Roberto Del Gado

Desmopressin and oxybutynin in monosymptomatic nocturnal enuresis: a randomized, double-blind, placebo-controlled trial and an assessment of predictive factors.

Study Type – Therapy (case series)

Height and weight in children with vesicoureteric reflux and renal scarring.

Height standard deviation scores (HSDS) and weight-for-height index (WHI) at diagnosis were evaluated in 156 children aged 2 months to 10.8 years (mean 3.7 years) with vesicoureteric reflux (VUR) and normal creatinine clearance, and in 156 age- and sex-matched healthy controls. Forty-three patients had bilateral VUR with scintigraphic signs of renal scarring (B SCAR+), 25 had bilateral VUR without renal scarring (B SCAR−); 40 had unilateral VUR with (U SCAR+) and 48 unilateral VUR without (U SCAR−) renal scarring. B SCAR+ patients had an average HSDS of −0.5±1.4 (SD) which was significantly (P=0.02) below that of controls (0.05±1 HSDS) and an average WHI of 100.6%±16% which was significantly (P=0.007) below that of controls (108%±12%); 14% of B SCAR+ patients had a height below −2 HSDS. B SCAR−, U SCAR+, and U SCAR− patients had heights near to O HSDS which was not different from that of controls, as well as WHI between 104% and 107.9%, which was not different from that of controls. HSDS and WHI were significantly (P=0.00001) correlated in patients but not in controls. B SCAR−, U SCAR+, and U SCAR− patients are similar to healthy controls in weight and in height growth and have, on average, some excess weight as do the latter. In contrast, B SCAR+ subjects have a significant decrease of the relative height and normal WHI.

Desmopressin is a safe drug for the treatment of enuresis.

Objective To verify the safety of desmopressin treatment and its associated side-effects in a large number of patients.Material and Methods The study was conducted in accordance with the guidelines of the Italian Club for Nocturnal Enuresis, whose criteria are: age >5 years; absence of malformations and infections of the urinary tract; absence of psychological disorders or neurological alterations; number of “wet nights” >5–7; control of liquid intake during the afternoon and evening; monitoring of serum electrolytes before beginning treatment; control of body weight before the beginning of treatment and during the first 4–5 days of therapy; and the informed consent of the parents. The therapeutic regimen provided for a maximum dose of desmopressin of 40 µg/day (four puffs/nostril or two tablets), starting from an initial dosage of 20 µg/day (two puffs/nostril or one tablet) 1 h before going to bed. The study involved two groups of patients with monosymptomatic enuresis: some of them had been administered desmopressin in the form of a spray and others in the form of tablets.Results A small percentage of patients presented mild, transient side-effects; in no case were severe side-effects verified.Conclusion Desmopressin is a safe drug with a low incidence of side-effects.

Ultrasonographic bladder measurements can replace urodynamic study for the diagnosis of non‐monosymptomatic nocturnal enuresis

Study Type – Diagnostic (exploratory cohort)
 Level of Evidence 2b

Correlations between enuresis in children and nocturia in mothers.

Abstract Objective. To demonstrate a relationship between enuresis and nocturia. Material and methods. The study investigated 250 mothers (average age 34.6 ± 3.3 years) whose children attended the Department of Pediatrics of the Second University of Naples because they suffered from enuresis. Data were collected by self-reported questionnaire and personal interview. All women provided written informed consent with guarantees of confidentiality. Both the presence of nocturia in adulthood and enuresis in childhood were taken into account. Results. The overall prevalence of nocturia was 38% (n = 95). There was a history of childhood bedwetting in eight mothers (5%) without nocturia and in 61 mothers (65%) with nocturia; the difference was significant (χ2 p < 0.01). Moreover, among the 110 enuretic children of nocturic mothers, 69 (62%) suffered from non-monosymptomatic nocturnal enuresis (NMNE), and 34 (56%) of their mothers suffered from NMNE in childhood. Nocturic mothers suffering from non-monosymptomatic enuresis during their childhood had offspring with a higher risk of developing non-monosymptomatic enuresis (odds ratio 4.3 95%, confidence interval 2.6–7.1, p < 0.01). Conclusions. These findings enabled a close connection between nocturia in adulthood and enuresis in childhood to be hypothesized. Furthermore, this analysis provided evidence of the link between suffering from nocturia, and previously from enuresis, and having children affected by enuresis.

Reduced response to hepatitis B virus vaccination in boys with steroid-sensitive nephrotic syndrome.

Vaccination against hepatitis B virus (HBV) was performed in 18 boys (aged 5.7±2.4 years) suffering from steroid-sensitive nephrotic syndrome (SSNS) and in a control group of 21 healthy boys (aged 5.6±3.8 years). The percentage of patients who responded to vaccination was significantly lower than the control group 1, 6, 8, 12, 18 and 24 months after the start of vaccination. The titre of antibodies to HBV surface antigen produced by responders at 6 and 24 months was significantly lower in patients than in the control group. Boys with SSNS have an impaired response to HBV vaccination.

Toll-free telephone medical information on nocturnal enuresis: the first Italian experience over a two-year period.

Purpose: The aim of the study is to promote, through this toll-free number (TFN) service, a health communication program providing information on nocturnal enuresis (NE) and related problems by a subspecialty-trained physician and to collect the callers’ characteristics too. All phone calls were scheduled to data collections. Methods: The telephone service operated as follows: the TFN was available from March 1 to May 31, 2000, and from April 1 to June 30, 2001. People called the free telephone line and received information needs. Results: A total of 12,806 calls were received by the help line during the two study periods (7,046 in 2000 and 5,760 in 2001). Of the calls, 61% came from subjects with NE without pharmacological or non-pharmacological treatment, 16% (2000) and 13% (2001) came from subjects >12 years old. Conclusions: A TFN for NE can be both accessible and effective in order to provide information on NE and related problems. Finally, such a service should be included in a national program to improve health and well-being.

Plasma Antidiuretic Hormone Levels in Children with Spina bifida

Purpose: Urological management of spina bifida patients is controversial. The goals of therapy of neurogenic bladder are continence, prevention of infections and preservation of urinary tract. Desmopressin has been recently used in a spina bifida population that is dry during the day (daytime continence was achieved with clean intermittent catheterization and anticholinergics) but wet at night. The aim of this study was to assess plasma antidiuretic hormone (ADH) levels in these children. Materials and Methods: The study included 24 patients, 11 males and 13 females (mean age 6.4 years) referred to the Spina Bifida Centre of the Catholic University of Rome, and 57 normal age-matched controls. Morning (07.30–08.00 h) plasma ADH levels were measured using a specific radioimmunoassay. Results: Plasma ADH levels (normal range 5–11 µg/l) did not differ between spina bifida population and healthy controls. Serum ADH had a mean of 6.8 µg/l in affected children and a mean of 7.4 µg/l in the controls. Conclusion: We conclude that the use of desmopressin in children with spina bifida should be reserved only in patients with decreased secretion of ADH, or may be useful in patients with persistent nocturnal incontinence to reduce night wetting. Therefore, research with a larger population is needed.

Desmopressin acetate for enuresis and diabetes insipidus

Desmopressin is a synthetic agonist of the natural pituitary hormone vasopressin acetate, with enhanced antidiuretic properties. In fact, owing to its selectivity for the V2 receptor, it has a greater antidiuretic activity, but lower pressure effects compared with natural antidiuretic hormone. Desmopressin is used in the diagnosis and treatment of cranial diabetes insipidus, in the treatment of monosymptomatic enuresis and for tests of renal function.