Our results indicate that diazepam resulted in a significant

reduction in nocturia episodes and irritative symptoms when

given to some men who unresponsive to the α-1

adrenoreceptor antagonist combined with anti-cholinergic

agent.

The sleep quality was also improved objectively by

diazepam add on therapy in these patients.

To determine whether administration of diazepam at night

would improve the frequency of nocturia and sleep quality in

men unresponsive to anti-cholinergics.

Purpose

Chonnam National University Medical School

Conclusions

Results

Diazepam add on therapy;

An effective pharmacotherapy for nocturia unresponsive to α-1

adrenoceptor antagonist combined with anti-cholinergics

treatment in men

Kim SO, Yu DH, Yu HS, Hwang EC, Kang TW, Kwon DD

Department of Urology, Chonnam National University Medical School

* * *

Mean age (years, mean±SD) 62.7±13.0

Duration of symptom (months, mean±SD) 42.2±39.7

Additional combined disease, n (%)

Hypertension 32 (40.0)

Diabetes mellitus 12 (15.0)

Cardiovascular disease 12 (15.0)

Others 10 (12.5)

No. nocturia, n (%)

1≤Nocturia<2 6 (7.5)

2≤Nocturia<3 18 (22.5)

3≤Nocturia 56 (70.0)

PSA (ng/ml, mean±SD) 0.93±0.79

Prostate volume (ml, mean±SD) 20.7±7.8

IPSS (mean±SD)

Total 21.9±6.7

Storage symptoms 9.32±2.9

Voiding symptoms 12.6±4.6

Quality of life 4.35±0.79

Qmax (ml/sec, mean±SD) 16.3±8.3

PVR (ml, mean±SD) 49.2±51.9

Nocturia is a common and bothersome urological

symptom that contributes to sleep loss, daytime fatigue

and mood disturbance. Asplund R et al. BJU Int 2002;90: 533

The number of nocturia episodes increased with age.

Nocturia is associated with further negative effects on

sleep quality, health-related QoL, and symptom bother. SO Kim et al. Int Neurourol J. 2011;15:82-6

Because of its associations with other morbidities,

nocturia predicts mortality in old men. Kupelian V et al. J Urol 2011;185: 571

Treatment of nocturia with α1-blockers and/or

anticholinergics is not generally effective. Weiss JP et al. BJU Int. 2011;108: 6

Benzodiazepine decreased nocturia. Fujikawa K et al. Scand J urol Nephrol. 2001;35(4):310-3

Kaye M. Can Urol Assoc J. 2008;2(6):604-8

Background

Table 1. Patients characteristics and comorbidities (n=80)

Table 2. Comparison of clinical parameters between groups

Male patient s (aged ≥40 years) who had nocturia (≥1/night) were taken α-blocker (tamsulosin 0.2mg) and anti-cholinergic agent (solifenacin 5mg) once daily at night for more than 12 wks.

Among them, the patients who did not show improvement were additionally administered diazepam 2mg once daily for 3 months.

IPSS, uroflowmetric parameters, Medical Outcomes Study (MOS) sleep scale, 3-day frequency volume chart.

Materials and Methods

Baseline α-blocker +

anti-cholinergics

Diazepam

add on p-value

IPSS total 21.9±6.7 19.6±6.1 18.7±7.4 0.041

Voiding symptoms 12.6±4.6 10.9±5.3 11.0±4.8 0.172

Storage symptoms 9.3±2.9 8.7±2.7 7.9±2.9 0.029

QoL 4.3±0.9 4.1±1.3 4.0±1.2 0.052

Maximal flow rate (ml/s) 16.3±8.3 18.7±8.9 18.9±7.9 0.219

Postvoid residual (ml) 49.2±51.9 58.1±60.1 56±63.5 0.128

No. of nocturia 3.54±1.1 3.04±1.4 1.89±1.3 0.001

Sleep problem index I 35.9±15.7 34.5±16.3 32.1±15.2 0.012

Hours of sleep 6.2±1.5 6.1±2.0 6.3±1.9 0.58

Sleep disturbance 34.9±21.5 33.1±24.7 31.8±22.6 0.004

Somnolence 28.7±25.9 28.4±25.5 27.4±24.8 0.079

Shortness of breath 27.3±30.6 27.9±31.8 26.1±30.5 0.046

Sleep adequacy 40.7±23.4 40.4±24.1 40.1±24.7 0.183

Snoring 38.3±18.8 38.1±19.1 37.3±18.9 0.047