What is the first line treatment for childhood enuresis after behavioral therapy fails?

Desmopressin is considered the first-line pharmacological treatment for childhood enuresis, particularly after behavioral therapies, such as bedwetting alarms and motivational strategies, have not achieved the desired outcome. Desmopressin is a synthetic analog of vasopressin, which helps to increase water reabsorption in the kidneys, thus reducing urine output at night. This mechanism addresses the nocturnal polyuria often seen in children with enuresis.

Using desmopressin can be particularly effective for children who have a history of bedwetting and typically have normal bladder capacity during the day, as the medication allows for more concentrated urine and decreases the likelihood of bedwetting episodes during the night.

The other treatment options listed do not serve as first-line therapies in this context. Imipramine, a tricyclic antidepressant, may be considered in certain cases but is not the preferred first-line due to its side effects and the potential for toxicity. Antibiotics are not indicated since enuresis is not caused by a urinary tract infection. Antihistamines also do not address the underlying causes of enuresis and could lead to urinary retention, which is counterproductive. Thus, desmopressin stands out