Controlling enuresis

Imipramine has been used for years in the treatment of enuresis. Are there any studies of treatment based on increasing antidiuretic hormone (ADH) or on higher levels of sleep with normalization of the diurnal ADH cycle?
—Roderic A. Smith, MD, Garland, Tex.

Normally, about 50% less urine is excreted during the night than the daytime. This circadian pattern is a result of vasopressin excretion. Some children with enuresis do not produce an appropriate amount of vasopressin and therefore make more urine at night. Interestingly, the use of daytime diuretics or fluid restriction late in the day, in an effort to physiologically diminish nighttime urine output, does not seem to improve enuresis. Desmopressin acetate (DDAVP) nasal spray can be an effective treatment for this group of patients. Complete cure occurs in less than one third of patients. Because DDAVP is expensive, less effective than urinary alarms worn on the body, and may be associated with serious side effects, it should not be used as a first-line therapy to treat enuresis (Walsh PC, Retik AB, Vaughan ED, et al, eds. Campbell's Urology. 8th ed. Philadelphia, Pa.:WB Saunders; 2002:2273-2280).
—David T. Noyes, MD (109-8)

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