Tamsulosin versus transurethral resection of the prostate: Effect on nocturia as a result of benign prostatic hyperplasia

Abstract

Abstract:Our objective was to compare the effect of tamsulosin versus transurethral resection of the prostate (TURP) for the management of nocturia in previously untreated men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) and no other predisposing factors for nocturia. The study group included 66 patients (mean age 68.9 years, range 52-81) randomized to receive either tamsulosin 0.4 mg per os daily (n = 33) or TURP (n = 33). Nocturia was assessed at baseline, after 3 months and after 1 year, by the number of nocturnal awakenings and hours of undisturbed sleep (HUS) obtained from a 72-h Frequency Volume Chart (FVC). Furthermore, the International Prostate Symptom Score (IPSS), the International Consultation on Incontinence Questionnaire Nocturia (ICIQ-N) and the International Consultation on Incontinence Questionnaire Nocturia Quality of Life (ICIQ-NQoL) were recorded. At baseline, there were no statistically significant differences between the two groups. ICIQNQoL and ICIQ-N scores correlated with the number of awakenings and HUS, respectively. Both tamsulosin and TURP improved all examined parameters during the follow up. TURP was associated with a statistically significant improvement in the number of nocturnal awakenings and in the IPSS, ICIQ-N and ICIQ-NQol scores in comparison with tamsulosin. HUS increased in both groups, but without any statistically significant difference. In conclusion, TURP is superior in comparison with tamsulosin for the management of BPH-related nocturia.

Increases in duration of first uninterrupted sleep period are associated with improvements in PSQI-measured sleep quality

“…The first uninterrupted sleep period (FUSP) has been used as a self-reported outcome in studies of various urological conditions including benign prostatic obstruction (BPO) (1) overactive bladder (OAB) (2) and nocturia (3). How this outcome relates to other, better recognized measures of sleep quality remains unclear.…”

Nocturia: Current Evaluation and Treatment for Urology

“…5-alpha reductase inhibitors either alone or in combination with an alpha-blocker have also been shown to have clinically negligible improvements in nocturia [45]. Irrespective of these findings, patients with bladder outlet obstruction should be considered for trials of alpha blockers and/or 5 alpha reductase inhibitors, in the case of the latter medication-only if the prostate is over 40 g. If a male patient has a large residual urine volume related to bladder outlet obstruction, he might benefit from surgical reduction of the prostate, such as transurethral resection (TUR) of the prostate [46]. Lastly, studies do not support the use of melatonin for nocturia [47].…”

“…No surgical or interventional therapy (including bladder outlet obstruction surgery) is indicated for nocturia as a sole indication [46]. Botulinum toxin detrusor injections, sacral neuromodulation, or tibial electric nerve stimulation are used to treat patients with OAB, but nocturia is regarded as a secondary outcome [51].…”

Nocturia

“…Simaioforidis és mtsai olyan alsó húgyúti panaszokkal rendelkező betegeket vizsgáltak, akiknél BPH igazolódott. A tamsulosinmonoterápiát a TURP-pal összehasonlítva azt találták, hogy szignifikánsan csökkent a nocturia előfordulásának gyakorisága (-0,6 v/é és -1 v/é), amellyel párhuzamosan szignifikáns javulás mutatkozott a nem megszakított alvá-si időben és a betegek életminőségében [47].…”