11/95. Cerebral oedema in enuretic children during low-dose desmopressin treatment: a preventable complication. Seven cases of cerebral oedema have been observed in enuretic children during low-dose desmopressin (DDAVP) treatment given in a dose of 7-21 microg daily in the czech republic between 1995 and 1999, after the drug started to be marketed for this indication and delivered in simple bottles with a dropper. All seven children (age 5-11 years, four boys) experienced a period of unconsciousness but all recovered without sequelae. In most cases, safety measures were underestimated and natraemia was not regularly controlled. Two children developed cerebral oedema after excessive water intake in preparation for uroflowmetry, another one drank much during a hot summer day, in one diabetes insipidus was not recognised and two children were clearly non-compliant with reduced fluid intake on a long-term basis. Only in one child, no risk factor was found. Conclusion. Proper selection and instruction of patients is needed to avert cerebral oedema during treatment with desmopressin for nocturnal enuresis. ( info) |
| Desmopressin, a synthetic analogue of the antidiuretic hormone, is an effective medication for primary nocturnal enuresis for both children and adults. Its safety is well established. Although it has a favorable side effect profile, because of its pharmacological effect, intranasal desmopressin can rarely induce water intoxication with profound hyponatremia if given without adequate restriction of water intake. The authors describe an adult patient with water intoxication and severe hyponatremia accompanied by loss of consciousness and seizures after 2-day intranasal administration of desmopressin. The present and the previously reported cases emphasize the need for greater awareness of the development of this serious and potentiallyfatal complication. In addition, to adjust the drug to the lowest required dosage, adequate restriction of water intake is recommended, and serum levels of sodium should be measured periodically to allow for early detection of water intoxication and hyponatremia. ( info) |
13/95. Retrovesical echinococcal cyst causing renal failure and nocturnal enuresis in a child. Although retrovesical hydatid cysts are observed in adulthood albeit very rarely, to our knowledge there is no case reported in childhood. In the current case, a huge retrovesical hydatid cyst caused obstructive uropathy, polydipsia, and secondary nocturnal enuresis in a child. Because the retrovesical hydatid cyst was firmly adherent to the neighboring structures, partial cystectomy could be performed. Perioperative and postoperative complications did not occur, and the symptoms relieved in the early postoperative period. ( info) |
14/95. DDAVP-associated hyponatremia. More than 250,000 patients with nocturnal enuresis have been treated with DDAVP in the united states since 1989. It adequately controls nocturnal enuresis in over half of patients with significant improvement in their quality of life. Although the overall incidence of adverse effects associated with treatment of nocturnal enuresis with DDAVP is low, it is not a benign drug particularly when used in patients at extreme of age. A review of the literature and the present case demonstrate that the potential risk factors for hyponatremia following administration of DDAVP include hepatic disease, surgery, stress, pain, renal disorder, excessive fluid intake, and increased dose of DDAVP. Potentially serious side effects of DDAVP administration such as hyponatremia and seizure may be prevented by close monitoring of serum electrolytes, urine output, as well as fluid restriction and avoidance of solutions with low-sodium content. ( info) |
| OBJECTIVE: To report the use and subsequent failure of the bladder-selective agent tolterodine, to treat clozapine-induced nocturnal enuresis in an adolescent patient with psychotic illness. CASE SUMMARY: A 16-year-old Hispanic girl was admitted to the state psychiatric hospital with a diagnosis of bipolar disorder with psychotic features. clozapine therapy was initiated, and after three months of treatment the patient began experiencing episodes of nocturnal enuresis. The bladder-selective agent tolterodine was tried and subsequently failed to resolve the enuresis episodes. Desmopressin was initiated, which resulted in amelioration of symptoms. DISCUSSION: This is the first published report of using tolterodine to treat clozapine-induced nocturnal enuresis. Several methods to decrease clozapine-induced urinary incontinence have been used and typically include the addition of agents with high anticholinergic properties. Tolterodine is a bladder-selective anticholinergic agent indicated for the treatment of urinary urge incontinence and may be employed as a treatment for antipsychotic-induced incontinence. CONCLUSIONS: nocturnal enuresis is an adverse effect that infrequently occurs with use of clozapine therapy. Although tolterodine was ineffective in our patient to treat clozapine-induced nocturnal enuresis, further trials are required to appropriately evaluate the effectiveness of tolterodine to treat this adverse drug reaction. ( info) |
16/95. nocturnal enuresis and obstructive sleep apnoea in two children. nocturnal enuresis was a symptom of childhood obstructive sleep apnoea, OSAS. We reported two children with secondary nocturnal enuresis which disappeared after tonsillectomy and adenoidectomy for proven OSAS. Pathogenesis of secondary nocturnal enuresis in OSAS was discussed. ( info) |
17/95. hyponatremia associated with desmopressin for the treatment of nocturnal polyuria. Desmopressin diacetate arginine vasopressin (DDAVP) is a synthetic analogue of the mammalian arginine vasopressin used in the treatment of central diabetes insipidus, bleeding disorders, and incontinence. The primary adverse reaction associated with DDAVP is hypotonic hyponatremia. hyponatremia has been reported in adults treated with DDAVP for Von Willebrand's disease and hemophilia and in children treated for enuresis, but as yet few cases of hyponatremia developing in enuretic adults treated with DDAVP have been reported. We report the cases of two elderly women taking DDAVP for nocturnal polyuria who developed severe hyponatremia. One patient died in the hospital. ( info) |
18/95. Management of intrinsic sphincter deficiency in adolescent females with normal bladder emptying function. PURPOSE: Intrinsic sphincter deficiency is rare in adolescent females with normal bladder emptying function. Information regarding the long-term outcome of therapy in this group of patients is sparse. We report our long-term experience with 3 adolescent females with intrinsic sphincter deficiency and normal bladder function who were treated with an artificial urinary sphincter. We critically reviewed the literature regarding experience with anti-incontinence surgery in adolescent females, not only regarding the outcome of the surgical technique, but also issues not usually considered in older adults, including the impact of physical development and future childbearing. MATERIALS AND methods: The charts of 3 adolescent females with intrinsic sphincter deficiency were reviewed. In addition, relevant peer reviewed articles were selected by a medline search. The results of the artificial urinary sphincter, pubovaginal sling and periurethral injection of bulking agents were reviewed. Long-term efficacy, the complication rate, impact of pregnancy and physical development were assessed. RESULTS: The 3 patients had an excellent long-term outcome with the artificial urinary sphincter, including 1 with 2 pregnancies that ended in a normal vaginal delivery. The literature showed that a good long-term outcome was consistently achieved with the artificial urinary sphincter. An equally good outcome was achieved with the pubovaginal sling but long-term data are lacking. While periurethral injection of a bulking agent provides good initial results, they do not appear to be durable. In addition, the artificial urinary sphincter does not appear to impact pregnancy or physical development negatively. CONCLUSION: Data support the artificial urinary sphincter and pubovaginal sling as effective therapies in adolescent females with intrinsic sphincter deficiency. However, long-term data on the pubovaginal sling are not available. When considering the impact on future childbearing and physical development, the artificial urinary sphincter is a favorable option. ( info) |
| A 10-year-old male referred to our clinic with the chief complaint of nocturnal enuresis also complained of daytime polyuria, frequency, and polydipsia. The clinical diagnosis was central diabetes insipidus. Since the patient's father had complained of similar symptoms, the arginine vasopressin-neurophysin II gene was examined. This revealed a single base substitution in one of two alleles in the patient, his father, and his grandfather (a C to T transition at nucleotide position 280 at codon 19 in the first exon). In conclusion, a history of polyuria or polydipsia should be carefully noted and the urinary volume and urine gravity or osmolarity examined in cases of nocturnal enuresis. ( info) |
20/95. Postoperative nephrogenic adenoma of bladder. Nephrogenic adenoma of the bladder, which has been associated with either a chronic infection or severe trauma to the bladder, occurred in a six-year-old girl apparently secondary to urologic surgery. It was also a possible cause of enuresis. ( info) |