Journal List > Korean J Urol > v.49(10) > 1005202

Jong and Son: Study on Persistent Nocturia after Treatment of Benign Prostatic Hyperplasia and Effectiveness of Desmopressin in Persistent Nocturia with Nocturnal Polyuria

Abstract

Purpose

We evaluated the differences in treatment outcomes between patients who complained of nocturia and patients who did not complain of nocturia after treatment with medication for benign prostatic hyperplasia (BPH) for >6 months. We also investigated the effectiveness of desmopressin on persistent nocturia after BPH medication.

Materials and Methods

One hundred forty-nine patients with 3 or more episodes of nocturia, despite treatment with BPH medications, were enrolled. Patients were divided into two groups according to complaints or absence of complaints of persistent nocturia. We compared differences of the International Prostate Symptom Score (IPSS), quality of life (QoL), and nocturia between the two groups. Patients who complained of persistent nocturia were subdivided into the following three groups after administration of desmopressin (0.2mg/day) with cessation of BPH medication: group I, decreased nocturia (>2 episodes per night) with desmopressin only; group II, decreased nocturia with desmopressin, but the BPH symptoms are aggravated, and the previous medication was added; group III, no change of nocturia despite desmopressin. We analyzed the differences in each group.

Results

Patients who complained of nocturia after BPH medication had a greater decrease in IPSS than those who did not complain of nocturia (p=0.047). Twenty percent (n=9) of the patients had decreased nocturia and were satisfied with desmopressin treatment, Twenty-four of the patients (53.3%) had decreased nocturia, but needed a combination with the previous BPH medication, while desmopressin was not effective in 26.7% (n=12) of the patients. The improvement of BPH after primary treatment was more evident in patients who experienced efficacy with desmopressin.

Conclusions

Desmopressin can be an effective treatment for persistent nocturia in patients with nocturnal polyuria components. The more improvement in BPH after primary treatment, the better the effects of desmopressin can be expected. We cannot overemphasize the importance of a voiding diary and analysis of nocturia.

References

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Fig. 1.
Progress of treatment for patients with persistent nocturia. BPH: benign prostatic hyperplasia, V.D: voiding diary, NPI: nocturnal polyuria index, NP: nocturnal polyuria, DDAVP: desmopressin acetate.
kju-49-899f1.tif
Fig. 2.
Comparison of the changes in IPSS, QoL, and number of nocturia after primary BPH treatment between groups A and B. ∗: p<0.05, IPSS: International Prostate Symptom Score, QoL: quality of life, BPH: benign prostatic hyperplasia.
kju-49-899f2.tif
Fig. 3.
Treatment-related changes of nocturia. ∗: p<0.05, BPH: benign prostatic hyperplasia, DDAVP: desmopressin acetate.
kju-49-899f3.tif
Table 1.
Comparison of primary BPH treatments in each group
  Group A (n=85) Group B (n=64)
Group I (n=9) Group II (n=24) Group III (n=12) Others (n=40) Total (n=85)
α-blocker (%) 9 (100) 12 (100) 24 (100) 40 (100) 85 (100) 64 (100)
5-ARI (%) 3 (33.3) 12 (50.0) 5 (41.7) 21 (52.5) 41 (48.2) 32 (50.0)

p>0.05, compared with group A and B, between I, II and III. BPH: benign prostatic hyperplasia, 5-ARI: 5-α reductase inhibitor

Table 2.
The characteristics of groups A and B before primary BPH treatment
  Group A (n=85) Group B (n=64) p-value
Age (years) 68.9±7.4 68.8±7.8 0.901
TPV (ml) 31.9±11.3 32.8±14.2 0.654
PSA (ng/ml) 1.5±1.3 1.5±1.3 0.880
IPSS 22.6±4.2 23.0±3.6 0.622
QoL score 3.7±0.6 3.8±0.6 0.906
Qmax (ml/s) 11.6±5.7 13.4±6.6 0.100
VV (ml) 182.1±113.7 204±111.3 0.275
PVR (ml) 50.2±41.3 48.5±44.3 0.831
No. of nocturia 4.1±0.8 3.9±0.8 0.233

TPV: total prostate volume, PSA: prostate-specific antigen, IPSS: International Prostate Symptom Score, QoL: quality of life, VV: voiding volume, PVR: post-void residual urine, BPH: benign prostatic hyperplasia

Table 3.
Comparison of the treatment outcomes before and after primary BPH treatment in groups A and B
Before primary BPH treatment After primary BPH treatment p-value
Group A      
IPSS 22.6±4.2 18.5±4.4 <0.001
QoL score 3.7±0.6 2.8±0.7 <0.001
No. of nocturia 4.1±0.8 3.5±0.7 <0.001
Group B      
IPSS 23.0±3.6 20.0±3.2 <0.001
QoL score 3.8±0.6 3.0±0.4 <0.001
No. of nocturia 3.9±0.8 3.0±0.3 <0.001

IPSS: International Prostate Symptom Score, QoL: quality of life, BPH: benign prostatic hyperplasia

Table 4.
The characteristics of subgroups I, II, and III before primary BPH treatment
  Group I Group II Group III
  (n=9) (n=24) (n=12)
Age (years) 66.7±6.9 70.0±8.0 69.3±7.2
TPV (ml) 25.3±4.8 32.7±12.9 34.0±9.6
PSA (ng/ml) 1.2±0.9 1.5±1.3 2.0±1.3
IPSS 19.1±5.4 22.4±4.1 23.5±4.4
QoL score 3.6±0.5 3.8±0.6 3.8±0.6
Qmax (ml/s) 18.5±5.6∗ 11.1±5.1 8.0±3.4
VV (ml) 200.7±132.8 181±83.9 147±77.0
PVR (ml) 34.6±30.8 49.7±37.1 52.6±41.3
No. of nocturia 4.0±0.7 3.95±0.7 4.0±0.7

: p<0.05, compared with group II and III. TPV: total prostate volume, PSA: prostate-specific antigen, IPSS: International Prostate Symptom Score, QoL: quality of life, VV: voiding volume, PVR: post-void residual urine, BPH: benign prostatic hyperplasia

Table 5.
Comparison of the treatment outcomes before and after primary BPH treatment in subgroups I, II, and III
Before primary BPH treatment After primary BPH treatment p-value
Group I      
TPV (ml) 25.3±4.8 21.6±2.2 0.017
PSA (ng/ml) 1.2±0.9 0.6±0.6 0.007
IPSS 19.1±5.4 15.1±4.6 <0.001
QoL score 3.6±0.5 2.7±0.5 0.002
Qmax (ml/s) 18.5±5.6 23.8±7.3 0.001
VV (ml) 200.7±132.8 222.9±76.0 0.558
PVR (ml) 34.6±30.8 11.2±10.1 0.019
Group II      
TPV (ml) 32.7±12.9 30.3±11.3 <0.001
PSA (ng/ml) 1.5±1.3 1.2±1.0 0.015
IPSS 22.4±4.1 19.0±3.9 <0.001
QoL score 3.8±0.6 2.8±0.7 <0.001
Qmax (ml/s) 11.1±5.1 14.0±6.1 <0.001
VV (ml) 181±83.9 236±116.4 0.019
PVR (ml) 49.7±37.1 40.4±23.9 0.187
Group III      
TPV (ml) 34.0±9.6 33.4±7.6 0.608
PSA (ng/ml) 2.0±1.3 1.6±1.2 0.058
IPSS 23.5±4.4 22.4±3.7 0.121
QoL score 3.8±0.6 3.5±0.5 0.104
Qmax (ml/s) 8.0±3.4 9.4±4.2 0.075
VV (ml) 147±77.0 192.6±66.7 0.008
PVR (ml) 52.6±41.3 35.8±37.4 0.015

TPV: total prostate volume, PSA: prostate-specific antigen, IPSS: International Prostate Symptom Score, QoL: quality of life, VV: voiding volume, PVR: post-void residual urine

Table 6.
Comparison of change-value before and after primary BPH treatment between the two groups (group I+II, DDAVP is effective; group III, DDAVP is not effective on nocturia)
  Group I+II Group III p-value
TPV (ml) −2.8±2.8 −0.6±4.2 0.058
PSA (ng/ml) −0.4±0.6 −0.4±0.7 0.940
IPSS −3.6±2.0 −1.1±2.2 0.001
QoL score −1.0±0.7 −0.3±0.7 0.004
Qmax (ml/s) 3.6±3.3 1.4±2.4 0.040
VV (ml) 46.2±107.0 45.0±48.5 0.972
PVR (ml) −13.1±31.4 −16.8±20.1 0.712

TPV: total prostate volume, PSA: prostate-specific antigen, IPSS: International Prostate Symptom Score, QoL: quality of life, VV: voiding volume, PVR: post-void residual urine, BPH: benign prostatic hyperplasia, DDAVP: desmopressin acetate

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