***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Summary The present study was partly a clinical pharmacological analysis of the action of imipramine in nocturnal enuresis and partly an attempt to select children who would benefit most from this treatment . 61 fairly severe cases of nocturnal enuresis were studied as out- patients , divided by the criteria primary / secondary enuresis and with/without associated behavioural disturbances . The patients received imipramine , imipramine-N-oxide , emepronium , and a placebo in r and om sequence in a double-blind cross-over trial . There was no difference in effect between placebo and emepronium ; after imipramine the frequency of enuresis fell to 58 % of the figure during placebo treatment , i.e. 31 % of the children became dry ; imipramine-N-oxide reduced the number of wet nights only to 78 % of the number on placebo , 18 % of the children became dry . When the patients were classified into groups imipramine and imipramine-N-oxide were found to have had the greatest effect in cases of presumed psychogenic aetiology , a 65 % reduction of the frequency of wet nights whilst taking the placebo . The most favourable results were in children with combined nocturnal and diurnal enuresis and in those with urinary frequency and imperative urgency . The effect was maintained during treatment for 3 months with the most suitable drug . The dose was 50 mg regardless of the body weight of the patient . There were no serious side effects . It was concluded that the psychopharmacological actions of imipramine and imipramine-N-oxide appear to be important in their effects on enuresis . Imipramine might have been the best drug because success may require the combination of antidepressant and anticholinergic activity . It was not possible to assess in detail its presumed effect on the level of sleep . Thus many children can be treated successfully and the final cure of enuresis may be hastened by breaking a vicious circle of psychological phenomena Purpose : The treatment approach for enuresis is controversial due to the lack of consensus as to the exact causes of nocturnal enuresis . Despite various treatment modalities , pharmacotherapy still appears to be the common choice . The aim of this prospect i ve study was the evaluation of the efficacy of combination therapy ( imipramine and oxybutynin ) in patients with enuresis nocturna . Patients and Methods : This prospect i ve study was done with 77 monosymptomatic nocturnal enuretics between July 1996 and December 1998 . Results : Even though there is no statistically significant difference between combination therapy ( imipramine plus oxybutynin ) and monotherapy , clinical data showed that combination therapy is more effective . Conclusions : We conclude that combination of imipramine with oxybutynin is a safe and new choice in the treatment of nocturnal enuresis Abstract Sixty-two children with nocturnal enuresis ( 43 boys , 19 girls aged 6–15 years ) were treated with either desmopressin ( Adiuretin-SD ) ( n=32 ) or sodium diclofenac ( n=30 ) . Desmopressin was effective in 85 % of children and diclofenac in 33 % . In children with primary nocturnal enuresis , the glomerular filtration rate was normal , whereas diuresis and solute excretion during the night were increased . Compared with healthy children , the nightly excretion of sodium was elevated by 43.7 % and magnesium by 58.4 % . A high correlation was found between the free water reabsorption and solute clearance ( P<0.001 ) in children with nocturnal enuresis . Changes in kidney function in nocturnal enuresis appear to be due to a decrease in the water and ion reabsorption in the thick ascending limb of Henle ’s loop because of a changed regulation of ion transport in this part of the nephron . Administration of desmopressin or a decrease in prostagl and in production after diclofenac administration restores the ion and water transport in the kidney , which results in the disappearance of nocturnal enuresis . The results indicate a role of changes in regulation of ion transport in renal tubules in the pathogenesis of one of the forms of primary nocturnal enuresis A double-blind clinical study of 30 boys , six to ten years of age , with primary nocturnal enuresis was undertaken to assess the role of and rogens in treating enuresis . The oral synthetic and rogen mesterolone was selected because of its minimal potential toxic effects . Twenty boys were treated with mesterolone and 10 received placebo . Fourteen boys ( 70 % ) became dry during treatment ( 20 mg daily for 14 days ) , and 5 ( 25 % ) remained dry for a follow-up period of four months . Increased cystometric bladder capacity and disappearance of uninhibited detrusor contractions were noticed in a significant number of cases after treatment . No side effects were recorded . Mesterolone has probably modulated the autonomic innervation of the vesical musculature with correction of the defective neural mechanism which is believed to be implicated in the pathogenesis of nocturnal enuresis The prostagl and in synthesis inhibitor indomethacin ( used as a suppository ) was compared to placebo in the treatment of primary nocturnal enuresis in a double-blind crossover study . There were 12 girls and 7 boys between 6 and 15 years old .  Indomethacin ( 50 to 100 mg . ) was significantly more effective than placebo in the treatment of primary enuresis OBJECTIVES To compare the efficacy of desmopressin and indomethacin and also determine the prostagl and in E2 ( PGE2 ) concentrations in the patient and control groups . METHODS Eighty-five children with primary nocturnal enuresis were followed up for a baseline period of 4 weeks , during which they recorded wet and dry nights . After this period , the patients were divided into three groups that used desmopressin , indomethacin , or placebo for 4 weeks . The dosage of desmopressin ( group A , n = 31 ) was 20 microg/day and the dosage of indomethacin ( group B , n = 29 ) was 100 mg/day . The placebo group ( group C ) consisted of 25 patients . We determined the serum PGE2 and urine PGE2 concentrations before and after treatment in the three groups and in a control group . RESULTS Treatment with desmopressin and indomethacin result ed in significantly more dry nights during the 4 weeks of observation than did placebo ( P < 0.005 ) . The number of dry nights was also significantly different in the desmopressin group than in the indomethacin group ( P < 0.01 ) . In the total patient group , the mean serum and urine PGE2 concentrations were significantly different from the control group 's serum and urine PGE2 concentrations ( P < 0.001 ) . There was a significant decrease in the serum and urine PGE2 concentrations in group A and group B after the treatment period ( P < 0.01 ) . CONCLUSIONS Desmopressin and indomethacin were found to be more effective than placebo . We conclude that prostagl and ins have an important role in the pathophysiology of primary nocturnal enuresis 1 . The prostagl and in synthesis inhibitor diclofenac sodium has been compared with a placebo in the treatment of primary nocturnal enuresis in a double‐blind crossover trial Summary A study of 45 children with enuresis showed that administration of Methedrine result ed in earlier and more complete relief , compared to those on a placebo The effect of imipramine , desmethylimipramine , and methscopolamine on blood pressure ( BP ) and plasma norepinephrine ( NE ) was measured in enuretic boys in a double‐blind , placebo‐controlled study . Measurements were obtained on the thirteenth day of medication ( 75 mg at bedtime ) . The tricyclic drugs induced a rise in diastolic BP as well as an increase in plasma NE but there was no significant relationship between the increments in plasma NE and BP . The plasma concentration of drug correlated with the drug‐induced BP rise . This is the fifth study to demonstrate a hypertensive effect of tricyclic drugs in children in contrast to the systolic hypotension usually seen in adult patients . It is not clear from our data whether children have different cardiovascular compensatory reflexes or whether they experience a greater stimulant effect from the drug SUMMARY A controlled trial of conditioning by alarm and of amphetamine for the treatment of enuresis was planned . The experimental group was to consist of 118 enuretic schoolchildren of 8 years and over , detected in a community survey , but only 37 could be enrolled for the trial ; 57 had remitted spontaneously or improved before appointments could be made , 15 defaulted , and 9 were rejected as unsuitable . The 37 cases were allocated at r and om to the two treatments . Assessment s were made six months later , by which time 4 further cases had been lost to the trial . Among 33 cases remaining , 16 on alarm and 17 on amphetamine , the results for the alarm were significantly better ; this was more so among the 23 cases whose treatment was considered adequate . Amphetamine had no greater effect than the natural remission-rate . The significance of this result to theories of conditioning and of the mechanism of enuresis is discussed . RESUME Un essai de traitement par conditionnement dans Venuresie nocturne Les auteurs projetaient de comparer l'effet du conditionnement par alarme et de l'amphetamine dans le traitement de l'enuresie . A cet effet , 118 ecoliers enuretiques âges de 8 ans et au-dessus ont ete depistes au cours d'une enquete ; ils devaient constituer le groupe experimental mais 37 seulement ont pu etre enroles pour l'essai . 57 se sont dedits spontanement ou ameliores avant qu'on ait pu les convoquer , 15 ont fait defaut et 9 ont ete rejetes comme impropres a l'essai . Parmi ces 33 restant , 16 traites par alarme et 17 par l'amphetamine , les result ats obtenus par Falarme ont ete nettement meilleurs . L'effet de l'amphetamine ne depassait pas le taux de remission naturel . Les auteurs discutent la signification de ces result ats pour la theorie du conditionnement et celle du mecanisme de l'enuresie Efficacy and tolerance of the anticholinergic and calcium antagonistic drug terodiline ( Mictrol ) were investigated in comparison to placebo in 42 children with diurnal enuresis . The study was double-blind with a modified cross-over design with 2 treatment periods of 4 weeks . Terodiline in a daily dose of 25 mg was well tolerated . A statistically significant decrease in the number of wet episodes per day was found with terodiline when compared to placebo . In addition a high patient preference for terodiline was observed . This study shows that terodiline is effective in the treatment of daytime enuresis in children . The low incidence of side-effects also favours the use of terodiline in children A double-blind study of terodiline compared with placebo was performed in 58 children aged 6 to 14 years with urgency or urge incontinence . All had an unstable bladder at cystometry . A bladder regimen was emphasised during the study . Continence was improved according to micturition charting and a pad test in both groups . Terodiline at 25 mg/day , however , gave significantly better results than placebo . In patients with a subnormal bladder capacity  ( less than or equal to 150 ml ) , a significant increase in capacity was recorded on cystometry during medication with terodiline but not with placebo . The improved continence seen in the placebo group was probably due to the non-specific bladder training achieved by the child 's increased awareness and adult involvement during treatment . The even better results attained in the terodiline group shows this drug to be a valuable adjunct to a bladder regimen in children with urge incontinence , particularly since no important adverse effects were noted during an 8-week period The efficacy of treatment with imipramine hydrochloride , desipramine hydrochloride , methscopolamine bromide , and placebo was compared in a study with 40 severely enuretic boys . Both tricyclic antidepressants were superior to placebo and methscopolamine , but they did not differ from each other . Psychiatric disturbance , sleep measures , and other clinical parameters did not predict antienuretic response to tricyclics nor was there a psychotropic response . Plasma concentrations of imipramine and desipramine showed a significant correlation with clinical effect . However , true nonresponders were found , and tolerance to the antienuretic drugs developed in some boys reported by several investigators , Eiectroencephaiographic abnormalities were found in a large percent age of enuretic children by Michael and Sectznd.a , l~ and by others . Some investigators have report , , : frequent occurrences of i : ui , minor genito-urinary abnorma lit i , , ’ ... such as inflammation of the tri~~~ and verumontanum , changes in E;z~ , shape of the internal urethral open ing , and valves or stenosis of tl~~= urethra . Others have described high incidence of coronal adho sions , vulvitis or spina bifida ofcuh,% in enuretics.5 , n. 8 , 10,:Z : Z Still nth&dquo ; , , , have noted a relationship l ~ eti,‘c~~.·tz allergy  
    Output:
    
MAIN RESULTS None of the drugs  ( phenmetrazine , amphetamine sulphate/ephedrine + atropine , furosemide ( sic ) or chlorprotixine )  were better than placebo during treatment .
The numbers were too small to draw reliable conclusions , and none are used in current practice in the UK .
Alarm treatment was better than drugs in one small trial .
REVIEW ER 'S CONCLUSIONS There was not enough evidence to suggest that the included drugs reduced bedwetting .
There was limited evidence to suggest that imipramine and alarms were better , and in other review s , desmopressin , tricyclics and alarm interventions have tentatively been shown to be effective