Amitriptyline in childhood enuresis. A comparison of amitriptyline, vasopressin and amitriptyline with vasopressin in nocturnal enuresis. Nocturnal enuresis: a placebo controlled trial of two antidepressant drugs. A controlled comparison of two treatments for nocturnal enuresis. Imipramine in childhood nocturnal enuresis: relationship of time of administration to effect. Desipramine in the treatment of enuresis. A prostaglandin synthesis inhibitor, diclofenac sodium in the treatment of primary nocturnal enuresis. General practitioners' forum. Imipramine in the treatment of childhood enuresis. Hypnosis and self-hypnosis in the management of nocturnal enuresis: a comparative study with imipramine therapy. Treatment of enuresis: a study with imipramine, amitriptyline, chlordiazepoxide-clidinium and piracetam. Viloxazine versus imipramine in the treatment of enuresis. Imipramine in childhood enuresis: further studies on the relationship of time of administration to effect. [Management of primary nocturnal enuresis in school children with slow learning ability: usefulness of imipramine]. Desmopressin and imipramine in the management of nocturnal enuresis: a multicentre study. Evaluation of various methods in treatment of enuresis. Effects of different methods of treatment of primary enuresis on psychologic functioning in children. Effect of Tofranil on enuretic boys. An investigation into the effects of imipramine hydrochloride on the incidence of enuresis in institutionalized children. Nocturnal enuresis: a study. Amitryptiline in the treatment of enuresis. Primary enuresis: relative success of three methods of treatment. Enuresis--a comparative study of imipramine and tranquillisers in its management. Enuresis: a descriptive analysis and a controlled trial. A controlled trial of imipramine ('Tofranil') and nortriptyline ('Allegron') in the treatment of enuresis. A controlled clinical trial of trimipramine and placebo in the treatment of enuresis. Enuresis and psychoactive drugs. [Enuresis nocturna. A double-blind study with furosemide, imipramine and placebo]. Mode of action and relative value of imipramine and similar drugs in the treatment of nocturnal enuresis. Enuresis--a study in general practice. [Treating enuresis nocturna by a combination of medicines and conditioning]. Imipramine pamoate in the treatment of childhood enuresis. A double-blind study. Comparison of effects of treatment of primary nocturnal enuresis with oxybutynin plus desmopressin, desmopressin alone or imipramine alone: a randomized controlled clinical trial. Treatment of enuretic children with imipramine (Tofranil). [Psychopharmacological aspects of the use of imipramine in enuresis in 26 deaf-mutes]. [Enuresis nocturna in school children in Bodö. A therapeutic trial with a vasopressin analog: desmopressin and imipramine]. A controlled trial of imipramine ('Tofranil') in the treatment of childhood enuresis. Enuresis: an analysis of 82 cases. Combination therapy of imipramine with oxybutynin in children with enuresis nocturna. [A controlled therapeutical attempt to treat sixty-two enuretic children with Tofranil mite]. The efficacy of imipramine in the management of enuresis.
nan Forty-five children aged 6-14 years with primary nocturnal enuresis were randomised to determine whether desmopressin is more effective than amitriptyline and whether the combination of amitriptyline/desmopressin is more effective than amitriptyline or desmopressin alone. Amitriptyline dosage was 25 mg for children 6-10 years and 50 mg for children aged 10-14 years. Desmopressin (20 micrograms) was given in the same dosage for all age groups. After a run-in period of 2 weeks, children were treated for 16 weeks and then observed for 12 weeks. In the amitriptyline group mean wet nights per week decreased from 5.8 +/- 0.9 to 3.3 +/- 1.9 (P < 0.0005); in the desmopressin group mean wet nights per week decreased from 6.0 +/- 0.9 to 4.7 +/- 1.7 (P < 0.02); in the amitriptyline/desmopressin group mean wet nights per week decreased from 6.3 +/- 0.9 to 3.3 +/- 2.5 (P < 0.0006). When comparing the groups, amitriptyline/desmopressin and amitriptyline were statistically more effective than desmopressin in week 6 (P < 0.009), week 8 (P < 0.03) and week 10 (P < 0.04). No significant side effects occurred. At this dose amitriptyline was more effective than desmopressin and the combination of desmopressin and amitriptyline did not confer any additional benefit. A multicentre, randomised, double blind treatment trial was set up comparing imipramine (a tricyclic antidepressant with anticholinergic action), mianserin (a quadricyclic antidepressant without anticholinergic activity), and placebo, (a) possibly to identify an effective alternative drug and (b) to elucidate the action of imipramine in enuretic children. Eighty children (65 boys, 15 girls) aged 5-13 years, wet three or more nights a week, were studied. Exclusions were a urinary tract infection or abnormality, other organic illness, or severe emotional disorders. After a four week assessment, 25 children were randomised to eight weeks' treatment with imipramine 25 mg, 26 to mianserin 10 mg and 29 to placebo, followed by four weeks without treatment. Dry nights and a wetness score were recorded throughout. During treatment, imipramine was superior to both placebo and mianserin (p < 0.001) in achieving dry nights and reducing wetness scores. It led to a definite improvement in 72% of children. Mianserin produced a mildly beneficial effect that was not superior to placebo. No side effects were recorded. Mianserin would not be a satisfactory alternative treatment for nocturnal enuresis. The efficacy of imipramine is unlikely to be the result of its antidepressant activity. This study assessed change in the frequency of primary nocturnal enuresis as produced by either behavioral conditioning with a urine alarm, pharmacotherapy with imipramine hydrochloride, or assignment to a clinical waiting list. The study also investigated the effect of treatment method and outcome on subjects' level of emotional and behavioral adjustment. An attempt was made to identify pretreatment predictors of treatment outcome and premature withdrawal from the treatment program. The results indicated a significantly more effective outcome for the conditioning approach. Comparison of pre- and post-treatment measures of adjustment provided insufficient evidence to support the hypotheses that either change in the frequency of nighttime wetting or the method of treatment received would influence the subject's level of emotional and behavioral adjustment. The enuresis tolerance scale was found to be a highly significant predictor of early termination from conditioning treatment. nan nan Various treatment modalities have been used in Primary Nocturnal Enuresis (PNE) and pharmacotherapy is widely accepted. Prostaglandins increase detrusor pressure, decrease urethral pressure and lead to sodium excretion. They also antagonize hydro-osmotic effect of vasopressin by competing with this hormone. According to these functions of prostaglandins it is suggested that inhibition of prostaglandin synthesis may have value in the management of PNE. We evaluated the efficacy or oral diclofenac sodium treatment in 78 patients. We conclude that diclofenac sodium, an inhibitor of prostaglandin synthesis, is a good alternative agent for nocturnal enuresis particularly as a supplementary treatment combined to Imipramine, with 60% complete response and 13.3% recurrence rate. nan Various therapeutic modalities have been used for treating enuresis due to the lack of a single identifiable cause. We carried out a comparative study of imipramine and direct hypnotic suggestions with imagery used for the management of functional nocturnal enuresis. Enuretic children, ranging in age from 5 to 16 years, underwent 3 months of therapy with imipramine (N = 25) or hypnosis (N = 25). After termination of the active treatment, the hypnosis group continued practicing self-hypnosis daily during the follow-up period of another 6 months. Of the patients treated with imipramine, 76% had a positive response (all dry beds); for patients treated with hypnotic strategies, 72% responded positively. At the 9-month follow-up, 68% of patients in the hypnosis group maintained a positive response, whereas only 24% of the imipramine group did. Hypnosis and self-hypnosis strategies were found to be less effective in younger children (5-7 years old) compared to imipramine treatment. The treatment response was not related to the hypnotic responsivity of the patient in either group. nan nan nan A comparative, longitudinal, blind prospective study was carried out in 20 students between the ages of 6 and sixteen with primary nocturnal bedwetting and slow learning abilities from the Fray Antonio Alcalde school, in order to evaluate the use of motivating reinforcement techniques, exercises in order to improve bladder function and treatment with imipramine. All of the patients were given motivation reinforcement and bladder exercises. They were later divided into two groups of 10 children; group A was given a placebo while group B was given imipramine. In group A a significant decrease was seen in the average number of days the children woke wet after the sixth month of treatment (13.2 +/- 9.7 days to 3.7 +/- 7.15 days) with P less than 0.05; and in group B since the fourth month (16.6 +/- 7.8 days to 8.1 +/- 8.3 days) with a P less than 0.05. At the end of the study, seven patients from group A and five patients from group B decreased in over 80% the number of days which they woke up wet. The motivating reinforcement and the exercises used to improve bladder functional capacity are useful in the management of primary nocturnal enuresis. Imipramine, when combined with these other routines can shorten the time towards a favorable response. The efficacy and safety of desmopressin (Minirin/DDAVP) treatment compared with imipramine were investigated in a multicentre, open, cross-over design in 57 patients, aged 6-15 years, affected by nocturnal enuresis to establish the best therapeutic approach to this condition. After a two-weeks observation and control period, patients were randomised to one of two groups: intranasal administration of desmopressin, 30 micrograms/day for three weeks, followed by imipramine, 0.9 mg/kg for a further three weeks, or imipramine 0.9 mg/kg for three weeks, followed by desmopressin, 30 micrograms/day for a further three weeks. Following treatment, all patients were observed for a further two weeks. Administration of either treatment protocol resulted in a statistically significant decline in the number of enuretic episodes per week compared to the control. The greater antidiuretic effect observed in the group receiving imipramine followed by desmopressin suggests the two compounds have different profiles. Also, when the treatment period was compared with the follow-up, the antidiuretic effect had a longer duration in the group initially given imipramine. No further improvement was seen when desmopressin was administered first, with a mild worsening of the effect sometimes occurring, suggesting a different carry-over effect between the two treatments. This suggests that desmopressin offers a better approach to the management of nocturnal enuresis. nan Sixty-two children with primary nocturnal enuresis were assigned randomly to one of two groups. Group 1 was treated with imipramine hydrochloride, and group 2 received a course of treatment with the Mozes Detector. Seventeen children from group 1 and 18 from group 2 were tested with the age-appropriate form of the Cattell personality questionnaire on three occasions: at the time of entry into the study, 2 months later and at follow-up, an average of 16 months later. The patients in group 2, who were older, had a higher rate of cure than did the patients in group 1. They also had significantly higher levels of extroversion and significantly lower levels of neuroticism at follow-up than did those in group 1. These findings indicate that better results are seen with the Mozes Detector than with imipramine in older children with primary nocturnal enuresis. nan nan nan nan A total of 169 children with primary enuresis were treated by one of three methods--use of a special diet, imipramine, or a waking device (the Mozes detector). Of 64 who received the diet 1 (1.6%) was cured; of 62 who were treated with imipramine 13 (20.9%) were cured; and of 43 who used the detector 23 (53.5%) were cured. Results at follow-up remained substantially unchanged for cure. Improvement rate without cure during treatment was higher for the children treated with imipramine than for those treated with the detector, but at follow-up the reverse was true. Parents of children who received the special diet, because they were unimpressed by the rate of improvement, would not permit their children to continue this form of therapy for longer than 1 or 2 months. nan nan nan nan nan nan nan nan nan nan We prospectively evaluated the efficacy of a combination of desmopressin and oxybutynin for treating children with nocturnal enuresis, compared to the single drugs imipramine and desmopressin.
                We enrolled 158 patients from 2003 to 2004. Children were randomly assigned to 1 of 3 groups and treated with desmopressin, imipramine or a combination of desmopressin plus oxybutynin. Of these patients 145 (100 boys and 45 girls, mean age 7.8 +/- 2.5 years, range 5 to 15) were followed for more than 6 months. Efficacy was measured at 1, 3 and 6 months in terms of average enuretic frequency, 5-scale response based on change in nocturnal enuretic frequency after treatment and posttreatment enuretic frequency as a percentage of pretreatment baseline frequency. The latter efficacy was classified according to daytime voiding symptoms. Statistical evaluation was performed using chi-square tests and ANOVA.
                Of the 145 children followed 48 received combination therapy, 49 received desmopressin and 48 received imipramine. A total of 68 patients (47%) had monosymptomatic enuresis and 77 (53%) had polysymptomatic enuresis. Combination therapy produced the best and most rapid results regardless of whether the children had monosymptomatic or polysymptomatic enuresis.
                Combination therapy with desmopressin plus oxybutynin for the treatment of pediatric nocturnal enuresis was well tolerated, and gave significantly faster and more cost-effective results than single drug therapy using either desmopressin or imipramine. nan nan nan nan Of 400 children over the age of four years, 82 (20.5%) were found to be enuretics. Enuresis was found to be statistically higher (p less than 0.001) in lower social class and between the age group 3 to 5 years. Enuresis was found to be significantly more among boys as compared to girls (p less than 0.001). Various stress factors (e.g. negligence, overprotection, strictness of parents etc) and other associated habit disorders (e.g. fear reactions, nailbiting, temper-tantrums etc) were significantly higher (p less than 0.001) in enuretics as compared to control group. The group who was put on combined drug (imipramine) and psychological treatment showed a better long term response than the patients who were put only on drug or psychological treatment (p less than 0.001). The treatment approach for enuresis is controversial due to the lack of consensus as to the exact causes of nocturnal enuresis. Despite various treatment modalities, pharmacotherapy still appears to be the common choice. The aim of this prospective study was the evaluation of the efficacy of combination therapy (imipramine and oxybutynin) in patients with enuresis nocturna.
                This prospective study was done with 77 monosymptomatic nocturnal enuretics between July 1996 and December 1998.
                Even though there is no statistically significant difference between combination therapy (imipramine plus oxybutynin) and monotherapy, clinical data showed that combination therapy is more effective.
                We conclude that combination of imipramine with oxybutynin is a safe and new choice in the treatment of nocturnal enuresis.
                Copyright 2000 S. Karger AG, Basel nan nan
Although tricyclics and desmopressin are effective in reducing the number of wet nights while taking the drugs, most children relapse after stopping active treatment. In contrast, only half the children relapse after alarm treatment. Parents should be warned of the potentially serious adverse effects of tricyclic overdose when choosing treatment. Further research is needed into comparisons between drug and behavioural or complementary treatments, and should include relapse rates after treatment is finished.