Diuretic treatment of nocturnal enuresis

Objective. Nocturnal polyuria is considered a major pathogenetic factor in nocturnal enuresis, and the antidiuretic drug desmopressin, given at bed-time, is consequently recognized as a first-line treatment alternative. The aim of this open, non-randomized study was to see whether diuretic medication, given in the afternoon, could give similar therapeutic benefit. Material and methods. Sixty-three children suffering from primary, monosymptomatic, nocturnal enuresis were included in the study by their primary care paediatrician. After 14 days without any treatment and 14 days for which 0.4 mg of desmopressin was given orally at bed-time, the children were given furosemide 1 mg/kg in the afternoon for 14 consecutive days. The numbers of wet and dry nights were recorded. Results. The numbers of wet nights at baseline, during desmopressin treatment and during furosemide treatment were 10.2+/-3.5, 6.4+/-4.6 and 8.2+/-4.5, respectively. Both drugs were significantly better than no treatment, but only a small proportion of patients became completely dry: 24% on desmopressin and 12% on furosemide. Desmopressin was significantly better than furosemide. Three children who showed no therapeutic effect on desmopressin treatment had a favourable response to furosemide. Conclusion. Furosemide, given in the afternoon, has minor therapeutic potential in nocturnal enuresis.