Desmopressin Add-On Therapy for Refractory Nocturia in Men Receiving α-Blockers for Lower Urinary Tract Symptoms

Bae, Woong Jin; Bae, Jang Ho; Kim, Sae Woong; Chung, Byung Ha; Kim, Jang Hwan; Kim, Choung Soo; Lee, Hyun Moo; Lee, Kyung Seop; Yoo, Tag Keun; Kim, Sun Il; Byun, Seok Soo; Lee, Ji Youl

doi:10.1016/j.juro.2013.01.057

Cited by 30 publications

(34 citation statements)

References 25 publications

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“…The study also demonstrated that this combination therapy improved the quality of sleep, whilst overall tolerability remained comparable to tamsulosin monotherapy . Similar results have been seen when low‐dose desmopressin was added to other α 1 ‐blockers for men with LUTS/BPH . A recently published, double‐blind, randomised, proof‐of‐concept study showed that a combination of desmopressin 25 μg and the antimuscarinic tolterodine provided a significant benefit in nocturnal void volume ( P = .034) and time to first nocturnal void ( P = .045) over tolterodine monotherapy in women with OAB and nocturnal polyuria …”

Section: Resultssupporting

confidence: 56%

A practical approach to the management of nocturia

et al. 2017

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SummaryAimTo raise awareness on nocturia disease burden and to provide simplified aetiologic evaluation and related treatment pathways.MethodsA multidisciplinary group of nocturia experts developed practical advice and recommendations based on the best available evidence supplemented by their own experiences.ResultsNocturia is defined as the need to void ≥1 time during the sleeping period of the night. Clinically relevant nocturia (≥2 voids per night) affects 2%‐18% of those aged 20‐40 years, rising to 28%‐62% for those aged 70‐80 years. Consequences include the following: lowered quality of life; falls and fractures; reduced work productivity; depression; and increased mortality. Nocturia‐related hip fractures alone cost approximately €1 billion in the EU and $1.5 billion in the USA in 2014. The pathophysiology of nocturia is multifactorial and typically related to polyuria (either global or nocturnal), reduced bladder capacity or increased fluid intake. Accurate assessment is predicated on frequency‐volume charts combined with a detailed patient history, medicine review and physical examination. Optimal treatment should focus on the underlying cause(s), with lifestyle modifications (eg, reducing evening fluid intake) being the first intervention. For patients with sustained bother, medical therapies should be introduced; low‐dose, gender‐specific desmopressin has proven effective in nocturia due to idiopathic nocturnal polyuria. The timing of diuretics is an important consideration, and they should be taken mid‐late afternoon, dependent on the specific serum half‐life. Patients not responding to these basic treatments should be referred for specialist management.ConclusionsThe cause(s) of nocturia should be first evaluated in all patients. Afterwards, the underlying pathophysiology should be treated specifically, alone with lifestyle interventions or in combination with drugs or (prostate) surgery.

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Section: Resultssupporting

confidence: 56%

A practical approach to the management of nocturia

et al. 2017

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“…a turkish study [22] evaluated 45 patients with BPH and nocturia and compared the use of combined desmopressin and alfuzosin with alfuzosin monotherapy and reported 36.11 % reduction in the mean nocturia number in patients receiving combined therapy that is significantly higher than in patients receiving alfuzosin only (25.71 %). In a recent randomized placebocontrolled Korean study, [25] reported only 18.57 % reduction in the mean nocturia number upon addition of desmopressin to different α blockers. However, they included only patients with refractory nocturia unresponsive to α blockers.…”

Section: Discussionmentioning

confidence: 99%

The impact of adding low-dose oral desmopressin therapy to tamsulosin therapy for treatment of nocturia owing to benign prostatic hyperplasia

et al. 2014

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“…The duration of the first sleep period also increased in the desmopressin group, which significantly improved the quality of sleep versus placebo [88]. Desmopressin add-on therapy is also effective in improving nocturia and storage symptoms in men receiving an alpha blocker for LUTSs [89]. …”

Section: Nocturnal Polyuria Remains An Important Cause Of Oab In Tmentioning

confidence: 99%

Practical points in the medical treatment of overactive bladder and nocturia in the elderly

Chen

Jiang

et al. 2016

Tzu Chi Medical Journal

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The prevalence of overactive bladder (OAB) increases with age. Degeneration of the central nervous system in the elderly has been proposed as one of the pathogenic factors of OAB. Antimuscarinic therapy is effective in the treatment of OAB; however, intolerable systemic adverse events and cognitive dysfunction during treatment with nonselective antimuscarinic agents is of growing concern in elderly patients. The newly developed beta-3 adrenoceptor agonist mirabegron does not adversely affect flow rate and detrusor pressure, and its therapeutic efficacy and tolerability are similar in patients aged > 65 years and > 75 years, suggesting it might be the therapeutic choice in older patients with OAB. Nocturia can cause sleep deprivation at night and increase daytime sleepiness and loss of energy in the elderly. Desmopressin add-on therapy is effective in improving nocturia and storage symptoms. However, elderly patients with a baseline serum sodium level below the normal range are at high risk of developing significant hyponatremia.

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Desmopressin Add-On Therapy for Refractory Nocturia in Men Receiving α-Blockers for Lower Urinary Tract Symptoms

Abstract: Desmopressin add-on therapy for refractory nocturia in men previously treated with an α-blocker for lower urinary tract symptoms improved voiding symptoms as well as nocturia, storage symptoms.

Cited by 30 publications

References 25 publications

A practical approach to the management of nocturia

A practical approach to the management of nocturia

The impact of adding low-dose oral desmopressin therapy to tamsulosin therapy for treatment of nocturia owing to benign prostatic hyperplasia

Practical points in the medical treatment of overactive bladder and nocturia in the elderly

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