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08:36 - 08:40
ICCS S3-8
(SO)
URINE: USING HIGH DOSE ANTICHOLINERGICS FOR REFRACTORY PATIENTS IN
COMBINATION WITH DESMOPRESSIN FOR NOCTURNAL ENURESIS
Pamela ELLSWORTH
1
and Aaron BERKENWALD
2
1) UMassMemorial Medical Center/University of Massachusetts Medical School, Department of Urology, Worcester, USA -
2) University of Massachusetts Medical School, Department of Urology, Worcester, USA
PURPOSE
Desmopressin (DDAVP) is the most common pharmacologic therapy for nocturnal enuresis. Combination therapy,
DDAVP plus fixed dose anticholinergic therapy improves symptoms in some patients who fail DDAVP monotherapy. We
sought to evaluate treatment response of high dose anticholinergic therapy plus DDAVP in prior DDAVP monotherapy
failures and factors predicting response.
MATERIAL AND METHODS
An IRB approved retrospective review was performed of all children treated from November 2013 through December
2014 with DDAVP monotherapy and combination therapy (DDAVP plus oxybutynin) with at least one visit after
treatment initiation/change to evaluate response and who satisfied study inclusion/exclusion criteria. Factors evaluated
included BMI, age, sex, ADHD, OAB, constipation, treatment for constipation, family history of nocturnal enuresis,
psychotropic medication use and postvoid residual.
RESULTS
63 children (39 males, 24 females, age 7-18 years) met study criteria and received DDAVP 0.2 to 0.6 mg. Of the 27
DDAVP monotherapy nonresponders, 25 tried combination therapy and attended at least 1 follow-up visit. Of the 63
patients, 36 (57%) responded to DDAVP monotherapy. Twenty five of the 27 nonresponders received combination
therapy, 68% responding to low dose combination therapy (DDAVP + oxybutynin 5mg). Of the 8 low dose combination
therapy nonresponders, 6 (75%) responded to high dose combination therapy (DDAVP + oxybutynin 7.5-10mg).
CONCLUSIONS
We demonstrate that titrating the dose of oxybutynin (5-10mg) in DDAVP nonresponders allowed for overall 92% of
patients to be dry at night. Failure of prior alarm therapy was more common in all nonresponders, whereas coexistent
ADHD, dysfunctional voiding and OAB were more common in monotherapy nonresponders. Males were more likely to
require high-dose combination therapy than females.