The authors recommend a short “drug holiday” to assess medication

efficacy. Another therapeutic alternative is the anticholinergic compounds. There have been several open, nonrandomized studies indicating beneficial effects in therapy-resistant children with enuresis. This has been corroborated by a recent randomized, placebo-controlled study by Austin and colleagues examining combination desmopressin and anticholinergic medication for nonresponders to desmopressin.7 The authors note that, once beginning anticholinergic therapy, the antienuretic effects should appear within 2 Inhibitors,research,lifescience,medical months or sooner. Parents should be warned to watch for constipation and should return within 4 to 6 weeks for a postvoid residual and urinalysis

when using these medications. They also discuss the use of tricyclic antidepressants. These drugs are thought to be third-line therapy at tertiary care centers because there have been safety concerns in the past. A 50% response rate has been shown in some children. Usually imipramine 25 to 50 mg is Inhibitors,research,lifescience,medical administered at bedtime and larger doses are given to children older than age 9 years. After 1 month, the child is reevaluated. If there is partial response, desmopressin may be added. Tolerance of this drug can occur so a drug holiday of at least 2 weeks interspersed every third month is recommended to lessen this risk. The authors suggest an electrocardiogram (EKG) prior to imipramine treatment, especially Inhibitors,research,lifescience,medical in those children with a history of palpitations or syncope or any sudden cardiac death or unstable arrhythmia in the family. I always Purmorphamine research buy obtain a pretreatment EKG and this is reassuring to parents Inhibitors,research,lifescience,medical once they learn of the potential cardiac side effects. The authors note mood change, nausea, and insomnia as side effects that may occur before nocturnal

continence is attained. Other therapies have included acupuncture, treatment of hypercalciuria, and noncardiotoxic alternatives to imipramine. At a recent pediatric urology meeting, hypnosis for MNE was discussed as a successful therapeutic alternative, and provides a concise guideline for practitioners for the treatment of MNE. Inhibitors,research,lifescience,medical Vesicoureteral Reflux Cannon and the investigators from Children’s Hospital in Boston determined whether improvement in reflux on serial imaging predicts resolution of vesicoureteral reflux.8 They evaluated 965 children who had a minimum of 2 years of follow-up. They noted the initial reflux grade and the grade on serial Histone demethylase imaging up to 5 years following diagnosis. The authors found several factors that were predictive of reflux resolution. Multivariant analysis showed that male sex, age younger than 1 year at diagnosis, lower grade at presentation, and unilateral reflux were independent predictors of reflux resolution. Additional independent predictors of reflux resolution were reflux improvement on imaging 1 year after diagnosis or improvement from the previous year at any point during follow-up.