Antidiuretic therapy for bladder disorders.

Abstract

Nocturia and nocturnal enuresis are common nonlife threatening problems which tend to occur more commonly at the extremes of age. Both these symptoms can have a major impact on quality of life particularly for children and the elderly people. Because children usually ‘grow out’ of bed wetting (primary nocturnal enuresis), the problem is sometimes trivialised and not treated. However children who suffer from this problem suffer considerably with reduced self esteem and are miserable as they cannot participate in activities which involve staying away from home overnight. For the elderly people, nocturia becomes more prevalent with each decade. It affects the quality of sleep causing daytime somnolence, fatigue, depression and for those still working reduced work productivity. This can be most disruptive for the individual and also for his/her family and friends. There are also several co-morbidities, such as night-time falls associated with nocturia. Treatment is available for these common problems and in particular antidiuretic therapy has been shown to improve the majority of children with primary nocturnal enuresis as well as adults with nocturia as a result of nocturnal polyuria and individuals suffering from neurogenic disorders, such as multiple sclerosis. More recently antidiuretic therapy has also been used for the treatment of other lower urinary tract symptoms, such as urinary incontinence and the overactive bladder syndrome. This supplement is divided into five chapters. Doctors Rittig and Frokiar from Denmark describe renal physiology and the process of antidiuresis. They give a history of the use of antidiuretics for a variety of indications including nocturia and nocturnal enuresis. Doctors Lottmann and Alova from France describe the common problem of primary monosymptomatic nocturnal enuresis in children and adolescents and outline the currently available management strategies. Doctor Stember and colleagues from New York explain the classification of nocturnal polyuria and review its causes and management in men. Nocturia in women, its causes, effect on quality of life and treatment in women is explained by Dr Robinson from the UK. Finally, Dr Hashim and Dr Abrams from the UK identify novel uses for antidiuretic therapy in the management of lower urinary tract symptoms including the overactive bladder syndrome and urinary incontinence in women. Thus this is a truly international multi-disciplinary contribution to the International Journal of Clinical Practice including chapters by basic scientists as well as practicing Urologists and Gynaecologists who treat these problems on a regular basis.