MARCOS FIGUEIREDO MELLO
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- A prospective and randomized study comparing the use of alarms, desmopressin and imipramine in the treatment of monosymptomatic nocturnal enuresis(2023) MELLO, Marcos Figueiredo; LOCALI, Rafael Fagionato; ARAUJO, Rogerio Mattos; REIS, Joceara Neves; SAIOVICI, Samuel; MELLO, Luiz Figueiredo; ROCHA, Flavio Eduardo TrigoBackground Monosymptomatic enuresis (MNE) results from a pathogenic triad that may include lack of vaso-pressin secretion during sleep, reduced functional bladder capacity and inability to wake up during sleep. The treatment of MNE can be performed through behavioral therapy, use of alarms or medi-cations such as desmopressin and imipramine.Objective To compare the effectiveness of different treat-ments of MNE.Study design Prospective and randomized study comparing different intervention and a control group (receiving only behavior therapy) for MNE. Inclusion criteria: age between 5 and 16 years old, with MNE, evalu-ated at the pediatric urology outpatient clinic of Hospital Infantil Menino Jesus. At first visit children were submitted to behavior therapy (urotherapy) for 3 months, children were subsequently characterized according to the ICCS as non-responders, partial responders, or full responders. Those partial re-sponders or non-responders received a patient ID and were randomized to four groups: Alarm Group (G1), Desmopressin Group -DDAVP (G2), Imipramine Group (G3) and Control (G4). All groups were moni-tored monthly, for a period of 6 months. After 6 months, the children were reevaluated for MNE.Results 93 patients were enrolled. Mean age was 10.96 years with a standard deviation of 2.28 years, 59,1% were male. All groups had improvement in the number of dry nights (Table). Taking in account success the population full responders and partial responders: Alarm Group (G1) achieve success in 100% of cases, Desmopressin Group -DDAVP (G2) in 63.6% of cases, Imipramine Group (G3) in 73.7% of cases (Table 3). No drugs side effects were observed in both groups (G2 and G3), there was no dropout in patients who used alarms.Discussion Our data suggests that the use of alarms is the most effective treatment of ENM with superior results when compared to imipramine and DDAVP. The small number of participants is a weakness of the study, as well as the lack of a voiding diary at the end of the study.Conclusion All therapeutics options utilized in the treatment of MNE are safe, effective and has a low rate of abandonment.