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Palmieri B, Iannitti T, Morales-Medina JC, Vadalà M. Monocentric single-arm study of desmopressin acetate efficacy on nocturnal polyuria in the elderly. Int J Clin Pract 2020; 74:e13612. [PMID: 32668490 DOI: 10.1111/ijcp.13612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/08/2020] [Indexed: 11/29/2022] Open
Abstract
AIM OF THE STUDY We designed a retrospective, monocentric, observational study to assess the efficacy and short-term side effect profile of desmopressin, a synthetic analogue of antidiuretic hormone, in 42 elderly patients affected by nocturnal polyuria (NP), a subset of nocturia (nocturnal overproduction of urine at night), which is characterised by nocturnal urine volume (NVU) exceeding 33% of the 24-hours total urine output. METHODS USED TO CONDUCT THE STUDY The subjects had NP and included 25 males, which had benign prostatic hyperplasia (12 out of 25 had been surgically or endoscopically operated) and 15 females that had increased urinary frequency, night-time voiding, loss of bladder control and recurrent bladder infections, due to perineal wall weakness and vaginal or bladder prolapse. Patients recorded the number of voids during waking hours using a digital continuous urine meter. The quality of life (QoL) and efficacy of desmopressin were assessed at baseline and 12 weeks after treatment using the International Consultation on Incontinence Questionnaire Nocturia Quality of Life Module (ICIQ-Nqol) and International Prostate Symptom Score questionnaire (IPPS-Q8). The dosage of desmopressin acetate varied according to the discretion of the physician, usually beginning with one tablet before going to bed at night for 3 months. The dose was increased at 1-week intervals if a reduction in the NVU or night-time frequency was not achieved. RESULTS OF THE STUDY We found that desmopressin treatment reduced the nocturnal voided volume (P < .0001), ICIQ-Nqol (P < .0001) and IPPS-Q8 (P < .0001). No significant serum sodium alterations or modifications in serum creatine, potassium, or body weight were observed in all the patients. No adverse effects were observed. CONCLUSIONS DRAWN FROM THE STUDY AND CLINICAL IMPLICATIONS Our findings show efficacy of desmopressin in the elderly for NP treatment supporting further clinical trials in larger cohorts of patients.
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Affiliation(s)
- Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia, Modena (MO), Italy
- Second Opinion Medical Network, Modena (MO), Italy
| | - Tommaso Iannitti
- Charles River Discovery Research Services UK Limited, Portishead, UK
| | - Julio Cesar Morales-Medina
- Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala CP 90000, AP 62, Tlaxcala, México
| | - Maria Vadalà
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia, Modena (MO), Italy
- Second Opinion Medical Network, Modena (MO), Italy
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Everaert K, Hervé F, Bosch R, Dmochowski R, Drake M, Hashim H, Chapple C, Van Kerrebroeck P, Mourad S, Abrams P, Wein A. International Continence Society consensus on the diagnosis and treatment of nocturia. Neurourol Urodyn 2019; 38:478-498. [PMID: 30779378 DOI: 10.1002/nau.23939] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/21/2018] [Accepted: 12/03/2018] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Patients with nocturia have to face many hurdles before being diagnosed and treated properly. The aim of this paper is to: summarize the nocturia patient pathway, explore how nocturia is diagnosed and treated in the real world and use the Delphi method to develop a practical algorithm with a focus on what steps need to be taken before prescribing desmopressin. METHODS Evidence comes from existing guidelines (Google, PubMed), International Consultation on Incontinence-Research Society (ICI-RS) 2017, prescribing information and a Delphi panel (3 rounds). The International Continence Society initiated this study, the authors represent the ICI-RS, European Association of Urology, and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU). RESULTS Diagnostic packages: consensus on, history taking for all causalities, intake diary (fluid, food) and bladder diary, not for its duration. Pelvic (women) or rectal (men) examination, prostate-specific antigen, serum sodium check (SSC), renal function, endocrine screening: when judged necessary. Timing or empty stomach when SSC is not important. Therapeutic packages: the safe candidates for desmopressin can be phenotyped as no polydipsia, heart/kidney failure, severe leg edema or obstructive sleep apnea syndrome. Lifestyle interventions may be useful. Initiating desmopressin: risk management consensus on three clinical pictures. Follow-up of desmopressin therapy: there was consensus on SSC day 3 to 7, and at 1 month. Stop therapy if SSC is <130 mmol/L regardless of symptoms. Stop if SSC is 130 to 135 mmol/L with symptoms of hyponatremia. CONCLUSION A summary of the nocturia patient pathway across different medical specialists is useful in the visualization and phenotyping of patients for diagnosis and therapy. By summarizing basic knowledge of desmopressin, we aim to ease its initiation and shorten the patient journey for nocturia.
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Affiliation(s)
- Karel Everaert
- Urology Department, Ghent University Hospital, Ghent, Belgium
| | - Francois Hervé
- Urology Department, Ghent University Hospital, Ghent, Belgium
| | - Ruud Bosch
- Urology Department, UMC Utrecht, Utrecht, The Netherlands
| | - Roger Dmochowski
- Urology Department, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marcus Drake
- Bristol Urological Institute, University of Bristol, Bristol, United Kingdom
| | - Hashim Hashim
- Bristol Urological Institute, University of Bristol, Bristol, United Kingdom
| | - Christopher Chapple
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield, United Kingdom
| | | | - Sherif Mourad
- Urology Department, Ain Shams University, Cairo, Egypt
| | - Paul Abrams
- Bristol Urological Institute, University of Bristol, Bristol, United Kingdom
| | - Alan Wein
- Urology Department, University of Philadelphia, Philadelphia, Pennsylvania
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Chen SL, Huang YH, Hung TW, Ou YC. Comparison of nocturia response to desmopressin treatment in elderly men with and without nocturnal polyuria in real-life practice. Int J Clin Pract 2016; 70:372-9. [PMID: 27039892 DOI: 10.1111/ijcp.12786] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To evaluate the safety and efficacy of low-dose desmopressin in elderly men with and without nocturnal polyuria (NP) in real-life practice. METHODS Patients with lower urinary tract symptoms (LUTS)/ benign prostate hyperplasia (BPH) who were≧ 65 years old with refractory nocturia were enrolled in this study. We retrospectively analysed elderly men treated with adding desmopressin to current medications for nocturia according to category of the baseline nocturnal urine volume. The 48-h frequency volume chart (FVC), International Prostate Symptom Score (IPSS) and quality of life (QoL) were initially assessed and re-evaluated 12 weeks later. Serum sodium level was checked 1 week, 4 weeks, and 12 weeks after initiation of desmopressin therapy or suspected hyponatremia event. The mean change in numbers of nocturnal voids was evaluated for efficacy of treatment. RESULTS A total of 136 patients were included with 55 in non-NP group and 81 in NP group. Hypertension was more common in NP group in regard of comorbidities. During treatment period, there were significant reductions of nocturnal voids from 4.22 ± 1.38 to 2.31 ± 0.98 (p < 0.001) in non-NP group and from 4.52 ± 1.23 to 2.07 ± 0.89 (p < 0.001) in NP group. The reduction in nocturnal voids was more significant in NP group (2.44 ± 1.15 vs. 1.91 ± 1.48, p = 0.003). The mean decrease in serum sodium levels were 3.89 ± 1.22 mmol/l (p < 0.001) in non-NP group and 4.69 ± 3.5 mmol/l (p < 0.001) in NP group at the extreme value. CONCLUSIONS Long-term treatment with low-dose desmopressin is safe and effective for nocturia with or without NP in elderly patients with LUTS/BPH during real-life practice. Patients should be well informed about the disease and are closely followed.
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Affiliation(s)
- S-L Chen
- Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Y-H Huang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - T-W Hung
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Nephrology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Y-C Ou
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
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Yazici CM, Kurt O. Combination therapies for the management of nocturia and its comorbidities. Res Rep Urol 2015; 7:57-63. [PMID: 25945323 PMCID: PMC4408945 DOI: 10.2147/rru.s51140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Nocturia is the most bothersome lower urinary tract symptom. It has a multifactorial etiology. It had been thought nocturia was a nonspecific symptom of lower urinary system dysfunction, but it has been determined that many diseases, related to different organ systems, might be reasons for this nonspecific symptom. Along with the importance of systemic diseases that cause nocturia, the symptom itself has adverse effects on patients’ health and quality of life. There are several studies reporting a direct relationship between nocturia and depression, cognitive dysfunction, mood disturbances, falls, and fractures. For this reason, it is important to treat nocturia both to increase quality of life and to decrease related complications. Treatment opportunities have been under investigation for 20 years. Most of the studies in the literature have reported the results of single-drug medication on nocturia, which may be insufficient for a situation that has such a multifactorial etiology. In this review, we evaluated the success of different treatment combinations on nocturia.
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Affiliation(s)
- Cenk Murat Yazici
- Department of Urology, Namik Kemal University School of Medicine, Tekirdag, Turkey
| | - Omer Kurt
- Department of Urology, Namik Kemal University School of Medicine, Tekirdag, Turkey
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Bae WJ, Bae JH, Kim SW, Chung BH, Kim JH, Kim CS, Lee HM, Lee KS, Yoo TK, Kim SI, Byun SS, Lee JY. Desmopressin Add-On Therapy for Refractory Nocturia in Men Receiving α-Blockers for Lower Urinary Tract Symptoms. J Urol 2013; 190:180-6. [DOI: 10.1016/j.juro.2013.01.057] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Woong Jin Bae
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jang Ho Bae
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sae Woong Kim
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Byung Ha Chung
- Department of Urology, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Jang Hwan Kim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Choung Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Kyung Seop Lee
- Department of Urology, Dongguk University, Kyungnam, Korea
| | - Tag Keun Yoo
- Department of Urology, Eulji University, Seoul, Korea
| | - Sun Il Kim
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
| | - Seok Soo Byun
- Department of Urology, Seoul National University, Bundang Hospital, Kyungki, Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Weiss JP, Wein AJ, van Kerrebroeck P, Dmochowski R, Fitzgerald M, Tikkinen KAO, Abrams P. Nocturia: new directions. Neurourol Urodyn 2011; 30:700-3. [PMID: 21661016 DOI: 10.1002/nau.21125] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The Nocturia Think Tank (TT) met during the 2010 meeting of the International Consultation on Incontinence-Research Society to discuss present knowledge and future directions in care and research of this prominent component of the spectrum of lower urinary tract symptoms. Questions raised included whether nocturia should be re-defined as a function of its bother, effects on quality of life, and economic impact upon society. At issue is the need to delineate the determinants of successful nocturia management. The multifactorial nature of nocturia requires that progress in its treatment will be dependent upon the cooperative investigation on the part of urologists, urogynecologists, geriatricians, epidemiologists, medical economists and pharma. Areas for future avenues of research were outlined at the conclusion of the meeting.
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Fu FG, Lavery HJ, Wu DL. Reducing nocturia in the elderly: a randomized placebo-controlled trial of staggered furosemide and desmopressin. Neurourol Urodyn 2011; 30:312-6. [PMID: 21305590 DOI: 10.1002/nau.20986] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Accepted: 07/01/2010] [Indexed: 11/07/2022]
Abstract
AIMS The purpose of this study was to investigate efficacy, safety, and impact on quality of sleep of staggered furosemide and desmopressin in the treatment of nocturia in the elderly. METHODS Patients aged >60 years with nocturia at least two voids per night were screened for enrollment into the study. A 3-week dose-titration phase established the optimum desmopressin dose (0.1, 0.2, or 0.4 mg). After a 1-week "washout" period, patients who showed sufficient response during the dose-titration period were randomized to receive staggered furosemide and the optimal dose of desmopressin or placebo in a double-blind design for 3 weeks. Voiding diaries were assessed before and after the treatment. RESULTS In all, 82 patients were randomized to either staggered furosemide and desmopressin (n=41) or placebo (n=41). In the study group, most patients reported a good response with both reduced nocturnal voids (3.5 vs. 2.0, P<0.01) and urine volume (919.6 ml vs. 584.2 ml, P<0.01). The mean duration of the first sleep period was improved by 70 min (133.6 vs. 203.2, P<0.01). Compared to placebo, staggered furosemide and desmopressin resulted in a significant reduction in the mean number of nocturnal voids (43% vs. 9%; P<0.01), nocturnal urine volume (37% vs. 5%; P<0.01), and increase in the mean duration of the first sleep period (52% vs. 19%, P<0.01). Adverse events were mild. CONCLUSIONS Staggered furosemide and desmopressin provide an effective and well-tolerated treatment for nocturia in the elderly.
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Affiliation(s)
- Fei-Guo Fu
- Department of Urology, TongJi Hospital, TongJi University School of Medicine, Shanghai, China
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Cho MC, Ku JH, Paick JS. α-Blocker Plus Diuretic Combination Therapy as Second-line Treatment for Nocturia in Men With LUTS: A Pilot Study. Urology 2009; 73:549-53; discussion 554-5. [PMID: 19100605 DOI: 10.1016/j.urology.2008.08.517] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 08/21/2008] [Accepted: 08/25/2008] [Indexed: 10/21/2022]
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Bae JH, Oh MM, Shim KS, Cheon J, Lee JG, Kim JJ, Moon DG. The Effects of Long-Term Administration of Oral Desmopressin on the Baseline Secretion of Antidiuretic Hormone and Serum Sodium Concentration for the Treatment of Nocturia: A Circadian Study. J Urol 2007; 178:200-3. [PMID: 17499799 DOI: 10.1016/j.juro.2007.03.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2006] [Indexed: 11/15/2022]
Abstract
PURPOSE We assessed the effects of long-term oral desmopressin on serum sodium and baseline antidiuretic hormone secretion in elderly patients with nocturia. MATERIALS AND METHODS A total of 15 elderly male patients with severe nocturia (greater than 3 voids nightly) who did not show hyponatremia within 7 days of administration of 0.2 mg desmopressin were enrolled in this study. Desmopressin (0.2 mg) was administered orally nightly for 1 year. Before and 1 month after the 1-year medication 24-hour circadian studies were performed to monitor changes in antidiuretic hormone. Every 3 months during the 1-year medication serum changes and timed urine chemistry were monitored. RESULTS Desmopressin significantly decreased nocturnal urine output and the number of nocturia episodes (p<0.01). Compared to before treatment desmopressin gradually decreased serum sodium and induced statistically but not clinically significant hyponatremia after 6 months of treatment. After discontinuing desmopressin serum sodium returned to the normal range in all patients. There were no significant differences when baseline and posttreatment endogenous antidiuretic hormone were compared. No serious systemic complications were found during medication. CONCLUSIONS Long-term desmopressin administration gradually decreased the serum concentration and induced significant hyponatremia from 6 months in patients who did not show initial hyponatremia. Long-term administration of desmopressin for 1 year in elderly patients did not affect baseline antidiuretic hormone secretion. For long-term desmopressin administration serum sodium should be assessed regularly, at least every 6 months.
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Affiliation(s)
- J H Bae
- Department of Urology, Korea University College of Medicine, and Korea University Guro Hospital, Seoul, Republic of Korea
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Cai T, Gardener N, Abraham L, Boddi V, Abrams P, Bartoletti R. Impact of surgical treatment on nocturia in men with benign prostatic obstruction. BJU Int 2006; 98:799-805. [PMID: 16978275 DOI: 10.1111/j.1464-410x.2006.06380.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To validate the International Consultation on Incontinence Nocturia Quality-of-life (NQoL) questionnaire in Italian (IT-NQoL) and use it to evaluate the impact of surgical treatment on nocturia in men with lower urinary tract symptoms related to benign prostatic obstruction (LUTS/BPO). PATIENTS AND METHODS All men attending one urological unit between November 2004 and April 2005 were enrolled in the study. They were assessed in two groups; those with and with no LUTS/BPO. An Italian translation of the NQoL was devised, and patients then completed this and validated Italian versions of the International Prostate System Score (IPSS), the Pittsburg Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Clinical, laboratory and instrumental data from each patient were recorded. The patients with LUTS/BPO then had surgical treatment, and 6 months later those with LUTS/BPO were asked to complete all the questionnaires again to evaluate the test sensitivity to change. RESULTS Of the 109 patients enrolled in the study, 61 were affected by LUTS/BPO and 48 were not. Cronbach's alpha for the IT-NQoL was 0.943 (95% confidence interval, CI, 0.922-0.959; P < 0.001) and the intra-class correlation coefficient was 0.999 (95% CI 0.998-0.999; P < 0.001) for the total IT-NQoL score. The correlation between the test and the re-test was statistically significant (P < 0.001; r = 0.999) for all items. The mean (sd) IT-NQoL score showed an improvement in QoL from before, at 23.4 (10.1), to after treatment, at 3.09 (2.48) (P < 0.001). In the LUTS/BPO group, the IT-NQoL correlated with the number of times when waking to urinate (Pearson's coefficient 0.80, P < 0.001). There was also a correlation for ESS (0.796) and for the seven PSQI subscales (0.614, both P < 0.001). The decrease in sleep quality, duration and efficiency resulted in an increase in daytime sleepiness (r = 0.639, 0.642). At the 6-month follow-up, all questionnaire results were statistically different from those before treatment. CONCLUSIONS The IT-NQoL is the first validated translation of the primary instrument into another language. This version is easy to use and has the same characteristic validity as the English version. Using the IT-NQoL showed that surgical treatment determines a decrease in the nocturia rate and an increase in QoL. There was also a significant increase in QoL after treatment as assessed by all the other questionnaires.
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Affiliation(s)
- Tommaso Cai
- Department of Urology, University of Florence, Florence, Italy.
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Paick JS, Ku JH, Shin JW, Yang JH, Kim SW. alpha-blocker monotherapy in the treatment of nocturia in men with lower urinary tract symptoms: a prospective study of response prediction. BJU Int 2006; 97:1017-23. [PMID: 16643483 DOI: 10.1111/j.1464-410x.2006.06075.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the efficacy of an alpha-adrenoceptor antagonist, terazosin, in reducing nocturia in men with lower urinary tract symptoms (LUTS), and to identify the factors predicting treatment outcome. PATIENTS AND METHODS In all, 100 patients were treated with 2 mg of terazosin once daily for the first 7 days, and continued to receive 4 mg of terazosin once daily for the following 3 weeks. The men were assessed at baseline and at the end of treatment using uroflowmetry, the International Prostate Symptom Score (IPSS), and the degree of nocturia estimated from a frequency-volume chart (FVC) and objectively. RESULTS On the FVC, 27 patients reported that the terazosin treatment reduced their nocturia by more than half, and 14 reported a reduction of 25-49%. On the IPSS, 31 patients reported that the treatment reduced their nocturia by more than half and 27 reported a reduction of 25-49%. On multivariate regression analysis, only the actual number of nightly voids on the FVC was associated with a 2.1-fold chance of an improvement of >25% in objective nocturia (P = 0.016). Using a comparable model, a greater nocturia score on the IPSS was associated with a higher likelihood of improvement in subjective nocturia (odds ratio, 1.653; 95% confidence interval, 1.079-2.533; P = 0.021). CONCLUSION Treatment with terazosin can reduce patients' episodes of nocturia both subjectively and objectively in some men with LUTS. Our results suggest that both subjective and objective numbers of nocturia episodes are associated with improvements in subjective and objective nocturnal frequencies, respectively.
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Affiliation(s)
- Jae-Seung Paick
- Department of Urology, Seoul National University College of Medicine, and Seoul Veterans Hospital, Seoul, Korea
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