Low-dose oral desmopressin therapy used alone or in combination with an α-blocker improves nocturia in men with benign prostatic hyperplasia (BPH), according to findings from a new systematic review and meta-analysis.

A team led by Diaa-Eldin Taha, MD, from Kafrelsheikh University in Egypt, pooled data from 18 studies published from 1980 to 2017. The studies included 3072 patients (50 years and older) with 1 or more voids nightly. After desmopressin monotherapy, nocturia was significantly reduced by 43%, according to results published in the Arab Journal of Urology. Severe nocturia responded better to treatment. Desmopressin doses ranged from 0.05 mg to 0.4 mg.

Using desmopressin along with an α-blocker reduced nightly voids by 64.3% compared with 44.6% using alpha-blockers alone. International Prostate Symptom Score, however, improved more in the α-blocker-only group. Sleep duration before the first void significantly increased from 82 to 160 min and from 83 to 124 min after combined therapy and alpha-blocker monotherapy, respectively.

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“Low-dose oral desmopressin therapy alone is an effective treatment for nocturia associated with LUTS in patients with BPH. Oral desmopressin combined with α-blockers is well tolerated and beneficial for improving the International Prostate Symptom Score and nocturnal symptoms,” Dr Taha and the team concluded. “All patients should be educated about the mechanism of desmopressin action to avoid treatment discontinuation due to adverse events.”

The most commonly reported adverse event from desmopressin use was hyponatremia in 4.4% to 5.7%. Other events included headache, dizziness, nausea, oliguria, diarrhea, and incontinence. Some patients discontinued treatment due to diarrhea or hyponatremia.

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Taha DE, Aboumarzouk OM, Shokeir AA, et al. Oral desmopressin in nocturia with benign prostatic hyperplasia: A systematic review of the literature. Arab J Urol. DOI:10.1016/j.aju.2018.06.007