Most patients with monosymptomatic
nocturnal enuresis can be effectively treated with an
enuresis alarm or antidiuretic
therapy (
desmopressin), depending on the pathophysiology of the condition in the individual patient.
Desmopressin is first-line
therapy for
enuresis caused by nocturnal
polyuria, an excessive urine output during the night. However, in a recent study, around one-third of patients thought to be resistant to
desmopressin were subsequently treated effectively with
desmopressin monotherapy in a specialist centre. The aim of this article is to review best practice in selecting patients for
desmopressin treatment, as well as outline eight recommendations for maximizing the chances of treatment success in patients receiving
desmopressin. The roles of formulation, dose, timing of administration, food and fluid intake, inter-individual variation in response,
body weight, adherence, withdrawal strategies and combination
therapies are discussed in light of the most recent research on
desmopressin and
enuresis. Possible reasons for suboptimal treatment response are explored and strategies to improve outcomes in patients for whom
desmopressin is an appropriate
therapy are presented. Through optimization of the treatment plan in primary and specialist care centres, the hope is that fewer patients with this distressing and often embarrassing condition will experience unnecessary delays in receiving appropriate care and achieving improvements.