Research Article|Articles in Press

“Comparative Analysis of Solifenacin Plus Desmopressin Versus Desmopressin Alone in the Treatment of Primary Mono Symptomatic Nocturnal Enuresis”



      To compare the efficacy and tolerability of Solifenacin plus Desmopressin and Desmopressin alone in the treatment of primary monosymptomatic nocturnal enuresis (PMNE).


      A total of 88 children, 5-14 years old, diagnosed with PMNE were enrolled in this randomized control trial (RCT) from June 2017 to June 2020. After informed written consent patients were randomized to one of the two therapeutic groups. Group 1 received one puff of desmopressin nasal spray one hour before bedtime every night. Group 2 received one pill of solifenacin 5mg plus one puff of desmopressin nasal spray one hour before bedtime every night. All patients were evaluated after three months for their response to treatment and drug side effects.


      The mean age in desmopressin alone group and solifenacin plus desmopressin group was 8.1 + 2.2 (5-14) and 7.9 +2.2 (5-14) years respectively (p-value > 0.05). In group 2, 37/44 (84.09%) patients achieved complete response after three months of treatment in comparison to group 1 in which 27/44 (61.36%) patients showed complete response (p-value < 0.05). In group 1, 8/44 (18.18%) patients developed treatment related side effects whereas in group 2, 12/44 (27.27%) patients developed side effects (p-value > 0.05). No case of discontinuation of treatment due to side effects was observed in any of the two groups. The recurrence rate was also significantly lower in group 2 in comparison to group 1 (8.1% vs 33.3%, p-value < 0.05).


      Our study demonstrated that the combination of Solifenacin plus Desmopressin is more effective than desmopressin monotherapy in the treatment of PMNE with an acceptable tolerability profile.

      Level Of Evidence

      Level I.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Austin PF
        • Bauer SB
        • Bower W
        • Chase J
        • Franco I
        • Hoebeke P
        • et al.
        The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the International Children's Continence Society.
        Neurourol Urodyn. 2016 Apr; 35: 471-481
        • Nevus T
        • Fonseca E
        • Franco I
        • Kawauchi A
        • Kovacevic L
        • Nieuwhof-Leppink A
        • et al.
        Management and treatment of nocturnal enuresis—an updated standardization document from the International Children's Continence Society.
        J Pediatr Urol. 2020 Feb 1; 16: 10-19
        • Hamed A
        • Yousf F
        • Hussein MM
        Prevalence of nocturnal enuresis and related risk factors in school-age children in Egypt: an epidemiological study.
        World J Urol. 2017 Mar; 35: 459-465
        • Sarici H
        • Telli O
        • Ozgur BC
        • Demirbas A
        • Ozgur S
        • Karagoz MA
        Prevalence of nocturnal enuresis and its influence on quality of life in school-aged children.
        J Pediatr Urol. 2016 Jun; 12: 159.e1-159.e6
        • Bakhtiar K
        • Pournia Y
        • Ebrahimzadeh F
        • Farhadi A
        • Shafizadeh F
        • Hosseinabadi R
        Prevalence of nocturnal enuresis and its associated factors in primary school and preschool children of khorramabad in 2013.
        Int J Pediatr. 2014;Oct 12; 2014120686
        • Huang HM
        • Wei J
        • Sharma S
        • Bao Y
        • Li F
        • Song JW
        • et al.
        Prevalence and risk factors of nocturnal enuresis among children ages 5–12 years in Xi’an, China: a cross-sectional study.
        BMC Pediatr. 2020 Dec; 20: 1-8
        • Wang QW
        • Wen JG
        • Song DK
        • Su J
        • Zhu QH
        • Liu K
        • et al.
        Bed‐wetting in Chinese children: Epidemiology and predictive factors.
        Neurourol Urodynamics. 2007 Jul; 26: 512-517
        • Jurković M
        • Tomašković I
        • Tomašković M
        • Smital Zore B
        • Pavić I
        • Roić AC
        Refugee status as a possible risk factor for childhood enuresis.
        Int. J. Environ. Res Public Health. 2019 Jan; 16: 1293
        • Joinson C
        • Sullivan S
        • von Gontard A
        • Heron J
        Stressful events in early childhood and developmental trajectories of bedwetting at school age.
        J Pediatr Psychol. 2016 Oct 1; 41: 1002-1010
        • Kiddoo D
        Nocturnal enuresis.
        BMJ Clin Evid. 2011 Jan 31; : 2011
        • Chatta MN
        • Ahmed N
        • Gul MS
        Frequency of nocturnal enuresis in rural areas of Sialkot.
        Pak J Med Health Sci. 2016 Jan 1; 10: 253-255
        • Shah S
        • Jafri RZ
        • Mobin K
        • Mirza R
        • Nanji K
        • Jahangir F
        • et al.
        Frequency and features of nocturnal enuresis in Pakistani children aged 5 to 16 years based on ICCS criteria: a multi-center cross-sectional study from Karachi, Pakistan.
        BMC Fam Pract. 2018 Dec; 19: 1-9
        • Glazener CM
        • Evans JH
        • Peto RE
        Alarm interventions for nocturnal enuresis in children.
        Cochrane Database of Systematic Reviews. 2005;
        • Keten T
        • Aslan Y
        • Balci M
        • Erkan A
        • Senel C
        • Oguz U
        • et al.
        Comparison of the efficacy of desmopressin fast-melting formulation and enuretic alarm in the treatment of monosymptomatic nocturnal enuresis.
        J Pediatr Urol. 2020 Oct 1; 16: 645-e1
        • Gözüküçük A
        • Kılıç M
        • Çakıroğlu B
        Desmopressin versus desmopressin+ oxybutynin in the treatment of children with nocturnal enuresis.
        J Pediatr Urol. 2021 Aug 1; 17: 451-e1
        • Azarfar A
        • Esmaeili M
        • Naseri M
        • Ghane F
        • Ravanshad Y
        • Vejdani M
        • et al.
        Comparison of combined treatment with desmopressin plus oxybutynin and desmopressin plus tolterodine in treatment of children with primary nocturnal enuresis.
        J Renal Inj Prev. 2015; 4: 80-86
        • Chapple CR
        • Martinez-Garcia R
        • Selvaggi L
        • Toozs-Hobson P
        • Warnack W
        • Drogendijk T
        • et al.
        STAR study group. a comparison of the efficacy and tolerability of solifenacin succinate and extended release tolterodine at treating overactive bladder syndrome: results of the STAR trial.
        Eur Urol. 2005 Sep 1; 48: 464-470
        • Glazener CM
        • Evans JH
        Desmopressin for nocturnal enuresis in children.
        Cochrane Database Syst Rev. 2002; 3
        • Alloussi SH
        • Mürtz G
        • Gitzhofer S
        • Eichel R
        • Lang C
        • Madersbacher H
        • et al.
        Failure of monotherapy in primary monosymptomatic enuresis: a combined desmopressin and propiverine treatment regimen improves efficacy outcomes.
        BJU Int. 2009; 103: 1706-1712
        • Montaldo P
        • Tafuro L
        • Rea M
        • Narciso V
        • Iossa AC
        • Gado RD
        Desmopressin and oxybutynin in monosymptomatic nocturnal enuresis: a randomized, double‐blind, placebo‐controlled trial and an assessment of predictive factors.
        BJU international. 2012 Oct; 110: E381-E386
        • Radvanska E
        • Kovács L
        • Rittig S
        The role of bladder capacity in antidiuretic and anticholinergic treatment for nocturnal enuresis.
        J Urol. 2006 Aug; 176: 764-769
        • Song P
        • Huang C
        • Wang Y
        • Wang Q
        • Zhu W
        • Yue Y
        • Wang W
        • Feng J
        • He X
        • Cui L
        • Wan T
        Comparison of desmopressin, alarm, desmopressin plus alarm, and desmopressin plus anticholinergic agents in the management of paediatric monosymptomatic nocturnal enuresis: a network meta‐analysis.
        BJU Int. 2019 Mar; 123: 388-400
        • Park SJ
        • Park JM
        • Pai KS
        • Ha TS
        • Lee SD
        • Baek M
        Desmopressin alone versus desmopressin and an anticholinergic in the first-line treatment of primary monosymptomatic nocturnal enuresis: a multicenter study.
        Pediatr Nephrol. 2014 Jul; 29: 1195-1200
        • Ghanavati PM
        • Khazaeli D
        • Amjadzadeh M
        A comparison of the efficacy and tolerability of treating primary nocturnal enuresis with solifenacin plus desmopressin, tolterodine plus desmopressin, and desmopressin alone: a randomized controlled clinical trial.
        Int Braz J Urol. 2020 Nov 18; 47: 73-81
        • Newgreen D
        • Bosman B
        • Hollestein-Havelaar A
        • Dahler E
        • Besuyen R
        • Sawyer W
        • et al.
        Solifenacin in children and adolescents with overactive bladder: results of a phase 3 randomised clinical trial.
        European Urology. 2017 Mar 1; 71: 483-490
        • Lee SD
        • Chung JM
        • Kang DI
        • Ryu DS
        • Cho WY
        • Park S
        Efficacy and tolerability of solifenacin 5 mg fixed dose in Korean children with newly diagnosed idiopathic overactive bladder: a multicenter prospective study.
        J Korean Med Sci. 2017 Feb 1; 32: 329-334