Desmopressin treatment: current status

Abstract

Desmopressin has a proven pharmacological effect in most enuretic patients, although a clinical response is not seen in all patients. Numerous questions about the current treatment status of desmopressin include the specific anti-enuretic effect of desmopressin, the effect of desmopressin on sleep and the use of desmopressin as a possible cure for enuresis. The Swedish Enuresis 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 with other treatments, including the alarm and oxybutinin, and after urotherapy. It is suggested that imipramine should not be used to treat enuresis unless the patient has attention deficit hyperactivity disorder. Bladder instability is also an important factor to consider when selecting treatment for enuresis. Bladder dysfunction (detrusor overactivity) can be the cause of lack of clinical response to either desmopressin or alarm treatment; in such cases, following a cystometrogram, patients should be treated with detrusor-relaxing drugs, and urotherapy should be considered as the first treatment option. The most effective treatment for enuresis is the treatment chosen by the patient and their families. Desmopressin and urotherapy have had promising results, with desmopressin acting as a bridge until spontaneous or treatment-induced remission occurs.