The possible pathology and treatment modalities can be summarized as follows:
(a) The child may have small bladder capacity. In this case, oxybynin might be the drug of choice. Drug combinations were reviewed in a 2012 Cochrane paper by Deshpande et al. They found that, for drugs versus behavioral therapy, bedwetting alarms were found to be better than oxybutynin, and also better than oxybutynin plus holding exercises, in reducing the number of children failing to achieve 14 consecutive dry nights [21]. However, a combination of desmopressin plus an antimuscarinic drug may be a more effective alternative to desmopressin monotherapy. This combination therapy was also found to be successful as a first-line therapy in a study by Park et al. [22] and, although this is promising, we keenly await independent confirmation.
(b) Some of these children may also have daytime incontinence, which was not discovered initially. A strict voiding regimen should be added to desmopressin plus alarm combination therapy for these children [2].
(c) Some of the non-responders may have absorptive hypercalciuria and may become desmopressin-responders after using a low-calcium diet [2].