EURURO Vol. 72 No. 5

developed a priori: age, sex, description of primary

pathology, severity, or bother of nocturia.

Studies are summarized in

Figure 1 .

Evidence synthesis

3.1.

Conservative management

One study investigated a behavioral modification program

with desmopressin in comparison with desmopressin

monotherapy in patients with nocturnal polyuria and

nocturia ( 2 voids/night; Levels of Evidence [LoE] 1b)

[8]

. Nocturnal voids declined by –1.5 with combined

therapy, compared with –1.2 on desmopressin alone (not

significant). Another group randomized obese men with

LUTS already on tamsulosin to receive a basic or a

comprehensive weight reduction program (LoE 2b)

[9]

. The improvement in nocturia episodes was similar in

both arms (–0.1 0.9). Both studies showed mild adverse

events only in pharmacotherapy-related arms.

3.2.

Antidiuretic therapy

The antidiuretic hormone arginine vasopressin increases

renal water reabsorption and urinary osmolality. Antidi-

uretic therapy using the arginine vasopressin V2 receptor

agonist desmopressin, with dose titration to achieve the

best clinical response (as defined by the researchers in each

study; including the dose to achieve either no voids per

night, a decrease in nocturnal urine production of 20%, or

nocturnal diuresis

0.5 ml/min), was more effective than

placebo in terms of reduced nocturnal voiding frequency

( Table 1

) and duration of undisturbed sleep

( Table 2

An RCT evaluated desmopressin (0.1 mg, 0.2 mg, or

0.4 mg, escalated according to response) in adults with 2

voids/night (LoE 1b)

[10] .

One hundred and twenty-seven

patients (85 men) achieving

20% reduction in nocturnal

diuresis entered a double-blind efficacy phase. More

desmopressin-treated patients showed

50% reduction in

nocturia (33% vs 11%), reduced mean number of nocturnal

voids (39% vs 15%; absolute difference –0.84 voids/night),

and duration of the first sleep.

Adult men (

= 151) with 2 voids/night were studied

for 3 wk, following a dose titration phase (LoE 1b)

[11]

. Nocturnal voids decreased from 3.0 to 1.7 on

desmopressin (vs 3.2–2.7 on placebo), with 34% and 3%

experiencing fewer than half the number of nocturnal voids,

respectively. Mean duration of the first sleep period

increased from 2.7 h to 4.5 h (vs 2.5–2.9 h). A fall in serum

sodium level to

130 mmol/l was seen in 4% of patients. In a

small short-term crossover study incorporating a dose-

response titration, desmopressin was associated with a

[(Fig._1)TD$FIG]

Embase, Medline, Cochrane SRs, Cochrane Central (Cochrane HTA, DARE, HEED)

No date restriction

3554 Citation(s)

3519 Nonduplicate

citations screened

Inclusion/exclusion

criteria applied

3376 Articles excluded

after title/abstract screen

143 Articles retrieved

Inclusion/exclusion

criteria applied

99 Articles excluded

after full-text screen

44 Articles included

Fig. 1 – Systematic review flow chart.

DARE = Database of Abstracts of Reviews of Effects; HEED = Health Economic Evaluations Database; HTA = Health Technology Assessment; SR = systemic

reviews.

E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 7 5 7 – 7 6 9

759