The effectiveness of desmopressin in the treatment of childhood nocturnal enuresis: predicting response using pretreatment variables

OBJECTIVE: To determine the factors that predict the effectiveness of desmopressin in the treatment of childhood nocturnal enuresis. PATIENTS AND METHOD: Sixty-six children with monosymptomatic nocturnal enuresis were treated with intranasal or oral desmopressin for a 4-week period. starting with a standard dose of 20 microg (0.2 mg oral) and increasing after 2 weeks where no progress was apparent to 40 microg (0.4 mg oral). Before treatment a range of variables (demographic, situational, enuretic history, physiological, parental attitude and child) were recorded. Three parameters of success acted as dependent variables, with stepwise linear regression models used to determine pretreatment predictors of success with desmopressin. RESULT: Each outcome variable produced a very similar model of predictors. Success, as assessed by the most dry nights over a 14-night period, was associated with less severe enuresis before treatment, a parental belief that the child's enuresis was unstable and higher birthweight. CONCLUSION: From the analysis, a model of arginine vasopressin release is proposed and the clinical implications of the findings addressed.