OBJECTIVES: To assess the effect of oral desmopressin on nocturia and nocturnal enuresis in patients after orthotopic neobladder reconstruction.
PATIENTS AND METHODS: Thirty-four of 55 patients who underwent radical cystectomy and orthotopic neobladder reconstruction at our medical center in 2004-2011 were deemed eligible for the study. Inclusion criteria were estimated glomerular filtration rate >50 ml/min/1.73 m2, normal baseline sodium serum level, intact daytime urinary continence, and any degree of nocturia or nocturnal enuresis. Patients were treated daily with oral desmopressin 0.1 mg at bedtime for 30 days and completed the Nocturia, Nocturnal Enuresis and Sleep Interruption Questionnaire at trial enrollment and closure. Sodium serum levels were monitored throughout.
RESULTS: Three patients withdrew from the trial because of headaches or anxiety. Mean (SD) number of nocturnal voids decreased from 2.5 (1.4)/night at baseline to 1.5 (1.3)/night at trial closure (p=0.015). The number of patients with one or no episodes of nocturnal enuresis per week increased from 6 (19%) to 12 (39%) (p=0.065). Thirteen patients (42%) reported an increase of a minimum 1-2 hours' sleep until the first nocturnal void; all of them asked to continue the drug. No significant adverse events or changes in sodium level were observed.
CONCLUSIONS: Bedtime treatment with low-dose oral desmopressin appears to effectively and safely decrease episodes of nocturia and nocturnal enuresis in about half the patients with neobladder, allowing for longer undisrupted sleep time and improved quality of life. Further investigation is warranted to determine if higher doses would result in a more meaningful clinical response.
Written by:
Goldberg H, Baniel J, Mano R, Gillon G, Kedar D, Yossepowitch O. Are you the author?
Institute of Urology, Rabin Medical Center, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Reference: BJU Int. 2013 Dec 9. Epub ahead of print.
doi: 10.1111/bju.12598
PubMed Abstract
PMID: 24314054
