PRİMER MONOSEMPTOMATİK ENÜREZİS NOKTÜRNA TEDAVİSİNDE DESMOPRESSİN

Giriş: Enürezis noktürna okul çağındaki çocukların %5-10’unda görülen yaygın bir durumdur. Vakaların büyük kısmı primer ve monosemptomatiktir. Bu çalışmada ampirik desmopressin’in monosemptomatik enürezis (MEN) tedavisindeki etkinliğinin ve güvenilirliğinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Ortalama yaşı 11.3 olan toplam 46 MEN hastası prospektif olarak değerlendirildi. Tüm hastalarda detaylı fiziksel muayeneye ek olarak idrar kültürü ve idrar osmolaritesi bakıldı, işeme günlüğünü de içeren değerlendirme formu dolduruldu. Hastalar 12 hafta boyunda yatmadan önce 10-20 mikrogram intranazal desmopressin aldı. Nüks görülen hastalara ikinci bir 12 haftalık tedavi uygulandı. Hastalar tedavi öncesi ve sonrası haftalık enüretik epizod sayısı ve yan etkiler açısından değerlendirildiler. Hastalar 6 ay boyunca izlendiler. Bulgular: Hastaların %65.2’inde pozitif aile anamnezi bulunmaktaydı. Tedavi öncesi ortalama 5.8±5.8 olan enürezik epizod sayısı tedavi sırasında 0.3±0.1’e geriledi ve tedavi sonrası 1.2±0.9 olarak saptandı (p=0.025). Tedavi alan 46 hastanın 32’sinde (%69.5) tam kuruluk sağlanırken diğer hastalarda enüretik epizodlar belirgin olarak azalmasına rağmen tam kuruluk sağlanamadı. Hiçbir hastada yan etki gözlenmedi. Sonuç: Desmopressin çabuk sonuç alınmak istenen, primer MEN bulunan hastalarda etkin, yan etki profili düşük ve ampirik tedavi için uygun bir ajandır. Tedavi sonrası yüksek bir nüks oranı görülebiliceği akılda tutulmalıdır.

DESMOPRESSIN IN THE TREATMENT OF PRIMARY MONOSYMPTOMATIC NOCTURNAL ENURESIS

Introduction: Nocturnal enuresis is a common condition seen in 5-10% of school-age children. Most of the cases are primary and monosymptomatic. In this study, we aimed to investigate the efficacy and safety of empirical desmopressin in the treatment of monosymptomatic nocturnal enuresis (MNE). Material and Methods: A total of 46 MNE patients with a mean age of 11.3 years which their data collected prospectivelly were evaluated prospectively. Urine culture and osmolarity were examined in addition to detailed physical examination and evaluation forms including voiding diary were filled. All patients received 10-20 microgram desmopressin in bedtime for 12 weeks. Patients with recurrence received a second 12-week treatment. Patients were evaluated before and after the treatment, in terms of the number of weekly enuretic episodes and side effects. Patients were followed-up for 6 months. Results: 65.2% of the patients had a positive family history. The mean number of enuretic episodes decreased from 5.8 ± 5.8 to 0.3 ± 0.1 during the treatment and 1.2 ± 0.9 after the treatment (p=0.025). Of the 46 patients receiving treatment, 32 (69.5%) had complete dryness, while in other patients enuretic episodes were significantly reduced but complete dryness could not be achieved. No side effects were observed in any patient. Conclusion: Desmopressin is an effective agent with low side effect profile for empirical treatment in patients with primary MNE whom fast results were required. It should be kept in mind that a high recurrence rate can be seen after treatment.

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