Purpose: We evaluate the therapeutic effectiveness of treating monosymptomatic primary nocturnal enuresis (PNE) that has persisted into adulthood.
Materials and methods: Patients older than 18 years with persistent monosymptomatic primary nocturnal enuresis were treated with 20 to 40 microg. desmopressin (DDAVP) nightly for 6 months. If the patients remained incontinent on maximal pharmacotherapy or if they became incontinent after cessation of DDAVP we initiated treatment with an enuretic alarm for 6 months. Patients not responsive to DDAVP or the enuresis alarm were given a trial of 50 mg. imipramine nightly. All patients were reassessed for continence 18 months after initiation of the treatment protocol.
Results: We treated 29 patients of a median age of 20 years (range 18 to 33) who were enuretic more than 4 nights per week. With the initial DDAVP treatment 19 (66%) became continent (enuresis 0 or 1 night a month) but after discontinuation of DDAVP only 2 (7%) remained continent. Of the 27 patients subsequently treated with an enuretic alarm 9 (33%) became continent and 18 had persistent enuresis. Of these 18 patients 11 resumed DDAVP and became dry, while 7 nonresponsive to DDAVP were given imipramine and 2 (29%) are continent.
Conclusions: Overall, 83% of patients (24 of 29) achieved continence, including 38% (11 of 29) who are continent off all treatment modalities and 45% (13 of 29) who are currently continent on pharmacotherapy (11 on DDAVP and 2 on imipramine). The remaining 17% of patients (5 of 29) have persistent primary nocturnal enuresis recalcitrant to all therapeutic attempts.