Constipation reduces desmopressin efficacy in children with nocturnal enuresis

Treatment response to desmopressin for paediatric nocturnal enuresis (NE) decreases in the presence of constipation, especially in children with severe enuresis and those prescribed with low-dose desmopressin, a study has shown.

Researchers looked at 383 patients (52.7 percent boys) with NE aged 5–15 years, among whom 54 (14 percent) presented with constipation. The majority of patients (76.0 percent) had severe enuresis, and the incidence of severe enuresis in the group of patients with constipation was higher than that in the nonconstipation group (94.4 percent vs 72.9 percent; p=0.001).

In the cohort, only 346 children completed desmopressin treatment. Complete response rate was significantly lower in the presence of constipation in the group of patients with severe enuresis. Constipation was associated with the effectiveness of desmopressin whether in monosymptomatic or nonmonosymptomatic NE.

In an analysis stratifying by dose of desmopressin, nonconstipated vs constipated patients who received 0.2 mg had significantly higher complete response rate. However, in subgroups of mild-to-moderate NE and 0.4 mg desmopressin, constipation showed no association with treatment response.

Multivariate logistic regression revealed constipation to be an independent risk factor for the efficacy of desmopressin in treating enuresis (odds ratio, 3.135; 95 percent CI, 1.185–8.295; p=0.021).

The present data suggest that complete response could be likely expected in children without constipation, researchers said. Additional studies with large sample size and are needed to verify the association between constipation and desmopressin efficacy.