Combined Dietary Recommendations, Desmopressin, and Behavioral In-terventions May Be Effective First-Line Treatment in Resolution of Enuresis.

PURPOSE: Nocturnal enuresis (NE) is a very common multifactorial pediatric disorder and in children with­out any other lower urinary tract symptoms is defined as monosymptomatic NE (MNE). Pharmacologi­cal, psychological/behavioral, and alternative interventions are commonly used and the first-line drug ther­apy for patients with MNE is desmopressin (dDAVP) but the response rate is less than 40-60% and the relapse rate is about 50-80% after treatment. Many studies show that some foods and beverages can promote diuresis or bladder irritability, which in some people can exacerbate bladder symptoms and NE. The pres­ent study aimed to compare the efficacy of combined specific dietary advices and dDAVP vs dDAVP alone. MATERIALS AND METHODS: We enrolled in the study 172 patients affected by MNE between January 2013 and May 2014, of these 35 were excluded. The inclusion criterion was primary MNE and exclusion criteria in­cluded non-MNE, secondary MNE and lactose intolerance. Children were treated with dDAVP at a dose of 120 μg a day and were randomized to receive dietary recommendations. They were asked to fill out a char­ter depicting their wet and dry nights for the period of treatment. Sixty-seven patients were randomly as­signed to receive dDAVP and dietary advices (group A) and 70 patients to receive dDAVP alone (group B). RESULTS: We included in our study 137 children, 102 (74.5%) male, and 35 (25.5%) female, aged be­tween 5 and 14 years. Our results show a higher response rate and a lower number of relapse in group A vs group B with 67.2% of responders in group A vs 58.6% in group B, after 3 months of ther­apy and 31.1% of relapse in group A vs 46.3% in group B one month, after the end of treatment. CONCLUSION: Our results show the effectiveness of specific dietary advices in the manage­ment of primary MNE. However further studies are needed to determine whether the differ­ence between therapy with combined dietary recommendations and dDAVP vs dDAVP alone