Drugs for nocturnal enuresis in children (other than desmopressin and tricyclics)
Abstract
Background
Enuresis (bedwetting) is a socially stigmatising and stressful condition which affects around 15 to 20% of five‐year olds and up to 2% of young adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs to the children can be great.
Objectives
To assess the effects of drugs other than desmopressin and tricyclics on nocturnal enuresis in children and to compare them with other interventions.
Search methods
We searched the Cochrane Incontinence Group Specialised Register of trials (searched 19 June 2007). The reference list of a previous version of this review was also searched.
Selection criteria
All randomised trials of drugs (excluding desmopressin or tricyclics) for nocturnal enuresis in children were included in the review. Trials were eligible for inclusion if children were randomised to receive drugs compared with placebo, other drugs or other conservative interventions for nocturnal bedwetting. Trials focused solely on daytime wetting were excluded.
Data collection and analysis
Two review authors independently assessed the quality of the eligible trials and extracted data.
Main results
In 33 randomised controlled trials (one new in this update), a total of 1268 out of 1700 children received an active drug other than desmopressin or a tricyclic. In all, 31 different drugs or classes of drugs were tested. The trials were generally small or of poor methodological quality (five were quasi‐randomised and the remainder failed to give adequate details about the randomisation process).
Although indomethacin and diclofenac were better than placebo during treatment, desmopressin was better than both of them and with less chance of adverse effects. There were no data regarding what happened after treatment stopped. Limited data suggested that an alarm was better than drugs during treatment.
Authors' conclusions
There was not enough evidence to judge whether or not the included drugs reduced bedwetting. There was limited evidence to suggest that desmopressin, imipramine and alarms were better than the drugs to which they were compared. In other reviews, desmopressin, tricyclics and alarm interventions have been shown to be effective.
PICOs
Plain language summary
Drug treatment for children with bedwetting (nocturnal enuresis) but not including the drug types desmopressin or tricyclics
Night‐time bedwetting is common in childhood and can cause stigma, stress and inconvenience. There is not enough reliable evidence to show that drugs (other than desmopressin or tricyclics) reduce night‐time bedwetting in children during treatment, but they do have unwanted side effects. In other Cochrane reviews, desmopressin, tricyclic drugs and alarms triggered by wetting have been shown to work. Alarms are more expensive than tricyclics, though less expensive than desmopressin, but may be more effective after treatment has finished. Alarms do not have the adverse effects of drugs.
