Predictive factors for relapse in pediatric patients with primary monosymptomatic nocturnal enuresis treated with the desmopressin oral lyophilisate.

Abstract

Objectives: To assess the predictive factors for relapse in pediatric patients with primary monosymptomatic nocturnal enuresis following the use desmopressin oral lyophilisate.

Methods: A prospective cohort study was conducted from 2018 to 2025. We evaluated whether patient age and gender, compliance, method of therapy discontinuation, and other parameters affected relapse occurrence. The study included 168 children diagnosed with PMNE, comprising 94 with relapse and 74 without relapse.

Results: Patients older than seven years were significantly more likely to remain relapse-free compared to younger children (56 % vs. 32.1 %, p = 0.002). Immediate cessation of therapy was significantly associated with relapse compared to structured withdrawal (66.7 % vs. 33.3 %, p = 0.005). A significant association was found between fluid intake after drug administration and relapse (61.6 % vs. 38.4 %, p = 0.037). A lack of adherence to dietary instructions was significantly associated with relapse (62.9 % vs. 37.1 %, p = 0.034). Functional daytime bladder capacity (FDBC) was significantly lower in patients who experienced relapse (p = 0.002). Multivariate analysis identified two independent predictors: age younger than seven years and abrupt therapy withdrawal as risk factors for relapse in PMNE patients.

Conclusions: Patient age under seven years and abrupt therapy withdrawal are two strong risk factors associated with relapse in patients using desmopressin oral lyophilisate for primary monosymptomatic nocturnal enuresis. Fluid intake after medication use and non-compliance with dietary recommendations also influence relapse occurrence, but they do not act as independent factors.