A Comparative Study of Imipramine and Tolterodine for the Treatment of Children with Primary Nocturnal Enuresis

Background: Nocturnal enuresis (NE), or bed-wetting, affects children aged ≥5 years after ruling out organic causes. The ICCS defines NE as intermittent urinary incontinence during sleep, categorized into monosymptomatic (MNE) and non-monosymptomatic (NMNE) forms. NE is also classified by onset: primary (no dry period) and secondary (bed-wetting after a dry period). Contributing factors include sleep disorders, stress, hereditary predisposition, and delayed bladder development. Management involves behavioral and pharmacological treatments, with desmopressin and anticholinergic drugs being common options. Aim of the study: This study aims to find out an alternate effective and safe drug for the treatment of primary nocturnal enuresis. Methods: This study was conducted at the Department of Urology(outdoor), Shahid Sk. Abu Naser Specialized Hospital, Khulna, Bangladesh from January 2020 to December 2021. After excluding 12 patient’s pre-randomizations for non-cooperation, 60 patients were split into two groups: Group A received 25mg of imipramine before bedtime, while Group B took 1mg of tolterodine tartrate twice daily evaluated efficacy over 6 months, including a 2-week behavioral modification baseline and follow-ups at 3 and 6 months. Data were analyzed using SPSS 26, employing various statistical tests with significance set at p <0.05. Result: The study involved 60 children (mean age 10.0±3.1 years, 55% male), assessing bed-wetting patterns and treatment outcomes. The majority (80%) had unsatisfactory behavioral modifications, with 35% having a family history of enuresis. Both groups (A and B) showed no significant difference in bed-wetting episodes at baseline or after 3 months of treatment. Complications were more common in Group A, including dry mouth, nausea, and insomnia. Imipramine led to a higher proportion of patients with fewer than 50 dry nights after drug withdrawal, while Tolterodine showed better results at month 3 but a higher decrease in dry ...