Comparison of Nocturia Response to Desmopressin Treatment in Elderly Men With and Without Nocturnal Polyuria in Real-life Practice

S.-L. Chen; Y.-H. Huang; T.-W. Hung; Y.-C. Ou

Disclosures

Int J Clin Pract. 2016;70(5):372-379. 

In This Article

Abstract and Introduction

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.

Introduction

Nocturia is defined as waking at night at least once to void.[1] The condition is the most bothersome factor in the lower urinary tract symptoms (LUTS) and is associated with impaired quality of life (QoL).[2] Nocturnal polyuria (NP) is a subclassification of nocturia characterised by nocturnal urine volume (NVU) over than 33% of the 24-h voided volume. The prevalence of nocturia in aged men is high and 29–59.3% reported at least two voids per night in the literatures.[3] Nocturia at least twice nightly is also reported by 35% of the population over 60 years of age[4] and by 69% of males and 49% of females over 80 years of age.[5] Most importantly, nocturia contributes to morbidity in elderly people via an increased risk of nocturnal falls and bone fractures.[6] Thus, how to manage nocturia seems to be a big issue in such population. Nocturia is a common manifestation of LUTS suggestive of benign prostate hyperplasia (BPH)[7] that is not only difficult to alleviate or cure but also resulting in 38% of patients treated surgically for benign prostatic obstruction.[8] Most of the nocturia is considered as associated condition and thus treated by medications for BPH or overactive bladder (OAB) or such as with αblocker, 5α-reductase inhibitor and antimuscarinics in daily practice. Unfortunately, the response seems to be unsatisfactory. Desmopressin has been proven to be an effective treatment for nocturia with NP for years.[9,10] However, an important adverse event was hyponatremia and the primary predictor for hyponatremia is age which makes the use of desmopressin in patients ≧ 65 years debatable.[11] On the other hand, whether desmopressin is equally effective in patients with noctruria without NP also remains unclear. Hence we conduct this study with the objective to examine the effect and safety of desmopressin in refractory nocturia with and without NP among patients with a history of LUTS/BPH and comorbidities in a Veterans Affairs-based aged male population.

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