Failure of monotherapy in primary monosymptomatic enuresis: a combined desmopressin and propiverine treatment regimen improves efficacy outcomes
OBJECTIVE To evaluate, in a prospective study, the combination of the antimuscarinic propiverine and the antidiuretic hormone‐agonist desmopressin in children and adolescents not responsive to previous monotherapy, as in primary monosymptomatic enuresis (PME), combined treatments are considered a se...
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| Veröffentlicht in: | BJU international 2009-06, Vol.103 (12), p.1706-1712 |
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| creator | Alloussi, Saladin Helmut Mürtz, Gerd Gitzhofer, Silvia Eichel, Robert Lang, Christoph Madersbacher, Helmut Strugala, Gerhard Alloussi, Schahnaz |
| description | OBJECTIVE
To evaluate, in a prospective study, the combination of the antimuscarinic propiverine and the antidiuretic hormone‐agonist desmopressin in children and adolescents not responsive to previous monotherapy, as in primary monosymptomatic enuresis (PME), combined treatments are considered a second‐line approach after the failure of monotherapy.
PATIENTS AND METHODS
The study included 122 children and adolescents (mean age 10.8 years, range 5–21) with PME and so far unresponsive to single or multiple monotherapy. Propiverine (body weight |
| doi_str_mv | 10.1111/j.1464-410X.2008.08285.x |
| format | Article |
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To evaluate, in a prospective study, the combination of the antimuscarinic propiverine and the antidiuretic hormone‐agonist desmopressin in children and adolescents not responsive to previous monotherapy, as in primary monosymptomatic enuresis (PME), combined treatments are considered a second‐line approach after the failure of monotherapy.
PATIENTS AND METHODS
The study included 122 children and adolescents (mean age 10.8 years, range 5–21) with PME and so far unresponsive to single or multiple monotherapy. Propiverine (body weight <30 kg, 15 mg/day; ≥30 kg, 20 mg/day) and desmopressin (0.4 mg/night) were administered over 3 months, followed by successive structured withdrawal programmes for propiverine and desmopressin, depending on the amount of loss of urine at night before treatment.
RESULTS
The re‐evaluation of unresponsive patients, incorporating video‐urodynamics, showed neurogenic detrusor overactivity, isolated detrusor sphincter dyssynergia and vesicorenal reflux in 12.3% (15/122) of patients, so far falsely treated as enuresis. In 107 of 122 patients the diagnosis of PME was confirmed. The primary efficacy outcome, continence at night, was achieved in 104 of 107 patients (97.2%). During the individual follow‐up periods (3–12 months), 23 of 107 (21.5%) patients relapsed after withdrawal of both medications. Adverse events of moderate intensity were rare (3.7%).
CONCLUSION
Re‐evaluation of patients after monotherapy has failed is justified, because other entities can be discovered in patients so far treated unsuccessfully for enuresis. The combination of propiverine and desmopressin is highly effective in children with PME. Our results support the case for further optimizing the inaugurated treatment algorithm of PME for treatment duration, dose‐titration and structured withdrawal programmes, thus possibly further decreasing relapse rates.</description><identifier>ISSN: 1464-4096</identifier><identifier>EISSN: 1464-410X</identifier><identifier>DOI: 10.1111/j.1464-410X.2008.08285.x</identifier><identifier>PMID: 19154456</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adolescent ; Adult ; Antidiuretic Agents - therapeutic use ; antimuscarinics ; Benzilates - therapeutic use ; Biological and medical sciences ; Child ; Child, Preschool ; combined treatment ; Deamino Arginine Vasopressin - therapeutic use ; desmopressin ; Drug Therapy, Combination ; Humans ; Medical sciences ; Muscarinic Antagonists - therapeutic use ; Nephrology. Urinary tract diseases ; Nocturnal Enuresis - drug therapy ; primary monosymptomatic enuresis ; propiverine ; Prospective Studies ; Secondary Prevention ; structured withdrawal programme ; treatment failures ; Treatment Outcome ; Urinary system involvement in other diseases. Miscellaneous ; Urinary tract. Prostate gland ; Young Adult</subject><ispartof>BJU international, 2009-06, Vol.103 (12), p.1706-1712</ispartof><rights>2008 THE AUTHORS. JOURNAL COMPILATION © 2008 BJU INTERNATIONAL</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3975-f2ed909b3cc3dacf4490b7af3dfe057ac9129425bd5d42f2e883c76cc04039883</citedby><cites>FETCH-LOGICAL-c3975-f2ed909b3cc3dacf4490b7af3dfe057ac9129425bd5d42f2e883c76cc04039883</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1464-410X.2008.08285.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1464-410X.2008.08285.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,781,785,1418,27926,27927,45576,45577</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21533648$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19154456$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Alloussi, Saladin Helmut</creatorcontrib><creatorcontrib>Mürtz, Gerd</creatorcontrib><creatorcontrib>Gitzhofer, Silvia</creatorcontrib><creatorcontrib>Eichel, Robert</creatorcontrib><creatorcontrib>Lang, Christoph</creatorcontrib><creatorcontrib>Madersbacher, Helmut</creatorcontrib><creatorcontrib>Strugala, Gerhard</creatorcontrib><creatorcontrib>Alloussi, Schahnaz</creatorcontrib><title>Failure of monotherapy in primary monosymptomatic enuresis: a combined desmopressin and propiverine treatment regimen improves efficacy outcomes</title><title>BJU international</title><addtitle>BJU Int</addtitle><description>OBJECTIVE
To evaluate, in a prospective study, the combination of the antimuscarinic propiverine and the antidiuretic hormone‐agonist desmopressin in children and adolescents not responsive to previous monotherapy, as in primary monosymptomatic enuresis (PME), combined treatments are considered a second‐line approach after the failure of monotherapy.
PATIENTS AND METHODS
The study included 122 children and adolescents (mean age 10.8 years, range 5–21) with PME and so far unresponsive to single or multiple monotherapy. Propiverine (body weight <30 kg, 15 mg/day; ≥30 kg, 20 mg/day) and desmopressin (0.4 mg/night) were administered over 3 months, followed by successive structured withdrawal programmes for propiverine and desmopressin, depending on the amount of loss of urine at night before treatment.
RESULTS
The re‐evaluation of unresponsive patients, incorporating video‐urodynamics, showed neurogenic detrusor overactivity, isolated detrusor sphincter dyssynergia and vesicorenal reflux in 12.3% (15/122) of patients, so far falsely treated as enuresis. In 107 of 122 patients the diagnosis of PME was confirmed. The primary efficacy outcome, continence at night, was achieved in 104 of 107 patients (97.2%). During the individual follow‐up periods (3–12 months), 23 of 107 (21.5%) patients relapsed after withdrawal of both medications. Adverse events of moderate intensity were rare (3.7%).
CONCLUSION
Re‐evaluation of patients after monotherapy has failed is justified, because other entities can be discovered in patients so far treated unsuccessfully for enuresis. The combination of propiverine and desmopressin is highly effective in children with PME. Our results support the case for further optimizing the inaugurated treatment algorithm of PME for treatment duration, dose‐titration and structured withdrawal programmes, thus possibly further decreasing relapse rates.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Antidiuretic Agents - therapeutic use</subject><subject>antimuscarinics</subject><subject>Benzilates - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>combined treatment</subject><subject>Deamino Arginine Vasopressin - therapeutic use</subject><subject>desmopressin</subject><subject>Drug Therapy, Combination</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Muscarinic Antagonists - therapeutic use</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Nocturnal Enuresis - drug therapy</subject><subject>primary monosymptomatic enuresis</subject><subject>propiverine</subject><subject>Prospective Studies</subject><subject>Secondary Prevention</subject><subject>structured withdrawal programme</subject><subject>treatment failures</subject><subject>Treatment Outcome</subject><subject>Urinary system involvement in other diseases. Miscellaneous</subject><subject>Urinary tract. Prostate gland</subject><subject>Young Adult</subject><issn>1464-4096</issn><issn>1464-410X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkc1u1TAQhS1ERUvhFZA3sLvBju38ILGAirZUldhQiZ3l2GPwVRwHOynNW_DIOL2h3dYbj2e-Mx6dQQhTUtB83u8Lyiu-45T8KEpCmoI0ZSOKu2fo5KHw_H9M2uoYvUxpT0hOVOIFOqYtFZyL6gT9PVeunyPgYLEPQ5h-QVTjgt2Ax-i8ist9Oi1-nIJXk9MYhswnlz5ghXXwnRvAYAPJhzHnU1aqwWR1GN0txFzFUwQ1eRgmHOGnywF2PtdvIWGw1mmlFxzmKTeD9AodWdUneL3dp-jm_Mv3s8vd9beLr2efrneatbXY2RJMS9qOac2M0pbzlnS1ssxYIKJWuqVly0vRGWF4memmYbqutCacsDY_TtG7Q988yO8Z0iS9Sxr6Xg0Q5iSrmpOmFiKDzQHUMaQUwcrNGEmJXLch93I1Wq6my3Ub8n4b8i5L32x_zJ0H8yjc7M_A2w1QSaveRjVolx64kgrGKr4O-_HA_XE9LE8eQH6-ulkj9g8x2KsK</recordid><startdate>200906</startdate><enddate>200906</enddate><creator>Alloussi, Saladin Helmut</creator><creator>Mürtz, Gerd</creator><creator>Gitzhofer, Silvia</creator><creator>Eichel, Robert</creator><creator>Lang, Christoph</creator><creator>Madersbacher, Helmut</creator><creator>Strugala, Gerhard</creator><creator>Alloussi, Schahnaz</creator><general>Blackwell Publishing Ltd</general><general>Wiley-Blackwell</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200906</creationdate><title>Failure of monotherapy in primary monosymptomatic enuresis: a combined desmopressin and propiverine treatment regimen improves efficacy outcomes</title><author>Alloussi, Saladin Helmut ; Mürtz, Gerd ; Gitzhofer, Silvia ; Eichel, Robert ; Lang, Christoph ; Madersbacher, Helmut ; Strugala, Gerhard ; Alloussi, Schahnaz</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3975-f2ed909b3cc3dacf4490b7af3dfe057ac9129425bd5d42f2e883c76cc04039883</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Antidiuretic Agents - therapeutic use</topic><topic>antimuscarinics</topic><topic>Benzilates - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>combined treatment</topic><topic>Deamino Arginine Vasopressin - therapeutic use</topic><topic>desmopressin</topic><topic>Drug Therapy, Combination</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Muscarinic Antagonists - therapeutic use</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Nocturnal Enuresis - drug therapy</topic><topic>primary monosymptomatic enuresis</topic><topic>propiverine</topic><topic>Prospective Studies</topic><topic>Secondary Prevention</topic><topic>structured withdrawal programme</topic><topic>treatment failures</topic><topic>Treatment Outcome</topic><topic>Urinary system involvement in other diseases. Miscellaneous</topic><topic>Urinary tract. Prostate gland</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Alloussi, Saladin Helmut</creatorcontrib><creatorcontrib>Mürtz, Gerd</creatorcontrib><creatorcontrib>Gitzhofer, Silvia</creatorcontrib><creatorcontrib>Eichel, Robert</creatorcontrib><creatorcontrib>Lang, Christoph</creatorcontrib><creatorcontrib>Madersbacher, Helmut</creatorcontrib><creatorcontrib>Strugala, Gerhard</creatorcontrib><creatorcontrib>Alloussi, Schahnaz</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>BJU international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Alloussi, Saladin Helmut</au><au>Mürtz, Gerd</au><au>Gitzhofer, Silvia</au><au>Eichel, Robert</au><au>Lang, Christoph</au><au>Madersbacher, Helmut</au><au>Strugala, Gerhard</au><au>Alloussi, Schahnaz</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Failure of monotherapy in primary monosymptomatic enuresis: a combined desmopressin and propiverine treatment regimen improves efficacy outcomes</atitle><jtitle>BJU international</jtitle><addtitle>BJU Int</addtitle><date>2009-06</date><risdate>2009</risdate><volume>103</volume><issue>12</issue><spage>1706</spage><epage>1712</epage><pages>1706-1712</pages><issn>1464-4096</issn><eissn>1464-410X</eissn><abstract>OBJECTIVE
To evaluate, in a prospective study, the combination of the antimuscarinic propiverine and the antidiuretic hormone‐agonist desmopressin in children and adolescents not responsive to previous monotherapy, as in primary monosymptomatic enuresis (PME), combined treatments are considered a second‐line approach after the failure of monotherapy.
PATIENTS AND METHODS
The study included 122 children and adolescents (mean age 10.8 years, range 5–21) with PME and so far unresponsive to single or multiple monotherapy. Propiverine (body weight <30 kg, 15 mg/day; ≥30 kg, 20 mg/day) and desmopressin (0.4 mg/night) were administered over 3 months, followed by successive structured withdrawal programmes for propiverine and desmopressin, depending on the amount of loss of urine at night before treatment.
RESULTS
The re‐evaluation of unresponsive patients, incorporating video‐urodynamics, showed neurogenic detrusor overactivity, isolated detrusor sphincter dyssynergia and vesicorenal reflux in 12.3% (15/122) of patients, so far falsely treated as enuresis. In 107 of 122 patients the diagnosis of PME was confirmed. The primary efficacy outcome, continence at night, was achieved in 104 of 107 patients (97.2%). During the individual follow‐up periods (3–12 months), 23 of 107 (21.5%) patients relapsed after withdrawal of both medications. Adverse events of moderate intensity were rare (3.7%).
CONCLUSION
Re‐evaluation of patients after monotherapy has failed is justified, because other entities can be discovered in patients so far treated unsuccessfully for enuresis. The combination of propiverine and desmopressin is highly effective in children with PME. Our results support the case for further optimizing the inaugurated treatment algorithm of PME for treatment duration, dose‐titration and structured withdrawal programmes, thus possibly further decreasing relapse rates.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>19154456</pmid><doi>10.1111/j.1464-410X.2008.08285.x</doi><tpages>7</tpages></addata></record> |
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| subjects | Adolescent Adult Antidiuretic Agents - therapeutic use antimuscarinics Benzilates - therapeutic use Biological and medical sciences Child Child, Preschool combined treatment Deamino Arginine Vasopressin - therapeutic use desmopressin Drug Therapy, Combination Humans Medical sciences Muscarinic Antagonists - therapeutic use Nephrology. Urinary tract diseases Nocturnal Enuresis - drug therapy primary monosymptomatic enuresis propiverine Prospective Studies Secondary Prevention structured withdrawal programme treatment failures Treatment Outcome Urinary system involvement in other diseases. Miscellaneous Urinary tract. Prostate gland Young Adult |
| title | Failure of monotherapy in primary monosymptomatic enuresis: a combined desmopressin and propiverine treatment regimen improves efficacy outcomes |
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