Efficacy of adding behavioural treatment or antimuscarinic drug therapy to α‐blocker therapy in men with nocturia

Abstract

• Nocturia is a common and bothersome lower urinary tract symptom, particularly in men. Many single drug therapies have limited benefit.• For men who have persistent nocturia despite alpha-blocker therapy, the addition of behavioural and exercise therapy is statistically superior to anticholinergic therapy. Objective• To compare reductions in nocturia resulting from adding either behavioural treatment or antimuscarinic drug therapy to a-adrenergic antagonist (a-blocker) therapy in men. Patients and Methods• Participants were men who had continuing urinary frequency >8 voids/day) and urgency after 4 weeks of a-blocker therapy run-in and who had Ն1 nightly episode of nocturia.• Participants received individually titrated drug therapy (extended-release oxybutynin) or multicomponent behavioural treatment (pelvic floor muscle training, delayed voiding and urge suppression techniques).• Seven-day bladder diaries were used to calculate reductions in mean nocturia. Results• A total of 127 men aged 42-88 years with Ն1 nocturia episode per night were included in the study.• There were 76 men who had a mean of Ն2 nocturia episodes.• Among those with Ն1 nocturia episode, behavioural treatment reduced nightly nocturia by a mean of 0.97 episodes and was significantly more effective than drug therapy (mean reduction = 0.56 episodes; P = 0.01).• Participants with Ն2 episodes nocturia at baseline also showed larger changes with behavioural treatment compared with antimuscarinic therapy (mean reduction = 1.26 vs 0.61; P = 0.008). Conclusions• Both behavioural treatment and drug therapy reduced nocturia in men with Ն1 episode of nocturia/night when added to a-blocker therapy.• These results were similar even when only those with Ն2 episodes of nocturia were considered. • The addition of behavioural treatment was statistically better than bladder-relaxant therapy for nocturia.

Low‐dose Desmopressin and Tolterodine Combination Therapy for Treating Nocturia in Women with Overactive Bladder: A Double‐blind, Randomized, Controlled Study

“…Second, both the treatment groups received behavioral therapy, which is the first‐line management strategy for nocturia, while pharmacotherapy is an add‐on therapy in those with failed behavioral therapy. Behavioral therapy has been reported to have similar to better efficacy than pharmacotherapy in older women with incontinence, and men with OAB . Antimuscarinics with behavioral therapy may therefore adequately address nocturia due to urgency and excessive fluid load, in some patients, though in others it may not respond due to the multifactorial etiology of nocturia …”

Effects of Bladder Training and Pelvic Floor Muscle Training in Female Patients with Overactive Bladder Syndrome: A Randomized Controlled Trial

“…Cochrane review published in 2014 supports the widespread recommendation that PFMT be included in first-line conservative management programs for women with stress and other types of urinary incontinence [21]. PFMT has evolved over decades, both as a behavioral therapy and a physical therapy, combining principles from behavioral science, nursing, and muscle physiology into a widely recommended conservative treatment [22] but before pharmacotherapy, BT including life style modifications and PFMT should be considered.…”

Thermobalancing conservative treatment for moderate-to-low-degree lower urinary tract symptoms (LUTS) secondary to prostate enlargement

“…These studies verify the exacerbating role of MetS-induced metabolic derangements in the development of BPE (4) . Investigating of uncomplicated lower urinary tract symptoms (LUTS) in men who used a self-management programme in addition to standard care or standard care alone demonstrated that behavioural treatment reduced nightly nocturia by a mean of 0.97 episodes and was significantly more effective than drug therapy (5) . However, all attention in alternative approach for BPH was usually associated with the phytotherapeutic agents, as natural products, containing inherently vast structural diversity than synthetic compounds, have been the major resources for discovering new drugs (6) .…”