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.
Nocturnal enuresis: correction of renal function by desmopressin and diclofenac.
Sixty-two children with nocturnal enuresis (43 boys, 19 girls aged 6-15 years) were treated with either desmopressin (Adiuretin-SD) (n = 32) or sodium diclofenac (n = 30). Desmopressin was effective in 85% of children and diclofenac in 33%. In children with primary nocturnal enuresis, the glomerular filtration rate was normal, whereas diuresis and solute excretion during the night were increased. Compared with healthy children, the nightly excretion of sodium was elevated by 43.7% and magnesium by 58.4%. A high correlation was found between the free water reabsorption and solute clearance (P < 0.001) in children with nocturnal enuresis. Changes in kidney function in nocturnal enuresis appear to be due to a decrease in the water and ion reabsorption in the thick ascending limb of Henle's loop because of a changed regulation of ion transport in this part of the nephron. Administration of desmopressin or a decrease in prostaglandin production after diclofenac administration restores the ion and water transport in the kidney, which results in the disappearance of nocturnal enuresis. The results indicate a role of changes in regulation of ion transport in renal tubules in the pathogenesis of one of the forms of primary nocturnal enuresis.