Older Pharmacologic Therapy for Nocturnal Enuresis

Since the early 1960s, a number of pharmacologic agents have been used to treat children with enuresis. Success has been reported with tricyclic antidepressants (imipramine), anticholinergics (oxybutynin), and desmopressin acetate (DDAVP). Sedatives, stimulants, or sympathomimetic agents have not proved beneficial. Because treatment with medication may be effective even in children with an organic problem such as infection or neuropathy, patients should always be evaluated carefully before drug therapy is started. Of the tricyclic antidepressants, imipramine has been investigated and used the most extensively. Oxybutynin is beneficial for children with small bladder capacity and daytime enuresis. DDAVP, introduced in the 1990s, has response rates similar to those of imipramine but with fewer side effects.