Controversie
Enuresi e desmopressina
ENURESIS AND DESMOPRESSIN: WHY SHOULD WE USE IT?
MARIA LAURA CHIOZZA1, MARCO PENNESI2, 3LEOPOLDO PERATONER
1Clinica Pediatrica, UniversitĂ di Padova
2Dipartimento di Scienze della Riproduzione e dello Sviluppo, Clinica Pediatrica, IRCCS “Burlo Garofolo”, Università di Trieste
3UO di Pediatria, Azienda Ospedaliera “S. Maria degli Angeli”, Pordenone
Maggio 2002 - pagg. 318 -322
Abstract
WHY SHOULD WE USE IT?
The Author underlines that disturbances in three different areas (sleeping quality, bladder maturity and diuresis control) concur to the the pathogenesis of enuresis.Therefore the case management should take all of them into account. A diary of micturition, a study of quantity and quality of nocturnal urine, and a dosage of nocturnal adiuretine provide the guide for individualised management. Patients with prevalence of bladder instability (85% out of 173 children in the Author’s series) will respond better to behavioural treatment and bladder training, those woth nocturnal polyuria and hypoosmolar urines will be better managed with desmopressin. Patients with hypercalciuria and abnormal sodium reabsorption are more difficult to manage and should never be given desmopressin. WHY SHOULD WE NOT USE IT
The Author describes a series of 111 enuretic patients. 98% of them were polysymptomatic and showed signs of bladder instability. 31% suffered from behavioural stipsis as well. The management of enuresis can be symptomatic (desmopressin) behavioural (alarm), or cognitive (explanation of the mechanism of micturition and guided acquisition of control). The cognitive approach allowed the Author to obtain 63% of permanent remission of enuresis within 4 months from the beginning of treatment.
The Author underlines that disturbances in three different areas (sleeping quality, bladder maturity and diuresis control) concur to the the pathogenesis of enuresis.Therefore the case management should take all of them into account. A diary of micturition, a study of quantity and quality of nocturnal urine, and a dosage of nocturnal adiuretine provide the guide for individualised management. Patients with prevalence of bladder instability (85% out of 173 children in the Author’s series) will respond better to behavioural treatment and bladder training, those woth nocturnal polyuria and hypoosmolar urines will be better managed with desmopressin. Patients with hypercalciuria and abnormal sodium reabsorption are more difficult to manage and should never be given desmopressin. WHY SHOULD WE NOT USE IT
The Author describes a series of 111 enuretic patients. 98% of them were polysymptomatic and showed signs of bladder instability. 31% suffered from behavioural stipsis as well. The management of enuresis can be symptomatic (desmopressin) behavioural (alarm), or cognitive (explanation of the mechanism of micturition and guided acquisition of control). The cognitive approach allowed the Author to obtain 63% of permanent remission of enuresis within 4 months from the beginning of treatment.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Norgaard JP, Pedersen EB, Djurhuus JC.
Diurnal anti-diuretic-hormone levels in enuretics.
J Urol 1985;134:1029-31.
2. Zerqueni G, et al. Valutazione urodinamica. Atti del Congresso “Update on enuresis”, 28-9- 1996, pag. 43-7.
3. Chiozza ML, Scaccianoce C, Zacchello G. Familiarità per l’instabilità detrusoriale nei bambini con enuresi associata a disturbi minzionali diurni. Atti del XIV Congresso Nazionale della SINP, 1998, pag. 187.
4. Yeung CK, Chiu HN, Sits FK. Bladder disfunction in children with refractory monosymptomatic primary nocturnal enuresis. J Urol 1999;162(3):1049-54.
5. Moffat MEK, Harlos S, Kirshen AJ, Burd L. Desmopressin acetate and nocturnal enuresis: how much do we know? Pediatrics 1993; 92:420-5.
6. Kruse S, Hellestrom AL, Hjalmas K. Daytime bladder dysfunction in therapy-resistant nocturnal enuresis. A pilot study in urotherapy. Scand J Urol Nephrol 1999 Feb; 33(1):49-52.
7. Zerqueni G, et al. Approccio pediatrico all’enuresi. Atti del Congresso “Update on enuresis”, 28-9-1996, pag. 123-7.
2. Zerqueni G, et al. Valutazione urodinamica. Atti del Congresso “Update on enuresis”, 28-9- 1996, pag. 43-7.
3. Chiozza ML, Scaccianoce C, Zacchello G. Familiarità per l’instabilità detrusoriale nei bambini con enuresi associata a disturbi minzionali diurni. Atti del XIV Congresso Nazionale della SINP, 1998, pag. 187.
4. Yeung CK, Chiu HN, Sits FK. Bladder disfunction in children with refractory monosymptomatic primary nocturnal enuresis. J Urol 1999;162(3):1049-54.
5. Moffat MEK, Harlos S, Kirshen AJ, Burd L. Desmopressin acetate and nocturnal enuresis: how much do we know? Pediatrics 1993; 92:420-5.
6. Kruse S, Hellestrom AL, Hjalmas K. Daytime bladder dysfunction in therapy-resistant nocturnal enuresis. A pilot study in urotherapy. Scand J Urol Nephrol 1999 Feb; 33(1):49-52.
7. Zerqueni G, et al. Approccio pediatrico all’enuresi. Atti del Congresso “Update on enuresis”, 28-9-1996, pag. 123-7.