Raes A, Dehoorne J, Van Laecke E, Hoebeke P, Vande Walle C, Vansintjan P, Donckerwolcke R, Vande Walle J
Department of Pediatric Nephrology, University Hospital Ghent, Ghent, Belgium.
J Urol. 2007 Sep;178(3 Pt 1):1048-51; discussion 1051-2. doi: 10.1016/j.juro.2007.05.060. Epub 2007 Jul 16.
The anti-incontinence effect of desmopressin resides in its concentrating capacity and antidiuretic properties. We compared nighttime urine production on wet and dry nights in a highly selected study population of children with monosymptomatic nocturnal enuresis associated with proved nocturnal polyuria who responded only partially to intranasal desmopressin.
We retrospectively analyzed 39 home recordings of nocturnal urine production and maximum voided volume in children 7 to 19 years old (median 8.9) with monosymptomatic nocturnal enuresis with nocturnal polyuria who had a partial response to desmopressin. Nocturnal diuresis volume and maximum voided volume were documented at baseline (14 days) and during 3 months of followup.
Baseline nocturnal urine output (439 +/- 39 ml) was significantly higher than the maximum voided volume (346 +/- 93 ml, p <0.01). During desmopressin treatment nocturnal urine output on wet nights (405 +/- 113 ml) differed significantly from that on dry nights (241 +/- 45 ml). During treatment nocturnal urine output on wet nights did not differ from baseline values.
Persistence of nocturnal polyuria on wet nights in partial desmopressin responders may be related to an insufficient antidiuretic effect. In addition to poor compliance and suboptimal dosing, the poor bioavailability of intranasal desmopressin may be a pathogenic factor. Further prospective studies are needed.
去氨加压素的抗尿失禁作用在于其浓缩能力和抗利尿特性。我们在一个经过高度筛选的研究人群中比较了单症状性夜间遗尿症伴夜间多尿且对鼻内去氨加压素仅部分反应的儿童在尿床夜和干爽夜的夜间尿量。
我们回顾性分析了39例7至19岁（中位数8.9岁）单症状性夜间遗尿症伴夜间多尿且对去氨加压素部分反应的儿童的夜间尿量和最大排尿量的家庭记录。在基线期（14天）和3个月的随访期间记录夜间利尿量和最大排尿量。
基线夜间尿量（439±39 ml）显著高于最大排尿量（346±93 ml，p<0.01）。在去氨加压素治疗期间，尿床夜的夜间尿量（405±113 ml）与干爽夜的夜间尿量（241±45 ml）有显著差异。治疗期间，尿床夜的夜间尿量与基线值无差异。
去氨加压素部分反应者在尿床夜夜间多尿持续存在可能与抗利尿作用不足有关。除了依从性差和剂量欠佳外，鼻内去氨加压素生物利用度低可能是一个致病因素。需要进一步的前瞻性研究。
