Impact of desmopressin on nocturia due to nocturnal polyuria in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH)

Abstract

Desmopressin is an effective and well-tolerated treatment for nocturia due to NP in patients with LUTS/BPH in daily practice under routine conditions.

Nocturia: state of the art and critical analysis of current assessment and treatment strategies

“…Note that a patient may need more than one treatment of nocturia with LUTS/BPH drugs, but nocturnal polyuria (and other causes) remained untreated. The observational study on desmopressin in patients with LUTS/BPH and nocturia due to nocturnal polyuria, which has also been included in this topic issue on nocturia, is in line with these statements [29]. It is therefore not surprising that nocturia is the most frequently reported (bothersome) symptom after prostate treatment, remaining in 68 % in a series of dissatisfied, symptomatic patients after transurethral resection of the prostate [30].…”

“…The dedicated teams of authors analyzed all major drug classes used in urology to treat LUTS/BPH, i.e., α-blockers (silodosin [24]), 5α-reductase inhibitors (dutasteride [25]), α-blocker + 5α-reductase inhibitor combination therapy (tamsulosin + dutasteride [26]), phosphodiesterase type 5 inhibitors (tadalafil [27]) and plant extracts (sabal serrulata + urtica dioica, PRO 160/120 [28]). Additionally, the effects of the arginine-vasopressin analogue desmopressin were analyzed in a cohort of LUTS/BPH patients with clinically relevant nocturia due to nocturnal polyuria [29]. For the purpose of this topic journal, databases of controlled, randomized phase II/III drug trials were used and evaluated homogeneously post hoc by using the same efficacy parameters to judge the effects on nocturia (e.g., number of nocturnal voids before vs. after treatment, number of patients with <2 nocturnal voids at treatment end and percent improved stable-worsened nocturia frequency).…”

Desmopressin for treating nocturia in men

“…BPH can cause BOO, which may induce secondary bladder overactivity and reduction in functional bladder capacity, resulting in nocturia . Men may also experience nocturia with or without detrusor overactivity or post‐void residual urine .…”

“…Desmopressin is the synthetic analogue of the human hormone vasopressin, also known as antidiuretic hormone, which is produced by the posterior pituitary gland and its role is to maintain serum osmolality and volume via modulation of free water excretion . It is the most frequently tested medication for the specific treatment of nocturia, but has traditionally been used to treat central diabetes insipidus, bleeding disorders such as Von Willebrand disease, and primary nocturnal enuresis . The USA Food and Drug Administration (FDA) approved desmopressin acetate nasal spray with the trademark name of Noctiva in March 2017 for nocturia due to nocturnal polyuria in adults who awaken at least twice per night to void .…”

“…The USA Food and Drug Administration (FDA) approved desmopressin acetate nasal spray with the trademark name of Noctiva in March 2017 for nocturia due to nocturnal polyuria in adults who awaken at least twice per night to void . However, desmopressin can cause hyponatraemia, which is often asymptomatic and in limited cases can have deleterious effects . For assessing efficacy, a common outcome measure is the decrease in the number of nocturnal voids; however, there is no existing consensus on its clinical significance .…”