An effective pharmacotherapy for nocturia unresponsive to -1 … · 2015-12-14 · men unresponsive...
Transcript of An effective pharmacotherapy for nocturia unresponsive to -1 … · 2015-12-14 · men unresponsive...
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