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ORIGINAL PAPER
Comparison of nocturia response to desmopressin
treatment in elderly men with and without nocturnal
polyuria in real-life practice
S.-L. Chen,1,2 Y.-H. Huang,2,3 T.-W. Hung,2,4 Y.-C. Ou5
1
Department of Urology, Chung
Shan Medical University
Hospital, Taichung, Taiwan
2
School of Medicine, Chung
Shan Medical University,
Taichung, Taiwan
3
Department of Physical
Medicine and Rehabilitation,
Chung Shan Medical University
Hospital, Taichung, Taiwan
4
Department of Nephrology,
Chung Shan Medical University
Hospital, Taichung, Taiwan
5
Division of Urology,
Department of Surgery,
Taichung Veterans General
Hospital, Taichung, Taiwan
Correspondence to:
Yen-Chuan Ou, #110, ChienKuo North Road, Section 1,
Taichung 402, Taiwan
Tel.: + 886 4 2473 9595 ext.
34808
Fax: + 886 4 2472 8098
Email: [email protected]
Disclosures
All authors disclose no conflict
of interest
SUMMARY
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
372
What’s known
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 reevaluated 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.
•
•
•
Nocturia is a common reason for interrupted
sleep in elderly adults. As patients continue to
grow, the complaint of nocturia will become
more common and our patients will continue to
demand effective and safe therapies to get them
through the night.
Nocturnal polyuria (NP) is a subclassification of
nocturia characterised by nocturnal urine volume
that is over 33% of the 24-h voided volume.
Desmopressin has level 1 evidence and grade A
recommendation for the treatment of nocturia
because of NP. Randomised, placebo-controlled
studies in adults with nocturia because of NP
showed that desmopressin can significantly
reduce the number of nocturnal voids, decreases
the ratio of night/24-h urine volume.
What’s new
•
This study revealed that noctutria continued to
bother elderly men with lower urinary tract
symptoms suggestive of benign prostate
hyperplasia despite of stereotyped medical
therapy. Adding on low-dose oral desmopressin
in real-life practice was shown to be safe and
effective for patients over 65 years with nocturia.
It also demonstrated desmopressin reduced
nocturnal void, IPSS total score and quality of life
index not only in NP patients but also in non-NP
group in elderly men with comorbidities in reallife practice.
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
ª 2016 John Wiley & Sons Ltd
Int J Clin Pract, May 2016, 70, 5, 372–379. doi: 10.1111/ijcp.12786
Desmopressin in nocturia with or without nocturnal polyuria
as with ablocker, 5a-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.
Methods
Study and patients selection
This was a retrospective cohort study, and patients
who were ≧ 65 years old and had LUTS suggestive
of BPH with medical treatment were enrolled and
followed prospectively from January 2006 to June
2010. History of comorbid illness was taken from
patient and reconfirmed from previous medical documentation. Patients with urolithiasis, previous
prostate-related surgery, active urinary tract infection were excluded. Standard medical treatments
used for BPH were a-blocker, 5a-reductase inhibitor, imipramine and antimuscarinics as monotherapy or in combination. Oral desmopressin was
added only in patients with refractory nocturia in
spite of previous medications and no further
improvement from these medications were expected,
and they had experienced at least two nocturnal
voids at screening while using the prescribed drugs.
The dosage of desmopressin varied according to the
discretion of the physician, usually beginning with
0.05 mg before going to bed at night. Dose increase
was permitted upon patient request in 1-week intervals and was escalated to 0.2 mg if the NUV or
nighttime frequency was not reduced. The dose
never exceeded 0.2 mg, with a minimum dose of
0.05 mg. Use of concomitant drugs was allowed as
long as patients did not change the dose. A digital
rectal examination was performed to assess prostate
size and serum prostate-specific antigen (PSA) value
was obtained. The patients were required to have
their serum sodium and potassium checked at baseline, 1 week, 4 weeks and 12 weeks after beginning
desmopressin therapy or suspected hyponatremia
event. The same protocol was repeated while changing desmopressin dosage. The data were analysed
retrospectively.
Nocturia was defined based on the International
Continence Society 2002 definition. NP was also
defined as nocturnal urine volume (NUV) that was
> 33% of the total daily urine volume (12). Patients
were asked to complete a 48-h frequency volume
chart (FVC), including the time and volume of each
void, bedtime and time of rising before desmopressin
prescription. Efficacy and quality of life (QoL) parameters were assessed at baseline and 12 weeks after
desmopressin use. Both patients and physicians evaluated the efficacy of desmopressin with International
Prostate Symptom Score and IPSS-QoL questions
(IPPS-Q8) completed by patients during the study.
Safety was evaluated from reported adverse events
and laboratory data with an emphasis on serum
sodium levels. Statistical analysis was performed using
SPSS (SPSS for Windows Version 16.0, SPSS Inc.,
Chicago, IL, USA). The Wilcoxon signed-rank test
was used for assessing statistical significance in
changes in outcome parameters before and after treatment (Figure 1). The Fisher’s exact test and Yate’s
correction of contingency were used as appropriate,
with p < 0.05 considered significant.
5
4.5
4.52
4.22
4
3.5
mean
3
2.5
Pre-tx nocturnal
void
2.31
2.07
2
Post-tx
nocturnal void
1.5
1
0.5
0
Non-PN
NP
Figure 1 Mean nocturnal voids changes before and after desmopressin treatment in both non-NP and NP groups
ª 2016 John Wiley & Sons Ltd
Int J Clin Pract, May 2016, 70, 5, 372–379
373
374
Desmopressin in nocturia with or without nocturnal polyuria
Results
In total, 136 eligible patients were identified (age 65–
82 years) who had been prescribed 0.05–0.2 mg
desmopressin in tablet form (Minirin, Ferring) to be
taken at bedtime. The data of enrolled 136 patients
were divided into two groups (55 in non-NP group
and 81 in NP group) according to their NUV before
desmopressin treatment. No significant statistical differences were noted in patient age, medical comorbidities (except for hypertension), a-blocker use,
antimuscarinics use, 5a-reductase inhibitor use, imipramine use, IPSS scores, number of nocturnal voids,
baseline serum sodium level, duration and dose of
desmopressin use (Table 1). The duration of desmopressin use in non-NP and NP group was
22.28 13.42 months and 23.95 14.80 months.
In non-NP group: Seven patients (7/55) satisfied
with 0.05 mg desmopressin and continued with this
dose until study end. Forty-four (44/55) increased
dose from 0.05 to 0.1 mg, one (1/55) to 0.15 mg
and three (3/55) to 0.2 mg. In NP group: Ten
patients (10/81) satisfied with 0.05 mg desmopressin
and continued with this dose until study end. Sixtytwo (62/81) increased dose from 0.05 to 0.1 mg, two
(2/81) to 0.15 mg and seven (7/81) to 0.2 mg. No
significantly statistical difference was observed with
regard to the treatment dose of desmopressin.
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
(Figure 1). The reduction was more significant in NP
group (2.44 1.15 vs. 1.91 1.48, p = 0.003).
There were 31 (56.4%) patients reduced to ≦ 2 nocturnal voids in non-NP group and 58 (71.6%) in NP
group (p = 0.099). However, the extent of nocturnal
voids ≧ 2 was 35(63.6%) in non-NP group, and 71
(87.7%) in NP group (p = 0.002) (Figure 2). The
total IPSS scores decreased from 15.75 5.45 to
9.21 3.3 (p < 0.001) in non-NP group and from
15.90 4.49 to 9.29 3.3 (p < 0.001) in NP group
(Figure 2). The IPSS-Q8 decreased from 2.41 1.76
to 1.96 0.46 (p < 0.001) in non-NP group and
from 2.8 1.43 to 1.83 0.54 (p < 0.001) in NP
group. But no difference in total IPSS and IPSS-Q8
changes were noted between both groups (Table 2).
The mean decreases in serum sodium level 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 during follow-up. But the reduction level in serum sodium and in below 135 mmol/l
were not significant between both groups (p = 0.216
and 0.159). There were two cases of significant
hyponatremia (i.e. < 125 mmol/l), each in both
groups, who claimed to have no symptoms and
Table 1 Demographic characteristics of nocturia with or without NP
Age (years)
PSA ng/ml
Use a-blocker
Use 5ARI
Use antimuscarinics
Use imipramine
BPO
Prostate cancer
DM
Hypertension
CVA
Insomnia
Renal insufficiency
Urothelail cancer
Dose of desmopressin
Mean SD (mg)
0.05 mg
0.1 mg
0.15 mg
0.2 mg
Treatment duration (months)
Non-NP (n = 55)
NP (n = 81)
p
72.78 8.28
4.74 3.19
43
8
19
17
43
10
2
6
3
10
4
1
73.52 7.45
5.46 13.26
64
17
21
23
68
10
0
25
4
6
1
3
0.647
0.058
0.908
0.376
0.398
0.901
0.565
0.477
0.161
0.012*
0.894
0.097
0.157
0.648
0.1 0.30
7
44
1
3
22.28 13.2
(78.2%)
(14.5%)
(34.5%)
(30.9%)
(79.6%)
(18.5%)
(3.7%)
(11.1%)
(5.6%)
(18.5%)
(7.4%)
(1.9%)
(79%)
(21%)
(26.3%)
(28.4%)
(85%)
(12.5%)
(31.2%)
(5%)
(7.5%)
(1.2%)
(3.7%)
0.1 0.35
10
62
2
7
23.95 14.8
0.611
0.903
0.640
*Statistically significant p < 0.05. NP, nocturnal polyuria; 5ARI, 5a-reductase inhibitor; BPO, benign prostate obstruction.
ª 2016 John Wiley & Sons Ltd
Int J Clin Pract, May 2016, 70, 5, 372–379
Desmopressin in nocturia with or without nocturnal polyuria
Figure 2 Percentage of nocturnal voids reduction according to the extent of reduced ≧ 1 episode, reduced ≧ 2 episodes
and reduced to ≦ 2 episodes in both non-NP and NP groups
Table 2 Efficacy and safety parameter changes before and after desmopressin treatment
Nocturnal voids
Pretreatment
Posttreatment
Reduced episodes
≧ one episode
≧ two episodes
Reduced episodes to ≦ two episodes
IPSS
Pretreatment
Posttreatment
Reduced IPSS
QoL
Pretreatment
Posttreatment
Reduced QoL
Adverse event (except hyponatremia)
Non-NP (n = 55)
NP (n = 81)
p
4.22 1.38
2.31 0.98***
1.91 1.48
47 (85.5%)
35 (63.6%)
31 (56.4%)
4.52 1.23
2.07 0.89***
2.44 1.15
78 (96.3%)
71 (87.7%)
58 (71.6%)
0.078
0.182
0.003**
0.050*
0.002**
0.099
15.75 5.45
9.21 3.3
6.54 2.83***
15.90 4.99
9.29 3.3
6.61 2.91***
0.707
0.701
0.956
2.41 1.76
1.96 0.46
1.58 0.65***
3 (5.5%)†
2.80 1.43
1.83 0.54
1.55 0.67***
6 (7.4%)‡
0.333
0.314
0.988
0.469
Side effect: †nausea (1), dizziness (1), oliguria (1); ‡headache (3), diarrhoea (1), oliguria (1), incontinence (1). *Statistically significant
p = 0.05. **Statistically significant p < 0.01. ***Statistically significant p < 0.001. NP, nocturnal polyuria; IPSS, International Prostate
Symptom Score; QoL, quality of life.
insisted on being allowed to continue the treatment
(Table 3). After normalisation of serum sodium values, the doses in both patients were reduced to
0.05 mg. Nine patients (6.61%) experienced AEs, of
those nausea (1), dizziness (1), oliguria (1) in nonNP group and headache (3), diarrhoea (1), oliguria
(1) and incontinence (1) in NP group (Table 2). No
patients discontinued desmopressin because of
adverse events including hyponatremia.
Discussion
Our study revealed that noctutria continued to
bother elderly men with LUTS/BPH despite of
ª 2016 John Wiley & Sons Ltd
Int J Clin Pract, May 2016, 70, 5, 372–379
stereotyped medical therapy. Adding on low-dose
oral desmopressin in real-life practice was shown to
be safe and effective for patients over 65 years with
nocturia. It reduced nocturnal void, IPSS total score
and QoL index not only in NP patients but also in
non-NP group.
Nocturia is one of the most bothersome urinary
symptoms in elderly people (13). Many elderly people have difficulty returning to sleep after interruption. It is reported that nocturia is associated with a
twofold increase in the risk of fall in ambulatory
elderly. Nocturia also has wide-ranging implications
for patients’ quality of life (QoL), productivity,
longer term physical and mental health, and possibly
375
376
Desmopressin in nocturia with or without nocturnal polyuria
Table 3 Serum sodium and potassium changes before and after desmopressin treatment
Serum sodium mmol/L
Pretreatment
Posttreatment
Reduced sodium
Pretreatment hyponatremia (< 135 mmol/l)
Posttreatment hyponatremia (< 135 mmol/l)
131–134 mmol/l
126–130 mmol/l
<125 mmol/l
Serum potassium mmol/L
Pretreatment
Posttreatment
Reduced potassium
Non-NP (n = 55)
NP (n = 81)
p
138.74 2.59
134.81 3.27***
3.89 2.22
2 (3.6%)
12 (21.8%)
7 (12.7%)
4 (7.3%)
1 (1.8%)
139.34 2.56
134.65 3.56***
4.69 3.5
2 (2.5%)
28 (34.6%)
21 (25.9%)
6 (7.4%)
1 (1.2%)
0.528
0.423
0.216
0.693
0.159
3.93 0.44
4.13 0.58
0.13 0.39
4.34 0.42
4.16 0.33
0.22 0.55
0.003**
0.544
0.076
**Statistically significant p < 0.01. ***Statistically significant p < 0.001. NP, nocturnal polyuria.
mortality (14). These findings were confirmed more
recently in a prospective cohort study of 692 community-dwelling elderly people with a mean age of
74.5 years where nocturia ≥ three voids was associated with a 28% increased risk of falls over 3 years
(15).
LUTS are one of the major causes of nocturia in
older men (16), while the pathophysiology of nocturia is considered multifactorial. NP as a result of
age-associated changes in the circadian rhythm of
urine excretion is the main mechanisms of nocturia
(17,18). As a consequence of different definitions,
the prevalence of NP in nocturia was reported to be
45–100% (19). The ICS has adopted a definition of
NP as a proportion of the 24-h urine voided at night
being > 20–33%; this threshold is age-dependent,
with 20% for younger subjects and 33% for the
elderly (12). With this definition, studies have shown
that in at least 25% of elderly men with nocturia
who are referred to urologists, the main factor contributing to nocturia is not bladder outflow obstruction or detrusor instability, but a syndrome known
as NP of elderly people (20,21). Weiss et al. reported
NP and excessive urine production remains up to
93% of nocturia in elderly patients (22). Yet, most of
the reports enrolled only the Caucasian population.
Marriappan et al. had compared Asians and
Caucasian men with nocturia. Asian men were found
to have a reduced nocturnal bladder capacity with
lesser nocturnal production while Caucasian men
suffered from more NP (23). Our study population
presented with 55/136 (40%) in nocturia without NP
and 81/136 (60%) in nocturia with NP. Our results
were compatible with previous study in revealing
that NP was a factor in nocturia in 43% of the
patients evaluated, 57% had decreased NBC and 36%
had a mixed aetiology (22).
Nocturia does not completely respond to LUTS/
BPH medical treatment of benign prostate obstruction (BPO). These include behavioural interventions,
a-blockers, 5a-reductase inhibitors, antimuscarinics
and combination of these treatments (24), based on
multiple aetiologies of nocturia in ageing men (25).
Accordingly, the International Consultation on
Incontinence renewed the grade A, Level 1 recommendation for desmopressin as the only treatment
for nocturia of polyuric origin (26). Wang et al.
demonstrated that low-dose oral desmopressin can
be an effective and well-tolerated treatment for NP
in patients with LUTS from BPO (27). However, the
trials are defined by relatively strict patient exclusion
criteria which limit the extrapolation of desmopressin effect in NP during real life practice. Aged
men usually presented with LUTS/BPH and associated comorbidities. Researches for desmopressin
response in nocturia without NP are also scarce and
debatable. Ho et al. had reported a short-term and
small patient population which demonstrated desmopressin to be an effective alternative in nocturia without NP refractory to antimuscarinics (28). Our
report with more study population revealed that
desmopressin was statistically effective in reducing
nocturnal voids in both groups in a longer treatment
period (22.28 13.32 months in non-NP, 23.95 14.80 months in NP). Animal study had observed
desmopressin induced increase in nighttime voided
volume as a result of a slower rate of bladder filling
(29) and regulated bladder activity to decrease
nocturia by affecting bladder-related neurons in the
micturition center (30). Further, if the nocturnal
ª 2016 John Wiley & Sons Ltd
Int J Clin Pract, May 2016, 70, 5, 372–379
Desmopressin in nocturia with or without nocturnal polyuria
urine output can be reduced, nocturnal frequency
because of detrusor overactivity or small bladder
capacity can also be reduced in these elderly patients.
These finding may partially explain the effect of
desmopressin in non-NP patients.
Comparing with non-NP group, hypertension is
more common in our NP group and with statistical
significance (p = 0.012). The same findings were
reported by Matthiesen et al. who presented a positive correlation between NUV and daytime mean
arterial blood pressure (31) and by Homma et al.
who presented higher mean blood pressure in men
with NP than in controls (32). A recent research also
demonstrated that NP was associated with nocturia,
systolic blood pressure and IPSS (33). Another
author proposed that NP and essential hypertension
are manifestations of the same pathophysiological
process (21). Thus we should pay much attention to
the nocturia patients with NP in their cardiovascular
health.
Diabetes mellitus (DM) and LUTS/BPH are common disorder in elderly men. It is well known that
DM can affect urinary function (34). Chung et al.
conducted a study in DM patients attending to outpatient diabetic clinic. Of 1301 consecutive subjects,
25.3% reported having severe nocturia (35). Wen
et al. presented their research to identify the risk factors of nocturia in Chinese people older than
40 years (36). Several mechanisms have been suggested to explain the relationship between DM and
LUTS. It is well established that frequency and nocturia result from hyperosmolality and polydipsia secondary to hyperglycemia in DM (37). Whether DM
affects desmopressin treatment effect in nocturia is
still unclear. The high incidence of undetected
obstructive sleep apnoea (OSA) in subjects with DM
with nocturia suggests that nocturia, OSA and DM
frequently coexist and may be interrelated (38,39). It
has been postulated that in patients with OSA, the
negative intra-thoracic pressure and stretching of the
myocardium releases atrial natriuretic peptide
(ANP). This, in turn, causes vasodilatation and inhibits aldosterone resulting in excess sodium and water
excretion (40,41). It seems to be advantageous for
desmopressin in treating nocturic patients with DM
and OSA. However, the difference of response in
desmopressin between DM and non-DM patient
needs to be elucidated with further studies in the
future.
The safety profile of desmopressin is well documented in preschool children with nocturnal enuresis
and in nocturia with NP in recent years. Most
adverse effects have been proven mild and infrequent (42,43). The only potentially serious adverse
effect is hyponatremia, which can occur because
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Int J Clin Pract, May 2016, 70, 5, 372–379
desmopressin reduces urine excretion. Short-term
randomised controlled trials (9,44,45) showed the
incidence of hyponatraemia (< 130 mmol/l) caused
by desmopressin treatment in elderly patients as
about 3–8.33%. One Korean report showed the
hyponatraemia incidence was about 4.4% in elderly
patients with more than 24 months of ongoing management (42). In contrast, our results showed a
higher incidence of hyponatraemia of 9.1% in nonNP group and 8.6% in NP group respectively
(< 130 mmol/l). We speculate that more comorbidities and relative low baseline serum sodium level in
our
groups
(138.74 2.59
in
non-NP,
139.34 2.56 in NP, 141.2 2.1 in Korean study)
may be the causes of this discrepancy. Our baseline
serum potassium level is statistically significant
higher in NP group compared with non-NP group.
More hypertensive population in NP group may
contribute the results. In our report, no serum potassium level drop phenomena caused by desmopressin
treatment was observed as Chang et al. reported
(46). Both of our groups patients have relatively high
nocturnal
voids
(4.22 1.38
in
non-NP,
4.52 1.23 in NP) compared with a recent German
nocturia report (47), with 3.7 1.1 void/per night
and Korean nocturia report (48) 3.631 1.61 void/
per night. However, our patients had lower baseline
IPSS QoL (2.41 1.76, 2.80 1.43) compared with
previous reports, 3.71 1.0, 4.63 0.8 respectively.
We presume that cultural differences and most of
our population are older veterans who have higher
endurance threshold may interpret these phenomena.
This study has some limitations. This study is a
retrospective study and might have inherent bias.
Secondly, most of our patients were initially and
ongoing treated with a-blocker (78% vs. 79.2%) after
initiation of desmopressin management. We doubt
whether a-blocker will contaminate the desmopressin-only treatment effect or not. A recent reference reported a decrease in nocturia frequency by
53% (from 3.8 to 1.7 nocturnal voids) with desmopressin monotherapy, but the combination of
desmopressin and a-blocker did not show any
synergistic effect (47). Thirdly, we only categorised
nocturia into NP and non-NP by a single FVC.
However, our patient population was poorly compliant with multiple-day diaries because of veteran with
comorbidities. Fourthly, this study showed that DM
was 3.7% in non-NP, but 0% in NP patients. It
seems that the prevalence of DM in current report is
lower in nocturic patients. Most of patients treating
in our hospital are older veterans who are often
reluctant to manage their DM and nocturia in different clinics. Thus, we should enrol DM and urologic
clinic patients in the future study. Lastly, nocturia
377
378
Desmopressin in nocturia with or without nocturnal polyuria
without NP includes decreased nocturnal bladder
capacity, OAB and sleep disturbance or a combination of these factors. We did not specify the exact
pathophysiology of nocturia without NP which limits
the extrapolation. These confounders seem not to
skew our aim to test the efficacy and safety of
desmopressin in older refractory nocturia patients
with LUTS/BPH in real-life practice. Further randomised controlled protocol and large population
studies are needed to elucidate the long-term efficacy
and safety of desmopressin in nocturia with different
etiologies.
Conclusions
Long-term treatment with low-dose desmopressin is
safe and effective for nocturia with or without NP in
elderly men during real-life practice. Patients should
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be well informed about the disease and are closely
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Acknowledgement
None.
Author contributions
Yu-Hui Huang, Tung-Wei Hung contributed to
study design, and interpretation of results. YenChuan Ou, Sung-Lang Chen contributed to all
aspects of study design, analysis, interpretation, and
drafting and revision of the manuscript. All authors
contributed to review and revision, as well as final
approval, of the manuscript.
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Paper received December 2015, accepted January 2016