Yüksel BICILIOĞLU, Mustafa BAK, Erkin SERDAROĞLU

Monosemptomatik Nokturnal Enürezis Tedavisinde Desmopressin ile Kombine Edilen Alarm Tedavisinin Etkinliği

Amaç: Geriye dönük olarak yapılan çalışmamızda amaç; monosemptomatik nokturnal enürezis tedavisinde kullanılan desmopressin, alarm ve kombine tedavileri karşılaştırmaktır.Materyal ve Metot: Monosemptomatik noktürnal enürezis tanısı alan hastalar geriye dönük olarak değerlendirildi. Desmopressin (33 hasta), alarm (34 hasta) ve kombine (34 hasta) tedavi başlanan toplam 101 hasta (67 erkek/34 kız) çalışmaya dahil edildi. Yaş ortalaması 10,7±2,4 yıl (5-16 yaş) saptandı. Hastaların tıbbi öyküsü, fizik muayene bulguları, özgeçmiş ve soygeçmişi, verilen tedavi bilgileri kayıt altına alındı. Tedavi başlanmadan 1 ay önceki, tedavi süresi ve tedavi kesildikten sonraki dokuz haftalık izlem süresi boyunca ıslak gece sayıları tespit edildi. Tedaviye yanıt ve sonrasında nüks oranları tespit edildi.Bulgular: Tedavi öncesi ıslak gecelerin ortalaması ayda 14,9±6,1 gün bulundu. Aylık ıslak gece sayısı tedaviden sonra her üç tedavi grubunda da anlamlı olarak azaldı (desmopressin; 14,5±5,7 ila 4,8±6,5; p<0,001, alarm; 14,1±5,9 ila 2,9±4,1; p<0,001, kombine tedavi;16,2±6,9 ila 1,9±2,5; p<0,001). Tedavi başarısı (ıslak gecelerde>%50 azalma) ve tam yanıt (%100 kuru) oranları desmopresin, alarm ve kombine tedavi gruplarında sırasıyla %79, %91 ve %97, %30 ve %27, %35 idi. Başarılı tedavi edilen hastalarda nüks oranları desmopresin, alarm ve kombine tedavi grubunda sırasıyla % 67, % 11 ve % 22 (p=0,002) saptandı.Sonuç: Alarm tedavisi, düşük nüks oranları ve yan etki olmaması nedeniyle en iyi tedavi seçeneği olarak karşımıza çıkmaktadır. Desmopressin tedavisinde yüksek oranda nüks saptanmıştır.

Anahtar Kelimeler:

enürezis, alarm, desmopressin, kombine tedavi

Efficacy of Desmopressin Combined with Alarm Therapy for Monosymptomatic Nocturnal Enuresis

Objective: The aim of the retrospective study was to compare desmopressin, alarm, and combined treatments in nocturnal enuresis.Materials and Methods: Patients diagnosed with monosymptomatic nocturnal enuresis is retrospectively evaluated. In total 101 patients (67 male/34 female) with desmopressin (33 patients), alarm (34 patients) and combined (34 patients) included to the study. The average age determined as 10.7±2.4 years (5-16 years). Medical history of the patients and family, physical findings, treatments are recorded. The wet night numbers are determined for 1 month before the beginning of the treatment, treatment duration and during the follow-up (monitoring) process for nine weeks after the completion of treatment. Response rates to the treatment and subsequent relapse rates were detected.Results: The number of wet nights per month was significantly reduced from before treatment and the last month of treatment in the desmopressin (14.5±5.7 to 4.8±6.5, p<0.001), alarm (14.1±5.9 to 2.9±4.1, p<0.001), and combined treatment (16.2±6.9 to 1.9±2.5, p<0.001) groups. The treatment success (>50% decrease in wet nights) and complete response (100% dry) rates were 79%, 91%, and 97%, and 30%, 27%, and 35% in the desmopressin, alarm, and combined treatment groups, respectively. The relapse rates in successfully treated patients were 67%, 11%, and 22% in the desmopressin, alarm, and combined treatment groups, respectively (p=0.002).Conclusion: Alarm treatment was the best intervention with low relapse rates and no potential adverse effects in nocturnal enuresis. The desmopressin group has a higher relapse rate.

Keywords:

enuresis, alarm, desmopressin, combined therapy,

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