Follow-up Survey On Children With Severe Nocturnal Enuresis Treated By Combined Drugs

ObjectiveTo study the long-term efficacy of triple drugs (DDAVP+oxybutynin+amitriptyline) on children with severe nocturnal enuresis 1-5 years after the short-term treatment; to investigate effects of these drugs on the children's growth and development such as height and nutritional status; to evaluate potential adverse reactions of the triple drug therapy, possibility of the drugs induced severe diseases,academic achievements of the children in schools and parents' perspectives on nocturnal enuresis after the treatment.MethodsThe children with severe nocturnal enuresis were diagnosed at the Shenzhen People's Hospital, all the patients accepted the treatment of the triple drugs,the cured patients were included after the standard therapeutic course and followed up for 1-5 years by telephone call, data such as weight,height,bladder capacity,recurrence of enuresis,side effects of the drugs,other serious diseases, academic achievements and parents'perspectives on nocturnal enuresis were collected and all the data were analyzed by SPSS 13.0 software.Results1 The short-term efficacy (3 months) by the triple drugs was significant and 92% of the children with sever nocturnal enuresis were cured2 Long term efficacy of the treatment on the severe nocturnal enuresis patients 1-5 years after the drug withdrawalThe patients completely without enuresis increased year by year after the treatment. There was no significant difference for the efficacy between the groups three months and one year after the drug withdrawal(P<0.05) but there were significant differences for the efficacy among the groups three months,3-years and 5-year after the drug withdrawal (P<0.05). Small part of the children still had enuresis, but the frequency of enuresis in the vast majority of them was less than 1-3 times per month,there was no need to further drug therapy for them;there was improvement of bladder capcity after the therapy for the children with reduction of functional bladder capcity, there was significant difference for the bladder capcities between prior to and post the therapy(P<0.05). 3 Effects of the drugs on the children's growth and development such as height and nutritional statusThere were no significant difference for the height percentiles and the nutritional status before and after treatment(P> 0.05) in the children with severe nocturnal enuresis; only one child with short stature after 5years prieod treatment, there was significant difference in nutritional status in two different groups(P< 0.05).4 Potential adverse reactions of the triple drug therapy,possibility of the drugs induced severe diseases53 of the treated children (13%) had adverse reactions during the medication,most of them were common adverse reactions such as poor appetite (23 cases,34.85%), thirsty(15,22.73%), low spirits (12 cases,18.18%), headache(6 cases,9.09%), irritable temper(5 cases,7.58%), blurred vision(2 cases,3.03%), skin allergy(2 cases,3.03%). no patients discontinued the triple drug therapy due to adverse reactions except one child with relapsed tic disorders, the tic disorders were disappeared 3-4 weeks after the medication was discontinued.8 cases with mild abnormal liver function, no abnormal renal function, malignant tumors, epilepsy and neurologic diseases were found5 Academic achievements of the children in schools and parents'perspectives on enuresis after the treatmentThere was no significant difference on children academic level in the schools before and after the therapy two different(P> 0.05); there was improvement for parents'perspectives on nocturnal enuresis.ConclusionOur study shows that the long term efficacy of the triple drug treatment for severe enuresis is stable and reliable, the treatment is safe, no negative effects on the children's height and nutritional status; the adverse reactions are mild, no drug induced severe diseases such as malignant tumors, epilepsy and neurologic diseases. Whether there is improvement on the children's academic level in the schools after the therapy is still to be investigated.