Effect of Combined Systematized Behavioral Modification Education Program With Desmopressin in Patients With Nocturia: A Prospective, Multicenter, Randomized, and Parallel Study

다국어 초록 (Multilingual Abstract)

Purpose: The aims of this study were to investigate the efficacy of combining the systematized behavioral modification program(SBMP) with desmopressin therapy and to compare this with desmopressin monotherapy in the treatment of nocturnal polyuria(NPU).
Methods: Patients were randomized at 8 centers to receive desmopressin monotherapy (group A) or combination therapy,comprising desmopressin and the SBMP (group B). Nocturia was defined as an average of 2 or more nightly voids. The primaryendpoint was a change in the mean number of nocturnal voids from baseline during the 3-month treatment period. The secondaryendpoints were changes in the bladder diary parameters and questionnaires scores, and improvements in self-perceptionfor nocturia.
Results: A total of 200 patients were screened and 76 were excluded from the study, because they failed the screening process. Atotal of 124 patients were randomized to receive treatment, with group A comprising 68 patients and group B comprising 56 patients.
The patients’ characteristics were similar between the groups. Nocturnal voids showed a greater decline in group B (−1.5)compared with group A (−1.2), a difference that was not statistically significant. Significant differences were observed betweengroups A and B with respect to the NPU index (0.37 vs. 0.29, P=0.028), the change in the maximal bladder capacity (−41.3 mLvs. 13.3 mL, P<0.001), and the rate of patients lost to follow up (10.3% [7/68] vs. 0% [0/56], P=0.016). Self-perception for nocturiasignificantly improved in both groups.
Conclusions: Combination treatment did not have any additional benefits in relation to reducing nocturnal voids in patientswith NPU; however, combination therapy is helpful because it increases the maximal bladder capacity and decreases the NPI.
Furthermore, combination therapy increased the persistence of desmopressin in patients with NPU.

참고문헌 (Reference)

1 Bartley JM, "Understanding clinic options for overactive bladder" 14 : 541-548, 2013

2 Swithinbank L, "The effect of fluid intake on urinary symptoms in women" 174 : 187-189, 2005

3 Cho SY, "Short-term effects of systematized behavioral modification program for nocturia: a prospective study" 31 : 64-68, 2012

4 이한이, "Short-term Effects of a Systematized Bladder Training Program for Idiopathic Overactive Bladder: A Prospective Study" 대한배뇨장애요실금학회 17 (17): 11-17, 2013

5 강동일, "Short Term Effect and Safety of Antidiuretic Hormone in the Patients with Nocturia" 대한배뇨장애요실금학회 14 (14): 227-231, 2010

6 Griebling TL, "Re: Efficacy of nondrug lifestyle measures for the treatment of nocturia. Editorial comment" 184 : 1004-, 2010

7 Tikkinen KA, "Nocturia frequency, bother, and quality of life: how often is too often? A population-based study in Finland" 57 : 488-496, 2010

8 McKown S, "Linguistic validation of the N-QOL (ICIQ), OAB-q (ICIQ), PPBC, OAB-S and ICIQ-MLUTSsex questionnaires in 16 languages" 64 : 1643-1652, 2010

9 Hashim H, "How should patients with an overactive bladder manipulate their fluid intake?" 102 : 62-66, 2008

10 Soda T, "Efficacy of nondrug lifestyle measures for the treatment of nocturia" 184 : 1000-1004, 2010

11 이혜원, "Desmopressin is an Effective Treatment for Mixed Nocturia with Nocturnal Polyuria and Decreased Nocturnal Bladder Capacity" 대한의학회 25 (25): 1792-1797, 2010

12 van Kerrebroeck P, "Desmopressin in the treatment of nocturia: a double-blind, placebo-controlled study" 52 : 221-229, 2007