What's new in enuresis?

Treatment of primary nocturnal enuresis (PNE) using desmopressin (dDAVP) is based upon the hypothesis that antidiuretic hormone (arginine vasopressin (AVP) secretion is insufficient during the night. Persisting doubts about the theoretical background of this treatment gave reason to different studies: In a first study, AVP regulation in children with PNE was investigated. AVP levels after fluid restriction were compared to those of healthy controls. In order to maintain osmolality, the plasma AVP concentrations of the enuretic children rose to significant higher levels than in the controls. In a second study, the short-time memory of children treated with dDAVP because of PNE was measured. Children under dDAVP showed a significantly better short- time memory.

CONCLUSIONS

The results are consistent with the established fact that AVP secretion is a function of plasma osmolality. They contradict the hypothesis that enuretic children have a AVP deficiency which has to be supplemented. Rather, the results point to central action of dDAVP, a defect at the central AVP receptor level or the signal transduction pathway.