Nocturnal enuresis treated by Minirin
A 12 year old boy suffers from nocturnal enuresis. He underwent a specialist examination, who advised a therapy with Minirin. Under minimal dosage of Minirin enuresis stopped. But as soon as the treatment was interrupted, the enuresis showed up again.
1. Is there a solving therapy?
2. If the answer to the previous question is no, do you think that this disorder will clear up spontaneously? If yes, by what age?
3. Do you think that keep taking Minirin for long periods at the dosage indicated could produce side effects? If yes, please, list them.
A 12 year old boy suffers from nocturnal enuresis. His sister suffered from the same problem in childhood. She, however, solved the problem spontaneously at the age of 11. For this reason, the boy was clinically evaluated only from 11 years on, when it was clear that enuresis would not have been solved in a natural way.
He underwent a specialist examination, who advised a therapy with Minirin that the young patient has already been taking for 14 months and, in particular, for 6 months at a minimum dosage of 60 mcg in the evening. The specialist confirmed it was a minimum dosage, nearly “homeopathic”, that, however, turned out to be extremely effective. In fact, as soon as the treatment was interrupted, the enuresis showed up again. In other words, the boy, if not awaken, wets the bed and, as his sleep is very deep, he realizes this only when he wakes up.
I assume that his renal US and VCUG are both normal. In the absence of anatomical problems, I think that this boy will spontaneously outgrow his enuresis. DDAVP, if given under close supervision, could be used for a prolonged period of time.
My inclination for this patient is to advice:
1- Oral fluid restriction after 6 pm.
2- Continue with the awakening routine or alternatively use an antienuretic alarm.
3- The awakening routine and the alarm could be used in combination with DDAVP under close supervision.
4- The family should be advised to keep a calendar with the dry and wet nights, and the boy should be rewarded if he stays dry during at least one month (positive reinforcement therapy).
5- The family must be told that eventually their son will outgrow his condition, thus, avoiding undue psychological stress on the patient.
6- If the renal US, VCUG, urinalysis, urine culture are normal I see no need for any other additional tests