Hypothesis
Solifenacin plus desmopressin is more effective than desmopressin alone in the treatment of primary mono symtomatic nocturnal enuresis
Objectives
1. To compare the efficacy of Solifenacin plus Desmopressin and Desmopressin alone in the treatment of primary mono symptomatic nocturnal enuresis
2. To compare the tolerability of Solifenacin plus Desmopressin and Desmopressin alone in the treatment of primary mono symptomatic nocturnal enuresis

This randomized control trail  was conducted  from April 2020 to June 2021. Total of 88 children 5-14 years of age, diagnosed with primary monosymptomatic nocturnal enuresis were included in the study. Patients having positive urine cultures, deranged renal functions and neurogenic disorders were excluded from the study. Informed written consent was taken from the parents of the children. Patients were then randomly assigned to one of the two therapeutic groups, Group 1-Desmopresin alone and Group 2-Solifenacin plus Desmopressin. Group 1 received one puff of desmopressin nasal spray every night. Group 2 received one pill of solifenacin 5mg plus one puff of desmopressin nasal spray every night. All patients were evaluated after three months for their response to treatment and drug side effects. Complete response was defined as 90–100% decrease in the number of nighttime wetting, partial response and Non-response were defined as , 50–90% and < 50% decrease in the number of nighttime wetting.

In Solifenacin plus desmopressin group 37 of 44 patients (84.09%) achieved complete response after three month of treatment in comparison with desmopressin alone group in which 27 of 44 patients (61.36%) achieved complete response

The mean age in desmopressin alone group and solifenacin plus desmopressin group was 8.11+ 2.21 and 7.91 + 2.21 years respectively. In Solifenacin plus desmopressin group 37 of 44 patients (84.09%) achieved complete response after three month of treatment in comparison with desmopressin alone group in which 27 of 44 patients (61.36%) achieved complete response. In desmopressin alone group 8 of 44 patients (18.18%) developed treatment related side effects whereas in solifenacin plus desmopressin group 12 of 44 (27.27%) developed side effects which were statistically insignificant. No case of discontinuation of treatment due to side effects was observed in any of the two groups.

according to guidelines Desmopressin is an established first line treatment of PMNE. As a monotherapy it often fails to achieve complete response. 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.

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