Nocturnal Enuresis Management in Adults

Introduction to Treatment

Desmopressin is the drug of choice for treating nocturnal enuresis in adults, particularly when associated with nocturnal polyuria, as recommended by the American Urological Association 1
The effectiveness rate of desmopressin ranges from 10-65% with potential for relapse, according to the International Continence Society 2

Desmopressin is a synthetic analogue of antidiuretic hormone (vasopressin) that decreases nighttime urine production, as stated by the European Association of Urology 1
The effectiveness rate of desmopressin ranges from 10-65% with potential for relapse, according to the International Continence Society 2

Oral tablets: 0.2-0.4 mg taken at least 1 hour before sleep, as recommended by the American Urological Association 3, 4
Oral melt tablets (lyophilisate): 120-240 μg taken 30-60 minutes before bedtime, according to the European Association of Urology 3, 4
Dosing is not influenced by body weight or age, as stated by the International Continence Society 3

Fluid restriction is essential with desmopressin - evening intake should be limited to 200 ml (6 ounces) or less with no drinking until morning, as recommended by the American Urological Association 3, 4, 5
Polydipsia is a contraindication to desmopressin treatment, according to the European Association of Urology 3, 4
Desmopressin combined with excessive fluid intake can cause water intoxication with hyponatremia and convulsions, as warned by the International Continence Society 3, 4
Nasal spray formulations are discouraged due to higher risk of hyponatremia, as stated by the American Urological Association 3, 4
Regular short drug holidays should be scheduled to assess whether medication is still needed, as recommended by the European Association of Urology 3, 4

Anticholinergic medications (oxybutynin, tolterodine, propiverine) may be considered when desmopressin is ineffective or contraindicated, particularly if there is evidence of detrusor overactivity, according to the International Continence Society 3, 6
Imipramine has been used historically with effectiveness of 40-60% but has higher relapse rates and more side effects than desmopressin, as reported by the American Urological Association 2

Enuresis alarm therapy has a success rate of approximately 66% with better long-term outcomes than medications alone, as stated by the European Association of Urology 1
Regular voiding habits should be established - patients should void regularly during the day and always at bedtime and upon awakening, as recommended by the International Continence Society 1, 4
Fluid management - minimize evening fluid and solute intake while encouraging liberal water intake during morning and early afternoon, according to the American Urological Association 1, 4
Treat constipation if present, as it can cause mechanical pressure on the bladder, as recommended by the European Association of Urology 2
Address any underlying sleep disorders, particularly sleep apnea, as stated by the International Continence Society 2

Rule out underlying medical conditions (urinary tract infections, diabetes, neurological disorders), as recommended by the American Urological Association 2
Implement non-pharmacological approaches (fluid management, regular voiding habits), according to the European Association of Urology 1
Start desmopressin therapy if nocturnal polyuria is confirmed, as stated by the International Continence Society 1
Consider alarm therapy as an alternative or adjunct to medication, as recommended by the American Urological Association 6
For treatment failures, consider combination therapy or alternative medications, according to the European Association of Urology 2