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Pediatrics International : Official... 2023Nocturnal enuresis is defined as intermittent urinary incontinence during sleep in children 5 years of age and older, occurring at least once a month for at least... (Review)
Review
Nocturnal enuresis is defined as intermittent urinary incontinence during sleep in children 5 years of age and older, occurring at least once a month for at least 3 months. In Japan, pediatricians who do not specialize in nocturnal enuresis have become more proactive in treating the condition since 2016, when the guidelines for treating it were revised for the first time in 12 years. For monosymptomatic nocturnal enuresis, the first step is lifestyle guidance, with a focus on the restriction of fluid intake at night; however, if lifestyle guidance does not decrease the frequency of nocturnal enuresis, aggressive treatment should be added. The first choice of aggressive treatment is oral desmopressin, an antidiuretic hormone preparation, or alarm therapy. However, there remain patients whose wet nights do not decrease with oral desmopressin or alarm therapy. In such cases, it is necessary to reconfirm the method of desmopressin administration and check for factors that may decrease the efficacy of desmopressin. If alarm therapy does not increase the number of dry nights, it is possible that the patient is fundamentally unsuitable for alarm therapy. If dry nights do not increase with oral desmopressin or alarm therapy, the next treatment strategy should be considered immediately to keep the patient motivated for treatment.
Topics: Nocturnal Enuresis; Humans; Cholinergic Antagonists; Adrenergic beta-3 Receptor Agonists; Deamino Arginine Vasopressin; Antidiuretic Agents
PubMed: 37428825
DOI: 10.1111/ped.15573 -
BMJ (Clinical Research Ed.) Feb 2019
Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Endocrinology; Humans; Male; Osmolar Concentration; Polydipsia; Polyuria; United Kingdom; Young Adult
PubMed: 30819684
DOI: 10.1136/bmj.l321 -
Current Urology Reports Jun 2020The goal of this paper is to describe the pathophysiology of adult nocturnal enuresis and develop a generalized approach for evaluation and treatment. (Review)
Review
PURPOSE OF REVIEW
The goal of this paper is to describe the pathophysiology of adult nocturnal enuresis and develop a generalized approach for evaluation and treatment.
RECENT FINDINGS
Although nocturnal enuresis (NE) impacts a significant proportion of the adult population, research on this topic remains lacking. In the few existing studies, the management strategy is extrapolated from research on pediatric nocturnal enuresis. Furthermore, treatment approaches highlight the importance of identifying risk factors and contributing pathologies. The modern urologist should understand the complexity of this problem and the variety of techniques to evaluate and treat the adult patient with NE. Adult nocturnal enuresis is multifactorial and may have multiple underlying pathologies. A comprehensive workup requires an understanding of the patient's history and symptomatology and the pathophysiologic processes that can occur. Treatment should first target identifiable etiologies, although a generalized algorithm can then be utilized with behavioral and lifestyle modifications, followed by medical therapy. Future studies will provide a better framework for treating this problem.
Topics: Adult; Algorithms; Antidiuretic Agents; Behavior Therapy; Cholinergic Antagonists; Deamino Arginine Vasopressin; Humans; Nocturnal Enuresis; Risk Reduction Behavior
PubMed: 32506170
DOI: 10.1007/s11934-020-00983-2 -
Current Urology Reports Nov 2019Nocturia is defined as awakening due to the desire to void during a period of intended sleep. The pathophysiology of nocturia is multifactorial and management remains a... (Review)
Review
PURPOSE OF REVIEW
Nocturia is defined as awakening due to the desire to void during a period of intended sleep. The pathophysiology of nocturia is multifactorial and management remains a challenge. Herein, we provide an overview of the management strategies for nocturia and summarize the existing evidence for treatment of nocturia across the condition's broad etiologic categories: nocturnal polyuria, diminished bladder capacity, and global polyuria.
RECENT FINDINGS
Treatment should begin with behavioral modification. A high level of evidence supports the efficacy of desmopressin in the treatment of nocturnal polyuria. Data supporting the efficacy of α-blockers, antimuscarinics, and surgical bladder outlet procedures in the treatment of nocturia remains limited. Treatment options for nocturia are determined by underlying mechanism. Desmopressin is effective in treating nocturnal polyuria. Surgical intervention, α-blockers, and antimuscarinics may improve nocturia when associated with lower urinary tract symptoms or overactive bladder in the setting of diminished bladder capacity.
Topics: Adrenergic alpha-Antagonists; Antidiuretic Agents; Behavior Therapy; Deamino Arginine Vasopressin; Humans; Lower Urinary Tract Symptoms; Muscarinic Antagonists; Nocturia; Organ Size; Polyuria; Urinary Bladder; Urinary Bladder, Overactive
PubMed: 31707521
DOI: 10.1007/s11934-019-0940-2 -
Blood Sep 2022
Topics: Adolescent; Deamino Arginine Vasopressin; Exercise; Factor VIII; Hemophilia A; Humans; Male; von Willebrand Diseases
PubMed: 36074536
DOI: 10.1182/blood.2022017652 -
Journal of Pain & Palliative Care... 2018The authors report a case of diabetes insipidus (DI) associated with a ketamine infusion. A 42-year-old Asian man underwent an exploratory laparotomy and splenectomy who...
The authors report a case of diabetes insipidus (DI) associated with a ketamine infusion. A 42-year-old Asian man underwent an exploratory laparotomy and splenectomy who was admitted to the surgical intensive care unit (ICU) for postoperative management. Pain control was attempted with escalating dose of opioids but was inadequate, prompting the addition of a ketamine infusion. Shortly after initiation, a massive rise in urine output ensued in addition to a change in his urine electrolyte studies, leading to the diagnosis of drug-induced diabetes insipidus. Ketamine was discontinued, and treatment with subcutaneous desmopressin was initiated. Treatment was continued for a total of 5 days, which resulted in a resolution of his DI. This report suggests that the patient likely experienced a medication-induced DI, which was successfully resolved through proper identification of the causative agent, removal, and subsequent treatment with desmopressin. Causality assessment between ketamine and DI was determined using the Naranjo Adverse Drug Reaction Probability Scale-a total score of 7 was achieved and thus identified the adverse drug reaction as probable. Clinicians should be aware of the possibility that ketamine may be contributory in a patient with unexplained DI.
Topics: Adult; Analgesics; Analgesics, Opioid; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Ketamine; Laparotomy; Male; Pain, Postoperative; Splenectomy
PubMed: 30702377
DOI: 10.1080/15360288.2018.1508111 -
Thrombosis Research Dec 2020The deficiency or abnormal activity of von Willebrand factor, a multi-adhesive protein which binds platelets to exposed subendothelium and carries factor VIII in... (Review)
Review
The deficiency or abnormal activity of von Willebrand factor, a multi-adhesive protein which binds platelets to exposed subendothelium and carries factor VIII in circulation, is responsible for von Willebrand disease, the most frequent inherited bleeding disorder. Clinical symptoms are characterized by mucous membrane and soft tissue bleeding, bleeding after surgery and rarely joint and gastrointestinal bleeding. Intriguingly, also factor VIII, the protein deficient in hemophilia A, may be variably reduced because VWF stabilizes it into circulation. Treatment strategies are well designed for patients with levels of VWF activity <30 U/dL, while the diagnosis and the magnitude of risk may be difficult to be assessed accurately for subjects with levels between 30 and 50 U/dL. Three types of the disorder have been identified according to partial (type 1) or severe VWF quantitative deficiency (type 3) while patients who present variable abnormality of VWF structure are categorized as type 2. The aim of treatment is to correct either the abnormal/reduced von Willebrand factor and the associated deficiency of factor VIII, when present. Desmopressin is able to transiently correct the deficiency of FVIII and VWF for up to 8-12 h in a significant proportion of patients with type 1 von Willebrand disease and factor VIII and von Willebrand factor levels ≥10 U/dL. When desmopressin is not usual (mainly in patients with type 2 and 3 VWD) or correction is required cannot be used for an extended time (e.g., major surgery), von Willebrand factor-containing concentrates, with or without FVIII, must be used.
Topics: Deamino Arginine Vasopressin; Factor VIII; Hemophilia A; Hemorrhage; Humans; von Willebrand Disease, Type 1; von Willebrand Diseases; von Willebrand Factor
PubMed: 32819724
DOI: 10.1016/j.thromres.2020.07.051 -
Minerva Urologica E Nefrologica = the... Feb 2016Nocturnal enuresis (NE) is a common disorder in children. Choice of treatment depends on the frequency and severity of symptoms, the child's age and motivation.... (Review)
Review
Nocturnal enuresis (NE) is a common disorder in children. Choice of treatment depends on the frequency and severity of symptoms, the child's age and motivation. Treatment options for NE are alarm, desmopressin and imipramine. In particular, the main desmopressin therapeutical effect is the antidiuretic activity. The different formulations of desmopressin are an injectable solution, an oral tablet formulation and the recent oral lyophilisate (MELT). MELT with its higher biodisponibility guarantees the same therapy response of other formulations with a lower doses and it represents the first line and safety treatment for the NE.
Topics: Administration, Oral; Antidiuretic Agents; Child; Deamino Arginine Vasopressin; Humans; Italy; Nocturnal Enuresis; Prevalence; Treatment Outcome
PubMed: 24990391
DOI: No ID Found -
Pediatric Nephrology (Berlin, Germany) Jul 2018Nocturnal enuresis (NE) is a common health problem. Approximately 10% of 7-year-old children wet the bed regularly during sleep. Enuresis can be categorized into... (Review)
Review
Nocturnal enuresis (NE) is a common health problem. Approximately 10% of 7-year-old children wet the bed regularly during sleep. Enuresis can be categorized into monosymptomatic (MEN) and nonmonosymptomatic (NMEN) forms. MEN occurs without any other symptoms of bladder dysfunction. NMEN is associated with dysfunction of the lower urinary tract with or without daytime incontinence. The rate of comorbid gastrointestinal, behavioral, and emotional disorders is elevated depending upon the subtype of NE. A careful clinical history is fundamental to the evaluation of enuresis. Diagnostic procedures include medical history and psychological screening with questionnaires, bladder and bowel diary, physical examination, urinalysis, ultrasound, and examination of residual urine. The mainstay of treatment is urotherapy with information and psychoeducation about normal lower urinary tract function, the underlying cause of MEN, disturbed bladder dysfunction in the child with NMEN and instructions about therapeutic strategies. Alarm therapy and the use of desmopressin have been shown to be effective in randomized trials. Children with NMEN first need treatment of the underlying daytime functional bladder problem before treatment of nocturnal enuresis. In patients with findings of overactive bladder, besides urotherapy, anticholinergic drugs may be useful.
Topics: Affective Symptoms; Biofeedback, Psychology; Child; Cholinergic Antagonists; Comorbidity; Deamino Arginine Vasopressin; Gastrointestinal Diseases; Humans; Nocturnal Enuresis; Patient Education as Topic; Problem Behavior; Psychometrics; Randomized Controlled Trials as Topic; Treatment Outcome; Ultrasonography; Urinalysis; Urinary Bladder; Urodynamics
PubMed: 28828529
DOI: 10.1007/s00467-017-3778-1 -
The Journal of Clinical Endocrinology... Nov 2022The desmopressin test was first described 30 years ago. Based on the differential secretagogue properties of desmopressin on adrenocorticotropin (ACTH) release between... (Review)
Review
The desmopressin test was first described 30 years ago. Based on the differential secretagogue properties of desmopressin on adrenocorticotropin (ACTH) release between normal and corticotroph tumor cells, this test was intended to facilitate the diagnosis of Cushing syndrome (CS). The distinct expression of the various arginine vasopressin receptors between normal pituitary, corticotroph tumors, or neuroendocrine tumors cells secreting ACTH ectopically suggested that this test could facilitate the etiological diagnosis of ACTH-dependent CS. In this review, we analyze the merits and pitfalls of desmopressin use in the diagnostic procedures of CS. Desmopressin response is not able to completely differentiate the various etiologies of CS; its wider availability has allowed its use for inferior petrosal sinus sampling confirmation of a pituitary source of ACTH excess. In addition, desmopressin can be useful to demonstrate adequate corticotroph tumor resection when its stimulatory effect is lost following pituitary surgery of patients with Cushing disease. Desmopressin response can also be a marker of the risk of longer-term postoperative recurrence. However, this review also highlights the lack of consensual criteria of normal or abnormal response to desmopressin in its various uses and requirement for further research on its usefulness.
Topics: Humans; Cushing Syndrome; Deamino Arginine Vasopressin; ACTH Syndrome, Ectopic; Hydrocortisone; Petrosal Sinus Sampling; Adrenocorticotropic Hormone; Diagnosis, Differential
PubMed: 36103267
DOI: 10.1210/clinem/dgac533