Combined Treatment with Oxybutynin and Imipramine in Enuresis

Background: primary nocturnal enuresis is a common disorderthat often leads to considerable distress in affected childrenand their family. in many countries pharmacologic therapyis preferred to non-pharmacologic behavioral and conditionalalarm therapy. imipramine, oxybutynin, and desmo pressinhave been used for enuresis with various efficacies.the aim of the present study was to compare the efficacy ofimipramine, oxybutynin , and combined imipramine and oxybutyninin enuretic children aged 6-14 years old.methods: in a randomized controlled study 89 primary enureticchildren who were otherwise normal were allocated to threegroups: group a (imipramine users, n=29), group b (oxybutyninusers, n=26), and group c (combined imipramine and oxybutyninusers, n=34). the number of wet nights per week during controlperiod (2 weeks prior treatment), and treatment period (i month)were compared in each group and inter groups. also the cure ratein the treatment period and the relapse rate in the follow up period(i month) were compared between the three groups.results: the mean ages in groups a, b, and c were 7.9± 1.1 years,8.2± 1.6 years, and 8.2±ia years respectively. there was no significantdifference in the mean ages in the three groups (p=0. 53).in each group the mean number of wet nights per week decreaseddurin g treatment period compared with pretreatmentperiod . this redu ction was s tatistica lly s ignificant (p<0.001 ineac h group). efficacy o f treatmen t betw een the three groupswas compared . there was si gnificant difference betw een them(p<0 .001), but there was no s ignificant difference betweengroup a, and group b (p=0.56). the cure rate during treatmentperiod was 13.7%, 23%, and 4 1% in groups a, b, and crespectively . thi s difference was statistica lly s ignificant(p=0.04). the relapse rate dur ing follow up period in groupsa, b, and c was 58.6%, 42.3% and 20.5% respe ct ively, revealing statistica l s ignificance (p=0.008) no sig nificant adverse effects for the medications were observed .conclusion: our findings suggest that combined umprarmneand oxybutynin for primary enuresis is more effective thaneith er drug used alone. the combined therapy is recommendedin enuretic children who are non-responsive toimipramine or oxybutynin alone.