Efficacy and safety of combination therapy (desmopressin with tolterodine) in nocturnal enuresis in children: An institutional experience

Abstract

ABSTRACT Background: Nocturnal enuresis is one of the most common problems of childhood. Desmopressin is started as a first-line treatment along with essential behavioral therapy like fluid restriction before bed and sleep hygiene. Given the high relapse rates seen with using desmopressin alone, the need of the hour is to reinforce its effects using another agent so that the remission is long-lasting. Aim: The aim is to look for efficacy and safety of treatment using combination therapy of desmopressin with tolterodine in nocturnal enuresis and further to look for the relapse rate with a structured withdrawal regimen. Results: A total of 150 patients of nocturnal enuresis were included in the study. Ninety patients (75%) were males, and 30 patients (25%) were females. The median age of patients was 12 years. Evaluation of the consequences at 1 month, 3 months, and 6 months revealed complete remission in 87 patients (72.5%), 105 patients (87.5%), and 105 patients (87.5%), respectively. After 12 months with desmopressin + tolterodine, it was found that 99 patients (82.5%) had complete remission, six patients (5%) had a relapse, and 12.5% of individuals still suffered from enuresis. The relapse rate on follow-up of 6 months after complete cessation of the treatment of 120 patients was 5% in combination therapy. The complication rate with combination therapy is 4.17%. There is no significant effect of gender or age on improvement with combination therapy. Conclusion: Desmopressin given in combination with tolterodine is safe and effective as combination therapy for treating nocturnal enuresis, and in most cases, long-term remissions can be achieved.