There was not enough evidence to judge whether or not the included drugs cured bedwetting when used alone. There was limited evidence to suggest that desmopressin, imipramine and enuresis alarms therapy were better than the included drugs to which they were compared. In other reviews, desmopressin, tricyclics and alarm interventions have been shown to be effective during treatment. There was also evidence to suggest that combination therapy with anticholinergic therapy increased the efficacy of other established therapies such as imipramine, desmopressin and enuresis alarms by reducing the relapse rates, by about 20%, although it was not possible to identify the characteristics of children who would benefit from combination therapy. Future studies should evaluate the role of combination therapy against established treatments in rigorous and adequately powered trials.
A placebo-controlled trial of the effects of hydrochlorothiazide on nocturnal enuresis.
To assess the efficacy, tolerability and side effects of the diuretic hydrochlorothiazide (HCTZ) in the management of monosymptomatic nocturnal enuresis by a placebo-controlled double-blind crossover trial.
                Forty patients suffering from nocturnal enuresis were blindly randomized into 2 groups of equal numbers. Group 1 first received placebo for 3 months, and group 2 received oral HCTZ once daily for the same period. Both groups, after a 2-week wash-out period, were crossed over in their medication and continued treatment for another 3 months. The main outcome measure (variable) for the assessment of drug efficacy was taken to represent the average reduction in the percentage of wet nights as compared to the baseline enuresis pattern. Statistical analysis was based on a t test (p <or= 0.05). A subjective scale was also used to assess patients' and their parents' satisfaction. Tolerability and side effects were also documented in the study.
                Both HCTZ and placebo were statistically effective in reducing the average percentage of wet nights. HCTZ resulted in a significantly better reduction than placebo (41.1 vs. 32.5%; p <or= 0.023). Overall short-term clinical cure and improvement, on the other hand, were comparable to those of placebo according to the standards of the International Children's Continence Society. Satisfaction, as a crude measure of success, was expressed more frequently in patients who received HCTZ (20 vs. 9). Both drugs were well-tolerated.
                The use of HCTZ in the treatment of nocturnal enuresis has never been previously evaluated. The drug, in this pilot study, has a promising statistical superiority to placebo. Its clinical value, however, deserves further definition in future controlled trials.
                Copyright 2010 S. Karger AG, Basel.