < 0.05). There was no significant difference in copeptin and CRF levels between the children with monosymptomatic and non-monosymptomatic nocturnal enuresis. DISCUSSION Copeptin is presumed to be a sensitive surrogate biomarker for arginine vasopressin release. To date, there are only two studies in the literature that assess the relationship between copeptin and monosymptomatic enuresis. The only study in the literature demonstrated significantly decreased levels of CRF in monosymptomatic enuretic children. It was demonstrated that the levels of copeptin and CRF differ in both children with monosymptomatic and non-monosymptomatic nocturnal enuresis from the control groups. It was also demonstrated that copeptin and CRF levels were not different between the children in monosymptomatic and non-monosymptomatic groups. CONCLUSION Those changes in both copeptin and CRF which were shown in this study in monosymptomatic and non-monosymptomatic enuretic children may contribute to the pathogenesis of nocturnal enuresis. Further case-control studies can evaluate the copeptin and CRF levels before treatments in monosymptomatic and non-monosymptomatic patients to decide potential effectiveness of treatment.
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Affiliation(s)
- I Girisgen
- Pamukkale University School of Medicine, Department of Pediatric Nephrology, Denizli, Turkey
| | - E Avcı
- Pamukkale University School of Medicine, Department of Biochemistry, Denizli, Turkey
| | - S Yüksel
- Pamukkale University School of Medicine, Department of Pediatric Nephrology, Denizli, Turkey.
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Song P, Huang C, Wang Y, Wang Q, Zhu W, Yue Y, Wang W, Feng J, He X, Cui L, Wan T, Wen J. Comparison of desmopressin, alarm, desmopressin plus alarm, and desmopressin plus anticholinergic agents in the management of paediatric monosymptomatic nocturnal enuresis: a network meta-analysis. BJU Int 2018; 123:388-400. [PMID: 30216627 DOI: 10.1111/bju.14539] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess the efficacy of desmopressin, alarm, desmopressin plus alarm, and desmopressin plus anticholinergic agent (AA) therapy in the management of paediatric monosymptomatic nocturnal enuresis (MNE) using a network meta-analysis. MATERIALS AND METHODS We searched the electronic databases PubMed, Cochrane Library, EMBASE and Web of Science from inception to 1 March 2018. Randomized controlled trials (RCTs) that compared desmopressin, alarm, desmopressin plus alarm, and desmopressin plus AAs were identified. The network meta-analysis was conducted with software R 3.3.2 and STATA 14.0. RESULTS Eighteen RCTs with a total of 1 649 participants were included. The meta-analysis results showed that complete response (CR) and success rates with desmopressin plus AAs were higher than with desmopressin or alarm monotherapy. Success rates for desmopressin plus alarm therapy were higher than for alarm monotherapy. No obvious difference was observed between desmopressin plus AAs and desmopressin plus alarm therapy with regard to CR rate and success rate. The relapse rate with alarm monotherapy was much lower than with desmopressin monotherapy. Adverse events seemed to be infrequently and tolerable for all treatments. The ranking probability results were as follows: desmopressin plus AA ranked first for the outcomes of CR and success, desmopressin plus alarm therapy ranked first for mean number of wet nights per week, and alarm therapy had the lowest relapse rate. CONCLUSIONS The network meta-analysis showed that desmopressin had similar efficacy to alarm therapy but a higher relapse rate. Desmopressin plus AA therapy was associated with better efficacy than and a similar relapse rate to desmopressin monotherapy. Desmopressin plus alarm therapy was similar to both desmopressin and alarm monotherapy in efficacy. All treatments, including desmopressin plus AAwere associated with tolerable adverse events; however, additional high-quality studies are needed for further evaluation of these treatments.
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Affiliation(s)
- Pan Song
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Chuiguo Huang
- Department of Urology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yan Wang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Qingwei Wang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Wen Zhu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yiwei Yue
- College of Clinical Medicine, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Wancong Wang
- Department of Digest, The fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jinjin Feng
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xiangfei He
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Lingang Cui
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Tingxiang Wan
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jianguo Wen
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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Abstract
Enuresis is a frequent complaint not always volunteered by parents or patients. The pediatric clinician has to inquire about enuresis to break the secrecy surrounding this symptom that could be related to a more serious underlying renal, endocrine, or psychosocial disease. Determining the type of enuresis is crucial to offer optimal treatment. We present a review for the pediatric clinician to optimize their care of the child with monosymptomatic enuresis. [Pediatr Ann. 2018;47(10):e390-e395.].
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Yu J, Yan Z, Zhou S, Han F, Xiao F, Han J, Sun C. Desmopressin plus anticholinergic agent in the treatment of nocturnal enuresis: A meta-analysis. Exp Ther Med 2017; 14:2875-2884. [PMID: 28966673 PMCID: PMC5613195 DOI: 10.3892/etm.2017.4897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 05/05/2017] [Indexed: 01/03/2023] Open
Abstract
The present study aimed to evaluate the clinical efficacy and safety of combination therapy comprising desmopressin plus anticholinergic agent compared with desmopressin alone for children with nocturnal enuresis (NE). A meta-analysis of 8 eligible studies was performed to analyze the effects of desmopressin plus anticholinergic agent combination therapy and desmopressin monotherapy in the treatment of NE in children. The overall odds ratio (OR) or standardized mean difference (SMD) and 95% confidence interval were calculated for full responders (FR), partial responders (PR), non-responders (NR), the change in the mean number of wet nights and adverse events. Following 1 month of treatment, efficacy analysis yielded an OR of 3.736, which suggested that the proportion of FR for patients treated with the combination therapy was higher than that for patients treated with monotherapy. Analysis of the change in the mean number of wet nights yielded an SMD of 0.719, which indicated that the change in the mean number of wet nights in the patients treated with combination therapy was greater than that in the patients treated with monotherapy. Following 3 months of treatment, the OR calculated for FR plus PR compared with NR was 2.857, indicating that the proportion of FR and PR was elevated by the combination therapy compared with desmopressin alone. The OR for adverse events was 4.074, which suggested that the combination therapy did not lead to more adverse events in the treatment of NE. Therefore, the present meta-analysis suggests that, compared with desmopressin monotherapy, a combination therapy comprising desmopressin and anticholinergic agent is more effective with equivalent safety for children with NE.
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Affiliation(s)
- Jianyong Yu
- Department of Pediatrics, Traditional Chinese Medicine Hospital of Yantai, Yantai, Shandong 264001, P.R. China
| | - Zhaojun Yan
- Department of Pediatrics, Traditional Chinese Medicine Hospital of Shandong, Jinan, Shandong 250011, P.R. China
| | - Shiying Zhou
- Department of Pediatrics, Qilu Hospital of Shandong University, Qingdao, Shandong 266035, P.R. China
| | - Feng Han
- Department of Pediatrics, Traditional Chinese Medicine Hospital of Yantai, Yantai, Shandong 264001, P.R. China
| | - Feng Xiao
- Department of Pediatrics, Traditional Chinese Medicine Hospital of Yantai, Yantai, Shandong 264001, P.R. China
| | - Jian Han
- Department of Pediatrics, Yantaishan Hospital of Yantai, Yantai, Shandong 264001, P.R. China
| | - Congling Sun
- Department of Pediatrics, Traditional Chinese Medicine Hospital of Yantai, Yantai, Shandong 264001, P.R. China
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Immediate 1-month efficacy of desmopressin and anticholinergic combination therapy versus desmopressin monotherapy in the treatment of pediatric enuresis: A meta-analysis. J Pediatr Urol 2016; 12:156.e1-9. [PMID: 26922714 DOI: 10.1016/j.jpurol.2015.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Several studies have proposed the combination of desmopressin and anticholinergic as a treatment regimen to address the pathophysiology of polyuria and bladder dysfunction in pediatric enuresis. However, the available literature is inconsistent with regards to the immediate 1-month efficiency of the combination therapy in the treatment for pediatric enuresis. OBJECTIVE The aim was to assess the immediate 1-month efficacy and safety of desmopressin and anticholinergic agent combination therapy versus desmopressin monotherapy in the treatment of pediatric enuresis using meta-analysis of randomized controlled trials (RCTs). STUDY DESIGN Systematic literature acquisition was carried out on electronic medical databases up to April 2015. RCTs relevant to the topic were critically appraised. Dichotomous data of the 1-month post-treatment response rate (defined as ≥90% reduction of wet nights) were extracted for calculation of the risk ratio (RR) and 95% confidence interval (CI). The Mantel-Haenszel method with the random effects model was used to pool effect estimates. Inter-study heterogeneity and publication bias were assessed. Subgroup analysis was done for the desmopressin treatment-naive versus treatment-resistant groups: PROSPERO (CRD42015017922). RESULTS Four RCTs of good methodological quality without heterogeneity were included for meta-analysis. The pooled effect estimates showed that combination therapy was associated with a significantly better immediate 1-month response rate than desmopressin monotherapy. Subgroup analysis showed a greater immediate 1-month response rate among desmopressin-resistant patients than treatment-naive patients. No severe adverse events were noted among combination therapy treated groups. DISCUSSION The limitation of the current meta-analyses is the small sample size, albeit with high-quality studies pooled for effect estimation. Despite the limitation, the study results were able to consistently illustrate a large treatment effect of combination therapy among desmopressin treatment-resistant patients. It was consistent with the literature review of retrospective and non-comparative studies by Alloussi et al. (2011), who summarized a similar impressive treatment outcome. However, due to the low level of evidence available at the time of their study, only a grade B-C recommendation was given to combination therapy as an approach for second-line treatment. This study also summarized that combination therapy was well tolerated and similar to desmopressin monotherapy. CONCLUSION This study was able to summarize the immediate 1-month efficacy of combination therapy compared with desmopressin monotherapy in the treatment of pediatric enuresis. For both treatment-naive and desmopressin-resistant pediatric enuresis, combination therapy of desmopressin with an anticholinergic agent is well tolerated and resulted in a significantly better immediate 1-month response rate than desmopressin monotherapy.
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Abstract
Enuresis is a common pediatric problem that creates a lot of stress for both the child and his/her family. Unfortunately, many of these patients do not seek medical attention for evaluation and treatment. It is important in the care of the child with enuresis to understand the definitions of the disorder, routinely ask about bowel and bladder habits, clarify the nature of the wetting (daytime, nighttime, or both) in the child, and perform a thorough history and physical examination. Laboratory studies are often minimal. Treatment (behavioral or medicinal) is dependent on the type of enuresis present, and patient compliance. Successful management of enuresis has benefits to both the child and family.
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