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Does Structured Withdrawal of Desmopressin Improve Relapse Rates in Patients with Monosymptomatic Enuresis?

2014; Lippincott Williams & Wilkins; Volume: 192; Issue: 2 Linguagem: Inglês

10.1016/j.juro.2014.01.094

1527-3792

Mehmet İlker Gökçe, Parviz Hajıyev, Evren Süer, Yusuf Kibar, Mesrur Selçuk Sılay, Serhat Gürocak, Hasan Serkan Doğan, Hasan Cem Irkılata, Tayfun Oktar, Bülent Önal, Erım Erdem, Cem Aygün, Mustafa Bahadır Can Balci, Ahmet Rüknettin Arslan, Cevdet Kaya, Tarkan Soygür, Şaban Sarıkaya, Serdar Tekgül, Berk Burgu,

Gastroesophageal reflux and treatments

No AccessJournal of UrologyPediatric Urology1 Aug 2014Does Structured Withdrawal of Desmopressin Improve Relapse Rates in Patients with Monosymptomatic Enuresis? Mehmet İlker Gökçe, Parviz Hajıyev, Evren Süer, Yusuf Kibar, Mesrur Selçuk Sılay, Serhat Gürocak, Hasan Serkan Doğan, Hasan Cem Irkılata, Tayfun Oktar, Bülent Önal, Erim Erdem, Yüksel Cem Aygün, Can Balcı, Ahmet Rüknettin Arslan, Cevdet Kaya, Tarkan Soygür, Şaban Sarıkaya, Serdar Tekgül, and Berk Burgu Mehmet İlker GökçeMehmet İlker Gökçe Department of Urology, Ankara University School of Medicine, Ankara, Turkey , Parviz HajıyevParviz Hajıyev Department of Urology, Ankara University School of Medicine, Ankara, Turkey , Evren SüerEvren Süer Department of Urology, Ankara University School of Medicine, Ankara, Turkey , Yusuf KibarYusuf Kibar Department of Urology, Gülhane Military Medical School, Ankara, Turkey , Mesrur Selçuk SılayMesrur Selçuk Sılay Department of Pediatric Urology, Bezmi Alem School of Medicine, Istanbul, Turkey , Serhat GürocakSerhat Gürocak Department of Pediatric Urology, Gazi University School of Medicine, Ankara, Turkey , Hasan Serkan DoğanHasan Serkan Doğan Department of Pediatric Urology, Hacettepe University School of Medicine, Ankara, Turkey , Hasan Cem IrkılataHasan Cem Irkılata Department of Urology, Gülhane Military Medical School, Ankara, Turkey , Tayfun OktarTayfun Oktar Department of Pediatric Urology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey , Bülent ÖnalBülent Önal Department of Pediatric Urology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey , Erim ErdemErim Erdem Department of Urology, Mersin University School of Medicine, Mersin, Turkey , Yüksel Cem AygünYüksel Cem Aygün Department of Urology, Başkent University School of Medicine, Ankara, Turkey , Can BalcıCan Balcı Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey , Ahmet Rüknettin ArslanAhmet Rüknettin Arslan Department of Urology, Haydarpaşa Education and Research Hospital, Istanbul, Turkey , Cevdet KayaCevdet Kaya Department of Urology, Haydarpaşa Education and Research Hospital, Istanbul, Turkey , Tarkan SoygürTarkan Soygür Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey , Şaban SarıkayaŞaban Sarıkaya Department of Pediatric Urology, Samsun University School of Medicine, Samsun, Turkey , Serdar TekgülSerdar Tekgül Department of Pediatric Urology, Hacettepe University School of Medicine, Ankara, Turkey , and Berk BurguBerk Burgu Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey View All Author Informationhttps://doi.org/10.1016/j.juro.2014.01.094AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Relapse after cessation of desmopressin is an important problem in treating patients with enuresis. Structured withdrawal of desmopressin tablets has been shown to decrease relapse rates. However, scientific data are lacking on the structured withdrawal of the fast melting oral formulation of desmopressin. We compared relapse rates of structured withdrawal using placebo and direct cessation in a population of patients with enuresis who were desmopressin responders. Materials and Methods: Patients diagnosed with enuresis and responding to desmopressin from 13 different centers were involved in the study. Patients were randomized into 4 groups. Two different structured withdrawal strategies were compared to placebo and direct withdrawal. Sample size was estimated as 240 (60 patients in each group), with a power of 0.80 and an effect size of 30%. Randomization was performed using NCSS statistical software (NCSS, Kaysville, Utah) from a single center. The relapse rates of the groups were compared using chi-square testing. Logistic regression analysis was performed to define the independent factors having an effect on relapse rates. Results: Desmopressin treatment was initiated in 421 patients, and 259 patients were eligible for randomization. Relapse rates were 39 (1%) and 42 (4%) for the structured withdrawal groups, which were significantly less than for direct withdrawal (55, 3%) and placebo (53, 1%). Logistic regression analysis revealed that initial effective dose of 240 μcg, greater number of wet nights before treatment and nonstructured withdrawal were associated with higher relapse rates. Conclusions: We found that structured withdrawal with the fast melting oral formulation of desmopressin results in decreased relapse rates. Application of a structured withdrawal program was also an independent factor associated with reduced relapse rates, together with lower initial effective dose and number of wet nights per week. 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Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byGökçe M (2018) Re: Letter to the Editor on Structured Withdrawal of Desmopressin in Patients with Monosymptomatic EnuresisJournal of Urology, VOL. 196, NO. 1, (288-288), Online publication date: 1-Jul-2016.Önol F, Guzel R, Tahra A, Kaya C and Boylu U (2018) Comparison of Long-Term Efficacy of Desmopressin Lyophilisate and Enuretic Alarm for Monosymptomatic Enuresis and Assessment of Predictive Factors for Success: A Randomized Prospective TrialJournal of Urology, VOL. 193, NO. 2, (655-661), Online publication date: 1-Feb-2015. Volume 192Issue 2August 2014Page: 530-534 Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.Keywordsdeamino arginine vasopressinenuresisrecurrenceMetricsAuthor Information Mehmet İlker Gökçe Department of Urology, Ankara University School of Medicine, Ankara, Turkey More articles by this author Parviz Hajıyev Department of Urology, Ankara University School of Medicine, Ankara, Turkey More articles by this author Evren Süer Department of Urology, Ankara University School of Medicine, Ankara, Turkey More articles by this author Yusuf Kibar Department of Urology, Gülhane Military Medical School, Ankara, Turkey More articles by this author Mesrur Selçuk Sılay Department of Pediatric Urology, Bezmi Alem School of Medicine, Istanbul, Turkey More articles by this author Serhat Gürocak Department of Pediatric Urology, Gazi University School of Medicine, Ankara, Turkey More articles by this author Hasan Serkan Doğan Department of Pediatric Urology, Hacettepe University School of Medicine, Ankara, Turkey More articles by this author Hasan Cem Irkılata Department of Urology, Gülhane Military Medical School, Ankara, Turkey More articles by this author Tayfun Oktar Department of Pediatric Urology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey More articles by this author Bülent Önal Department of Pediatric Urology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey More articles by this author Erim Erdem Department of Urology, Mersin University School of Medicine, Mersin, Turkey More articles by this author Yüksel Cem Aygün Department of Urology, Başkent University School of Medicine, Ankara, Turkey More articles by this author Can Balcı Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey More articles by this author Ahmet Rüknettin Arslan Department of Urology, Haydarpaşa Education and Research Hospital, Istanbul, Turkey More articles by this author Cevdet Kaya Department of Urology, Haydarpaşa Education and Research Hospital, Istanbul, Turkey More articles by this author Tarkan Soygür Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey More articles by this author Şaban Sarıkaya Department of Pediatric Urology, Samsun University School of Medicine, Samsun, Turkey More articles by this author Serdar Tekgül Department of Pediatric Urology, Hacettepe University School of Medicine, Ankara, Turkey More articles by this author Berk Burgu Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey More articles by this author Expand All Advertisement PDF downloadLoading ...