Modulation by desmopressin of neuronal activity in brainstem micturition center

Iwasaki, Hiroshi; Koyama, Yoshimasa; Tanaka, Yoshiyuki; Kawauchi, Akihiro; Jodo, Eiich; Kayama, Yukihiko; Miki, Tsuneharu

doi:10.1016/j.urology.2003.11.036

Cited by 11 publications

(6 citation statements)

References 14 publications

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“…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 and regulated bladder activity to decrease nocturia by affecting bladder‐related neurons in the micturition center . Further, if the nocturnal urine output can be reduced, nocturnal frequency because of detrusor overactivity or small bladder capacity can also be reduced in these elderly patients.…”

Section: Discussionsupporting

confidence: 83%

Comparison of nocturia response to desmopressin treatment in elderly men with and without nocturnal polyuria in real-life practice

et al. 2016

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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 AE 1.38 to 2.31 AE 0.98 (p < 0.001) in non-NP group and from 4.52 AE 1.23 to 2.07 AE 0.89 (p < 0.001) in NP group. The reduction in nocturnal voids was more significant in NP group (2.44 AE 1.15 vs. 1.91 AE 1.48, p = 0.003). The mean decrease in serum sodium levels were 3.89 AE 1.22 mmol/l (p < 0.001) in non-NP group and 4.69 AE 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. What's known• 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.

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Section: Discussionsupporting

confidence: 83%

Comparison of nocturia response to desmopressin treatment in elderly men with and without nocturnal polyuria in real-life practice

et al. 2016

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“…Desmopressin most likely improves NBC as follows. Type E2 neurons in and around the micturition center directly regulate the activity of the bladder, and type E1 and type I neurons modulate the activity of type E2 neurons by excitatory and inhibitory effects (23). Desmopressin suppresses bladder activity by inhibiting type E1 neurons or activating type I neurons.…”

Section: Discussionmentioning

confidence: 99%

Desmopressin is an Effective Treatment for Mixed Nocturia with Nocturnal Polyuria and Decreased Nocturnal Bladder Capacity

et al. 2010

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To investigate the efficacy and safety of desmopressin in patients with mixed nocturia, Patients aged ≥18 yr with mixed nocturia (≥2 voids/night and a nocturnal polyuria index [NPi] >33% and a nocturnal bladder capacity index [NBCi] >1) were recruited. The optimum dose of oral desmopressin was determined during a 3-week dose-titration period and the determined dose was maintained for 4 weeks. The efficacy was assessed by the frequency-volume charts and the sleep questionnaire. The primary endpoint was the proportion of patients with a 50% or greater reduction in the number of nocturnal voids (NV) compared with baseline. Among 103 patients enrolled, 94 (79 men and 15 women) were included in the analysis. The proportion of patients with a 50% or greater reduction in NV was 68 (72%). The mean number of NV decreased significantly (3.20 to 1.34) and the mean nocturnal urine volume, nocturia index, NPi, and NBCi decreased significantly. The mean duration of sleep until the first NV was prolonged from 118.4±44.1 to 220.3±90.7 min (P<0.001). The overall impression of patients about their quality of sleep improved. Adverse events occurred in 6 patients, including one asymptomatic hyponatremia. Desmopressin is an effective and well-tolerated treatment for mixed nocturia.

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“…Observed desmopressin-induced 20% increase in average nighttime voided volume in patients with increased NBCi before treatment may have been due to a slower rate of bladder filling, as was found in a study involving pigs [21]. In addition, desmopressin modulates the activity of the brainstem micturition center, as discussed by Lee et al [20] in studies on rats [22]. This underscores the multifactorial causative role of bothersome nocturia, and suggests the need for combined treatments.…”

Section: Discussionmentioning

confidence: 81%

Comparison of Nocturia Response to Desmopressin Treatment between Patients with Normal and High Nocturnal Bladder Capacity Index

Hajdinjak

Leskovar

2013

The Scientific World Journal

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Objective. To compare efficacy of desmopressin for treatment of nocturia between patients with normal and high nocturnal bladder capacity index (NBCi). Methods. Retrospective analysis of adult patients treated with desmopressin for nocturia. Patients were analyzed according to high or normal NBCi value before treatment. Results. 55 patients were identified, aged 49–84, 47 males, 8 females, who started desmopressin 0.2 mg nocte between 2009 and 2011. Two groups (N: normal and H: high NBCi) were similar regarding number, gender, age, 24 h urine volume, and nocturnal urine volume. On treatment, nocturnal volume decreased by mean of 364 mL. Number of nightly voids decreased in N group from 3.11 to 1.50, in H from 3.96 to 1.44. Nocturnal polyuria and nocturia indices also decreased significantly. NBCi remained the same in N group (0.56 on therapy) and in H group decreased to mean 0.63. All on-treatment values were statistically similar in N and H groups. Pretreatment differences were abolished with treatment. NBCi was significantly correlated to nocturia reduction—larger reduction was observed in patients with higher NBCi. In 8/55 patients, hyponatremia was detected, but without clinical consequences. Conclusions. The results indicate that the effectiveness of desmopressin on nocturia is not dependent upon the patient's pretreatment NBCi.

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Modulation by desmopressin of neuronal activity in brainstem micturition center

Cited by 11 publications

References 14 publications

Comparison of nocturia response to desmopressin treatment in elderly men with and without nocturnal polyuria in real-life practice

Comparison of nocturia response to desmopressin treatment in elderly men with and without nocturnal polyuria in real-life practice

Desmopressin is an Effective Treatment for Mixed Nocturia with Nocturnal Polyuria and Decreased Nocturnal Bladder Capacity

Comparison of Nocturia Response to Desmopressin Treatment between Patients with Normal and High Nocturnal Bladder Capacity Index

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