ENURESIS AND DESMOPRESSIN: WHY SHOULD WE USE IT?

Key words: Enuresis, Desmopressin, Hypercalciuria, Bladder training

WHY SHOULD WE USE IT?
The Author underlines that disturbances in three different areas (sleeping quality, bladder maturity and diuresis control) concur to the the pathogenesis of enuresis.Therefore the case management should take all of them into account. A diary of micturition, a study of quantity and quality of nocturnal urine, and a dosage of nocturnal adiuretine provide the guide for individualised management. Patients with prevalence of bladder instability (85% out of 173 children in the Author’s series) will respond better to behavioural treatment and bladder training, those woth nocturnal polyuria and hypoosmolar urines will be better managed with desmopressin. Patients with hypercalciuria and abnormal sodium reabsorption are more difficult to manage and should never be given desmopressin. WHY SHOULD WE NOT USE IT
The Author describes a series of 111 enuretic patients. 98% of them were polysymptomatic and showed signs of bladder instability. 31% suffered from behavioural stipsis as well. The management of enuresis can be symptomatic (desmopressin) behavioural (alarm), or cognitive (explanation of the mechanism of micturition and guided acquisition of control). The cognitive approach allowed the Author to obtain 63% of permanent remission of enuresis within 4 months from the beginning of treatment.