Desmopressin for nocturnal enuresis in children.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
PubMed 40728007 · doi:10.1002/14651858.CD002112.pub2
What was done
This Cochrane systematic review update searched multiple databases (Cochrane Incontinence Specialised Register, CENTRAL, MEDLINE, CINAHL, ClinicalTrials.gov, WHO ICTRP) through January 2023 for randomised and quasi-randomised trials evaluating desmopressin (alone or combined with other interventions) in children aged 5 to 16 years with nocturnal enuresis. Three review authors independently extracted data and assessed risk of bias across 95 included studies involving 8,473 participants (5,434 received desmopressin).
What was found
Desmopressin versus placebo reduced the mean number of wet nights per week (MD -1.81, 95% CI -2.24 to -1.39; 16 studies, n = 1,267; low-certainty) and increased the proportion of children achieving 14 consecutive dry nights by treatment end (RR 3.18, 95% CI 1.75 to 5.80; 11 studies, n = 922; moderate-certainty), with no clear difference in adverse effects (RR 1.11, 95% CI 0.81 to 1.52; 3 studies, n = 269; low-certainty). Compared with alarm therapy, desmopressin showed no clear difference in wet nights (MD 0.63, 95% CI -0.49 to 1.75; 4 studies, n = 285; I² = 82%; very low-certainty) or 14 dry nights (RR 0.98, 95% CI 0.88 to 1.09; 15 studies, n = 1,530; low-certainty). Desmopressin plus alarm therapy reduced wet nights versus desmopressin monotherapy (MD -0.88, 95% CI -1.38 to -0.38; 2 studies, n = 156; moderate-certainty) and increased 14 dry nights (RR 1.26, 95% CI 1.06 to 1.51; 5 studies, n = 370; low-certainty). Adverse effects included dizziness, headache, mood changes, gastrointestinal discomfort, nasal discomfort, hyponatraemia, and one convulsion.
Why it matters
This review establishes that desmopressin provides effective short-term relief for pediatric bedwetting comparable to alarm therapy, with combination regimens potentially offering modest additional benefit.
Limits
Most comparisons were graded as low or very low certainty due to risk of bias in primary trials and high statistical heterogeneity (I² ranging up to 84%). Post-treatment relapse rates and long-term resolution after stopping therapy were not reported in the abstract, and rare but serious risks like hyponatremic seizures require clinical caution.
Cited by
- supports Desmopressin is used clinically to treat nocturnal enuresis (bedwetting) in children.