كارآيي درمان تركيبي قطره بيني وازوپرسين (دسموپرسين ) و قرص اكسي بونينين خوراكي در درمان شب ادراري اوليه مقاوم به درمان هاي منفرد دارويي ...

Efficacy of Desmopressin (Nasal Spray) and Oxybutinin Combination Therapy in the Treatment of Patients with Primary Nocturnal Enuresis that were Resistant to Single Drug Therapy

Introduction & Objective: Enuresis is defined as involuntary voiding. It is a socially disruptive and stressful condition which affects around 15% of five years old children and up to 1% of adults. Aim the aim of this study was to assess the efficacy of desmopressin (nasal spray) and oxybutinin combination therapy in treatment of patients with primary nocturnal enuresis that were resistant to single drug therapy. Materials & Methods : This study is a prospective clinical trial conducted on patients aged 5-15 years old referred to urology clinic due to nocturnal enuresis. After taking history , physical examination , checking laboratory test , and ruling out the organic causes patients were treated with vasopressin or imipramin or oxybutinin at first. If no responses to this treatment was observed after 3 weeks, then the patients were treated by combination therapy ,giving desmopressin (10-20µg) and oxybutinin 2.5-5 mg) at bed time for 4-6 months. 70 patients were treated by combined therapy and then patients were followed up evaluated for responses, relapses and side effects of this drugs . Results :The results demonstrate the efficacy of this treatment. 60 % of patients were responded completely, 34.3% partially responded and no response was found in 57% of cases. 5.7% of patients developed minor side effects with combination therapy. Finally 44.3% of patients showed partial or complete relapse of enuresis I month after treatment . Conclusion : Based on these results , we can suggest that children with nocturnal enuresis who are resistant to single drug therapy, can be treated with this combination therapy . Reduction of urinary output and thus lowering of bladder filling by desmopressin , decreases the onset of inhibited bladder contraction and enhances the activity of oxybutinin. However due to cost and shortage of this drugs, we recommend this treatment only for patients with no response to single drug therapy , or other current therapies.