TREATMENT OF NOCTURIA: WHAT REALLY WORKS?

INTRODUCTION AND OBJECTIVE: This study aims to assess the efficacy of behavioral modification alone vs. combined behavioral modification with traditional first-line pharmacologic treatments in reducing nocturnal voiding frequency among men with nocturia. METHODS: Retrospective analysis of voiding diaries completed by patients treated for lower urinary tract symptoms (LUTS) at a Veterans Affairs urology clinic was performed. Diaries were abstracted for 24-h total volume, nocturnal urine volume (NUV), and actual number of nocturnal voids (ANV). Patients were included if they were male, ≥18 years, had ≥1 nocturnal void(s) on baseline diary, and a follow-up diary within 365 days of baseline. Patients were deemed to have experienced improvement if ANV decreased by ≥1 voids(s) from baseline to follow-up. RESULTS: 321 voiding diaries (176 diary pairs) were analyzed from 98 unique patients who met the inclusion criteria. Mean duration from baseline to follow-up was 181 days. Improvement was observed in 67 diary pairs (mean improvement -1.76 [±1.07] voids); no change was observed in 44 diary pairs, and 65 demonstrated an increase in ANV (+1.86 [±1.91] voids). Among those who improved, baseline ANV was significantly greater (3.5 vs. 2.1 voids, p<0.001), and baseline post-void residual (PVR) volume was lower (45.7 vs. 89.3, p=0.03). No other differences were observed in standard diary parameters. Improvement in ANV was accompanied by a significant decrease in 24-h volume (-344 mL, p=0.01), NUV (-262 mL, p<0.001), and an increase in first uninterrupted sleep period (FUSP) duration (+1.92 hours, p<0.001). Patients prescribed behavioral modification + 1 or more pharmacologic agent were no more likely to improve than patients prescribed lifestyle modification alone. Irrespective of pharmacotherapy status, improvement was accompanied by significant decreases in ANV, total 24-h voids voids, nocturnal bladder capacity index (NBCi), and nocturia index (Ni), as well as increased FUSP (Table). CONCLUSIONS: In this study, no significant difference was observed in nocturia severity between patients treated with behavioral modification alone vs. combined behavioral modification + pharmacologic agent(s). Alternative pharmacologic options may be needed to expand the urologist’s toolkit beyond an initial individualized lifestyle modification plan in the management of nocturia.Source of Funding: None