Chertin Boris, Koulikov Dmitry, Abu-Arafeh Wael, Mor Yoram, Shenfeld Ofer Z, Farkas Amicur
Department of Urology, Shaare Zedek Medical Center, Jerusalem.
J Urol. 2007 Oct;178(4 Pt 2):1744-7. doi: 10.1016/j.juro.2007.03.171. Epub 2007 Aug 17.
Children with attention deficit hyperactivity disorder disproportionately experience voiding dysfunction and persistent nocturnal enuresis due to a combination of sphincter and detrusor overactivity and nocturnal polyuria. The different treatment approaches to nocturnal enuresis often fail in these patients. Therefore, we performed a prospective study to compare the efficacy of combination therapy with desmopressin and oxybutynin vs the tricyclic antidepressant imipramine in patients with attention deficit hyperactivity disorder who have nocturnal enuresis.
A total of 54 patients with attention deficit hyperactivity disorder and nocturnal enuresis were randomly stratified into 2 groups. Demographic data on patient age and gender were identical in the 2 groups. Functional bladder symptoms were judged using the dysfunctional voiding symptoms survey. The initial dysfunctional voiding symptoms survey score was similar in the 2 groups. The total survey score was compared between the 2 groups in aggregate as well as specifically regarding the incidence of nocturnal enuresis following treatment.
The first group consisted of 27 patients who received desmopressin and oxybutynin, and the second group of 27 was treated with imipramine. Of the 27 children in each group 23 (85%) received methylphenidate for attention deficit hyperactivity disorder. The mean +/- SD initial dysfunctional voiding symptoms survey score in groups 1 and 2 was 20.5 +/- 3.3 and 20.9 +/- 4.1, respectively. Following treatment the mean survey score decreased significantly in groups 1 and 2 (6.5 +/- 2.5 and 9.4 +/- 2.1, respectively, p <0.001). However, between groups analysis showed that the dysfunctional voiding symptoms survey score was significantly lower in group 1 than in group 2 (mean 6.5 +/- 0.5 vs 9.6 +/- 0.4, p <0.001). There was also a statistically significant decrease in the incidence of nocturnal enuresis in group 1 (survey question 2 score 0.9 +/- 0.2 vs 2.9 +/- 0.2).
Our data show that there is a high incidence of voiding dysfunction in children with attention deficit hyperactivity disorder. Combination therapy with desmopressin and oxybutynin is a feasible, safe and effective treatment for nocturnal enuresis in these children.
注意力缺陷多动障碍（ADHD）患儿因括约肌和逼尿肌过度活动及夜间多尿，排尿功能障碍和持续性夜间遗尿的发生率不成比例地偏高。针对夜间遗尿的不同治疗方法在这些患者中常常失败。因此，我们进行了一项前瞻性研究，比较去氨加压素与奥昔布宁联合治疗与三环类抗抑郁药丙咪嗪对患有夜间遗尿的注意力缺陷多动障碍患者的疗效。
总共54例患有注意力缺陷多动障碍和夜间遗尿的患者被随机分层分为2组。两组患者的年龄和性别等人口统计学数据相同。使用排尿功能障碍症状调查问卷来判断膀胱功能症状。两组的初始排尿功能障碍症状调查问卷评分相似。比较两组总体的调查问卷总分，以及具体治疗后夜间遗尿的发生率。
第一组由27例接受去氨加压素和奥昔布宁治疗的患者组成，第二组27例接受丙咪嗪治疗。每组27名儿童中，23名（85%）因注意力缺陷多动障碍接受了哌甲酯治疗。第一组和第二组的平均±标准差初始排尿功能障碍症状调查问卷评分分别为20.5±3.3和20.9±4.1。治疗后第一组和第二组的平均调查问卷评分显著降低（分别为6.5±2.5和9.4±2.1，p<0.001）。然而，组间分析显示，第一组的排尿功能障碍症状调查问卷评分显著低于第二组（平均6.5±0.5对9.6±0.4，p<0.001）。第一组夜间遗尿的发生率也有统计学显著下降（调查问卷问题2评分0.9±0.2对2.9±0.2）。
我们的数据表明，注意力缺陷多动障碍患儿排尿功能障碍的发生率很高。去氨加压素与奥昔布宁联合治疗是这些儿童夜间遗尿的一种可行、安全且有效的治疗方法。
