Does Combination Therapy with Desmopressin and Tolterodine Improve the Treatment Outcomes of Patients with Monosymptomatic Nocturnal Enuresis? A Randomized Clinical Controlled Trial

Several therapeutic options have been described for children with nocturnal enuresis, but still their efficacy and outcomes are controversial. This study compares the combined Desmopressin and Tolterodine efficacy versus Desmopressin alone efficacy in the treatment of nocturnal enuresis. One hundred children 5–16 years old with nocturnal enuresis were enrolled in a randomized trial study and were assigned to two equal groups. In a double-blind manner, we used 2？mg of Tolterodine tablet plus 20？μg of nasal Desmopressin in group A and 20？μg of nasal Desmopressin plus placebo in group B. The two groups were matched for age and sex (P = 0.547, P = 0.414). The mean number of the wet nights was reduced in both groups (P < 0.001, P < 0.001). Upon ICCS scoring in the Tolterodine + Desmopressin group, 27 (54%) had full response, 17 (34%) had partial response, and 5 (10%) had an unsuccessful outcome. In the Desmopressin + placebo group, 17 (34%) had full response, 23 (46%) had partial response, and 10 (20%) had an unsuccessful outcome. The response in the Tolterodine + Desmopressin group was significantly higher (P = 0.049). Regarding the results, combined Tolterodine plus Desmopressin is slightly more effective than monotherapy. 1. Introduction Primary nocturnal enuresis is intermittent nocturnal incontinence in children aged more than 5 years in the absence of structural and nervous system abnormalities. The overall prevalence of enuresis at the age of 5 years is about 15–20% and 1-2% in the age of 15 years [1]. Treatment may consist of certain medications, behavioral therapy, conditional therapy, or most often a combination of these approaches. Behavioral modification is recognized as the first step of management in enuresis. Although many approached have considered behavioral modification to enuresis, by far alarm units have counted as the most effective method [2]. It is known a successful outcome depends to appropriate compliance of the child and her or his parents. For this reason the most common cause of failure is their poor cooperation. Medication used for the treatment of enuresis includes Desmopressin, anticholinergic agents, and tricyclic antidepressants. Initial treatment with Desmopressin has been proven in various studies. Desmopressin improves enuresis in 65–80% patients, but refractory rate is 20–25% to Desmopressin [3]. Regarding the high prevalence of enuresis (15–20%) and the unsuccessful response to Desmopressin alone (25–20%) and critical side effects of tricyclic antidepressants, the need to identify a new strategy with minimal side