Dehoorne J L C, Walle C Vande, Vansintjan P, Raes A M, De Guchtenaere A R P, Van Laecke E, Hoebeke P, Vande Walle J G J
Department of Pediatric Nephrology and Urology, University Hospital Ghent, Ghent, Belgium.
J Urol. 2007 Mar;177(3):1130-7. doi: 10.1016/j.juro.2006.10.093.
We evaluated pretreatment values of circadian rhythm of urine production and urine osmolality in children with different subtypes of monosymptomatic nocturnal enuresis, and investigated their predictive value for desmopressin response.
We assessed 125 consecutive patients with monosymptomatic nocturnal enuresis, nocturnal polyuria and normal functional bladder capacity who were treated with desmopressin for a median of 17 months (range 3 to 100). Patients were characterized according to the desmopressin response as full responders or nonfull responders. Baseline parameters were obtained from a 2-week home recording diary. Results were compared with 125 consecutive children with monosymptomatic nocturnal enuresis and reduced functional bladder capacity.
No differences in pretreatment values of functional bladder capacity, circadian rhythm of urine production or urine osmolality were found between desmopressin full responders and nonfull responders. Patients with nocturnal polyuria had a significantly higher 24-hour diuresis volume compared to children with reduced functional bladder capacity. Some children with reduced functional bladder capacity also had nocturnal polyuria.
Our findings show that the characteristics of nocturnal polyuria in patients with monosymptomatic nocturnal enuresis and normal functional bladder capacity do not predict desmopressin response. The wide overlap among the different subgroups suggests that dividing patients with monosymptomatic nocturnal enuresis into those with reduced functional bladder capacity and those with desmopressin responsive nocturnal polyuria might be insufficient. Patients with nocturnal polyuria and normal functional bladder capacity have a significantly higher daytime and nighttime diuresis volume compared to children with reduced functional bladder capacity, suggesting a direct correlation between daytime fluid intake and nocturnal diuresis rate. Some children with reduced functional bladder capacity also have nocturnal polyuria.
我们评估了单症状性夜间遗尿不同亚型患儿的尿液生成昼夜节律和尿渗透压的治疗前值，并研究了它们对去氨加压素反应的预测价值。
我们评估了125例连续的单症状性夜间遗尿、夜间多尿且膀胱功能容量正常的患者，他们接受去氨加压素治疗的中位时间为17个月（范围3至100个月）。根据对去氨加压素的反应将患者分为完全反应者或非完全反应者。基线参数来自为期2周的家庭记录日记。将结果与125例连续的单症状性夜间遗尿且膀胱功能容量降低的儿童进行比较。
去氨加压素完全反应者和非完全反应者在膀胱功能容量、尿液生成昼夜节律或尿渗透压的治疗前值方面未发现差异。与膀胱功能容量降低的儿童相比，夜间多尿的患者24小时尿量显著更高。一些膀胱功能容量降低的儿童也有夜间多尿。
我们的研究结果表明，单症状性夜间遗尿且膀胱功能容量正常的患者夜间多尿的特征不能预测去氨加压素反应。不同亚组之间的广泛重叠表明，将单症状性夜间遗尿患者分为膀胱功能容量降低者和对去氨加压素反应性夜间多尿者可能是不够的。与膀胱功能容量降低的儿童相比，夜间多尿且膀胱功能容量正常的患者白天和夜间尿量显著更高，这表明白天液体摄入量与夜间利尿率之间存在直接相关性。一些膀胱功能容量降低的儿童也有夜间多尿。
