Imipramine for therapy resistant enuresis: a retrospective evaluation.

OBJECTIVE

Imipramine has a proven effect in enuresis but is now seldom used. We reviewed the records of children who had been treated with imipramine to determine prognostic indicators.

METHODS

The records of all enuretic children treated with imipramine at our clinic were retrospectively evaluated, with special emphasis on history, and for most children bladder volume, renal concentrating capacity and urine production.

RESULTS

All 49 children included in the study had previously received desmopressin, alarm and anticholinergic treatment without success. Of the children 31 (64.6%) were responders (R), with at least 50% reduction in enuresis frequency (22 became completely dry) and 17 (35.4%) were nonresponders (NR). Older age (R 11.4 +/- 3.4, NR 8.7 +/-1.8 years, p = 0.004) and low spontaneous bladder capacity (R 2.6 +/- 0.9, NR 3.4 +/- 0.9 ml/kg body weight, p = 0.03) were prognostically favorable, whereas constipation (p = 0.02) and a history of daytime incontinence (p = 0.04) indicated poor prognosis. Ten children experienced nausea or other minor problems. Seven children with attention deficit and hyperactivity became more focused during treatment.

CONCLUSIONS

Imipramine is a useful treatment for enuresis when everything else has failed, especially among older children. Factors related to detrusor function provide prognostic information.