A multicomponent behavioral and drug intervention for nocturia in elderly men: Rationale and pilot results

Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Emory University School of Medicine, Atlanta, GA, USA.
BJU International (Impact Factor: 3.53). 02/2009; 104(1):69-74. DOI: 10.1111/j.1464-410X.2009.08353.x
Source: PubMed


To evaluate the number of medical and urological conditions associated with nocturia in a cohort of older men who were primary-care enrolees, and to assess the feasibility and efficacy of using a multicomponent intervention to reduce nocturia and its bother.
Men aged ≥50 years and with two or more episodes of nocturia were recruited from the primary-care clinics at one Veterans Affairs Medical Center to participate in a 4-week, open-label, prospective pilot study. A multicomponent intervention composed of behavioural therapy and targeted drug therapy was administered according to a specified protocol based upon identified risk factors for nocturia. Outcome measures included self-reported nocturia and bother on the American Urological Association (AUA)-7 Symptom Index, 3-day bladder diaries and self-reported sleep-related measures recorded using 7-day sleep diaries.
Fifty-five men completed the protocol (mean age 67 years, sd 8.3); they had a mean of 4.5 of nine defined conditions potentially related to nocturia. Highly prevalent conditions included moderate-to-severe benign prostatic hyperplasia (87%), hypertension (86%) and urinary frequency (71%). The mean diary-recorded nocturia decreased from 2.6 to 1.9 (P < 0.001), and bother score reduced from 3.1 to 1.1, representing a change from a ‘medium’ to a ‘very small’ problem (on a 5-point scale). Sleep diary-derived measures also improved significantly (time to initiate sleep, time to return to sleep after awakening, quality of sleep).
Given that individual older patients often have multiple coexistent risk factors for nocturia, identifying a principal cause of nocturia, a concept emphasized in treatment guidelines, proved to be difficult. Implementing a multicomponent behavioural intervention combined with drug(s) was feasible in older men and reduced nocturia frequency, bother from nocturia, and time to initiate sleep, within 4 weeks. These promising results merit repeating using a randomized, controlled trial.

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    • "Vaughan et al conducted a randomized, controlled trial study implementing a multicomponent behavioural intervention combined with drug(s) in old men bothered from nocturia. They reduced nocturia frequency and time to initiate sleep within 4 weeks.19 "
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    ABSTRACT: Nocturia may be due to urological and non-urological diseases and some of the possible underlying non-urological diseases may be life-threatening. We investigated the efficacy and safety of lowest dose of oral desmopressin in treatment of nocturia in elderly men. 60 old men referring to urology clinic of Imam Reza hospital in Tehran, Iran from 2008-2009 for treatment of nocturia were included in a double-blind placebo-controlled study. Patients were randomly divided into 2 study groups (30 patients in each group). Care was taken to match the patients of the 2 groups by age and clinical criteria. They complained of about 2 voids per night. We divided the patients into 2 study groups. Patients belonging to group A (n = 30) received placebo and patients of group B (n = 30) received 0.1 mg desmopressin at bed time for 8 weeks. Patients were assessed after 4 and 8 weeks of treatment. The means were compared using paired sample t-test and chi-square test for time of nocturia before and after treatments and also between the two groups. ANOVA test was used for assessement of statistical differences between outcomes of the two groups. Mean number of nocturia before and after receiving desmopressin were 2.6 and 1.6 respectively which differed significantly (p < 0.001). Mean number of nocturia before and after receiving placebo were 2.5 and 2.3 respectively with no significant difference (p = 0.344). After 4 weeks of treatment with desmopressin, 17 patients (56.7%) had less than 2 voids, 5 patients (16.7%) had 2 voids and 8 (26.7%) had more than 2 voids per night (p < 0.05). After 8 weeks, patients were evaluated and it was noticed that in group B, 4 patients (13.3%) had 2 voids, 24 (80%) had less than 2 voids and 2 patients (6.7%) had more than 2 voids per night (p = 0.004). Oral administration of desmopressin is an effective and well-tolerated treatment for nocturia in elderly men.
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    ABSTRACT: Nocturia (ie, waking at night to void) is common and disrupts sleep. Traditionally, one nightly episode has been regarded as clinically meaningless, yet the justification for this belief remains weak. To evaluate the association among frequency of nocturia and bother and health-related quality of life (HRQoL). In 2003-2004, a survey was mailed to a random sample of 6000 subjects aged 18-79 yr who were identified from the Finnish Population Register Centre (response proportion was 62.4%; 53.7% were females). HRQoL and bother from nocturia were examined in relation to self-reported nocturia frequency (using the American Urological Association Symptom Index and the Danish Prostatic Symptom Score). Bother from nocturia was assessed on a four-point scale (none, small, moderate, major). HRQoL was measured with the generic 15D instrument on a 0-1 scale with a minimum clinically important difference of 0.03. Degree of bother increased with nocturia frequency (p<0.01). The most commonly cited degree of bother for those with one, two, and three nightly voids was no bother, small bother, and moderate bother, respectively. The mean age-adjusted 15D score for men (and women) without nocturia was 0.953 (0.950) and 0.925 (0.927) with one void per night, 0.898 (0.890) with two voids per night, and 0.833 (0.840) with three or more voids per night. Statistically significant decreases were found in 15D score and in all 15D dimensions except eating. Although the response rate was high, approximately one third of those contacted did not participate in the study. At least two voids per night is associated with impaired HRQoL. The majority of people report having bother when the number of nocturia episodes is two and moderate or major bother when the number is three or more. One void per night does not identify subjects with interference from nocturia and, thus, is not a suitable criterion for clinically relevant nocturia.
    European Urology 04/2009; 57(3):488-96. DOI:10.1016/j.eururo.2009.03.080 · 13.94 Impact Factor

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