Department of Woman, Child and of General and Specialized Surgery, Università Della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Napoli, Italy.
Department of Woman, Child and of General and Specialized Surgery, Università Della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Napoli, Italy.
J Pediatr Urol. 2019 Apr;15(2):166.e1-166.e7. doi: 10.1016/j.jpurol.2018.11.004. Epub 2018 Nov 14.
The nocturnal polyuria is considered a significant predictive value for response to desmopressin. The cutoff value useful to define nocturnal polyuria is still a matter of debate. Moreover, it is current notion that maximal voided volume (MVV) could be used as a predictor for desmopressin response.
The objective of this study was to assess the impact of different definitions of nocturnal polyuria (and of its frequency) and MVV in predicting the response to desmopressin.
A total of 103 patients with frequent monosymptomatic nocturnal enuresis (≥4 wet nights/week) were enrolled. A bladder diary over a 4-day period was collected. The MVV was defined as the highest micturition volume detected at bladder diary. Nocturnal diuresis was measured in 5 wet nights. Then, patients were administered with 120 mcg of sublingual desmopressin. After 2 months, if there was no complete response, the dose was increased to 240 mcg. Nocturnal polyuria was defined as follows: 1.Definition 1: nocturnal urine production >130% of the expected bladder capacity (EBC). 2. Definition 2: >100% EBC. 3. Definition 3: > 20×(age + 9) mL. The primary outcome was 'response to desmopressin' after 3 months of treatment.
Fifty-three patients responded to desmopressin. Comparing the responses to desmopressin on the basis of the three definitions of nocturnal polyuria, no significant difference was found. There was no cutoff value of nocturnal polyuria expressed as %EBC useful in providing a significant receiver-operating characteristic (ROC) curve. The area under the ROC curve for MVV expressed as %EBC was 0.67 (95% confidence interval [CI], 0.54-0.80; p = 0.01). A MVV >103.1% of EBC had 78.8% (95% CI, 61.1-91.0) sensitivity and 47.5% (95% CI, 31.5-63.9) specificity for predicting response to desmopressin. Among the patients with nocturnal polyuria according to definition 1, a higher percentage of subjects with nocturnal polyuria in 4 out of 5 or 5 out of 5 nights responded to desmopressin, compared with other patients. Patients presenting with nocturnal polyuria according to definition 3 in 5 out of 5 nights showed a 100% of response to desmopressin. At multivariate analysis, the only significant odds ratio (OR) to respond to desmopressin was that of patients with nocturnal polyuria according to definition 1 in >3 nights (OR = 7.1, 95% CI, 1.3-40.3).
The presence or absence of nocturnal polyuria-according to all three definitions-in at least one night was not effective in predicting the response to desmopressin. Predictors of desmopressin response were nocturnal polyuria in >3 out of 5 wet nights according to definition 1 and in 5 out of 5 wet nights according to definition 3.
夜间多尿被认为是对去氨加压素反应的一个有重要预测价值的指标。定义夜间多尿的有用截止值仍存在争议。此外，目前认为最大排尿量（MVV）可以用作去氨加压素反应的预测指标。
本研究旨在评估不同的夜间多尿（及其频率）定义和 MVV 对预测去氨加压素反应的影响。
共纳入 103 例频繁单症状性夜间遗尿症（≥4 个湿夜/周）患者。收集 4 天的膀胱日记。MVV 定义为膀胱日记中检测到的最高排尿量。在 5 个湿夜中测量夜间尿量。然后，患者给予 120 mcg 舌下含服去氨加压素。如果 2 个月后没有完全反应，则将剂量增加至 240 mcg。夜间多尿定义如下：1. 定义 1：夜间尿量超过预期膀胱容量（EBC）的 130%。2. 定义 2：>100% EBC。3. 定义 3：>20×（年龄+9）mL。主要结局是治疗 3 个月后的“去氨加压素反应”。
53 例患者对去氨加压素有反应。根据三种夜间多尿定义比较去氨加压素的反应，未发现显著差异。以 EBC 表示的夜间多尿的截止值无显著意义的接收者操作特征（ROC）曲线。以 EBC 表示的 MVV 的 ROC 曲线下面积为 0.67（95%置信区间 [CI]，0.54-0.80；p=0.01）。MVV>103.1%EBC 对预测去氨加压素反应的灵敏度为 78.8%（95%CI，61.1-91.0），特异性为 47.5%（95%CI，31.5-63.9）。根据定义 1 有夜间多尿的患者中，4 个或 5 个湿夜中有夜间多尿的患者对去氨加压素的反应率高于其他患者。根据定义 3，5 个湿夜中有夜间多尿的患者对去氨加压素的反应率为 100%。多变量分析显示，唯一对去氨加压素有显著比值比（OR）的是至少有 3 个夜间有夜间多尿的患者（OR=7.1，95%CI，1.3-40.3）。
根据所有三种定义，至少有一个夜间存在或不存在夜间多尿，对预测去氨加压素反应并不有效。去氨加压素反应的预测指标是根据定义 1 有 3 个或更多夜间有夜间多尿和根据定义 3 有 5 个湿夜有夜间多尿。
