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

Abstract

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.

Nocturia and Sleep: Focus on Common Comorbidities and Their Association with Obstructive Sleep Apnea

“…An effective treatment can benefit OAB patients to a significant degree, with improvements in sleep parameters [43]. Mirabegron, a beta-3 adrenoreceptor agonist, was reported to be efficacious, with a relatively safe drug profile, in elderly patients with OAB [44]. Desmopressin can also be used, but caution is needed in patients at risk of hyponatremia [44].…”

“…Mirabegron, a beta-3 adrenoreceptor agonist, was reported to be efficacious, with a relatively safe drug profile, in elderly patients with OAB [44]. Desmopressin can also be used, but caution is needed in patients at risk of hyponatremia [44]. For those with nocturnal urgent urinary incontinence, which stems from the imbalance between bladder capacity and nocturnal urinary production, fesosterodine, an antimuscarinic drug, has been recommended for the alleviation of symptoms [45].…”