Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Atlanta, GA 30033, USA.
BJU Int. 2013 Jul;112(1):100-8. doi: 10.1111/j.1464-410X.2012.11736.x. Epub 2013 Feb 28.
WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Nocturia is a common and bothersome lower urinary tract symptom, particularly in men. Many single drug therapies have limited benefit. For men who have persistent nocturia despite alpha-blocker therapy, the addition of behavioural and exercise therapy is statistically superior to anticholinergic therapy.
To compare reductions in nocturia resulting from adding either behavioural treatment or antimuscarinic drug therapy to α-adrenergic antagonist (α-blocker) therapy in men.
Participants were men who had continuing urinary frequency >8 voids/day) and urgency after 4 weeks of α-blocker therapy run-in and who had ≥1 nightly episode of nocturia. Participants received individually titrated drug therapy (extended-release oxybutynin) or multicomponent behavioural treatment (pelvic floor muscle training, delayed voiding and urge suppression techniques). Seven-day bladder diaries were used to calculate reductions in mean nocturia.
A total of 127 men aged 42-88 years with ≥1 nocturia episode per night were included in the study. There were 76 men who had a mean of ≥2 nocturia episodes. Among those with ≥1 nocturia episode, behavioural treatment reduced nightly nocturia by a mean of 0.97 episodes and was significantly more effective than drug therapy (mean reduction = 0.56 episodes; P = 0.01). Participants with ≥2 episodes nocturia at baseline also showed larger changes with behavioural treatment compared with antimuscarinic therapy (mean reduction = 1.26 vs 0.61; P = 0.008).
Both behavioural treatment and drug therapy reduced nocturia in men with ≥1 episode of nocturia/night when added to α-blocker therapy. These results were similar even when only those with ≥2 episodes of nocturia were considered. The addition of behavioural treatment was statistically better than bladder-relaxant therapy for nocturia.
中文译文：
本研究旨在比较在α-肾上腺素能拮抗剂（α-阻滞剂）治疗的基础上，添加行为治疗或抗毒蕈碱药物治疗对男性夜尿症的治疗效果。
研究对象和方法：
本研究纳入了持续存在夜尿症（>8 次/天）和尿急的男性患者，这些患者在接受 4 周的α-阻滞剂治疗后仍有上述症状，且每晚至少有 1 次夜尿。患者接受个体化滴定药物治疗（控释羟丁宁）或多组分行为治疗（盆底肌训练、延迟排尿和抑制尿急技术）。使用 7 天膀胱日记计算平均夜尿次数的减少。
研究结果：
本研究共纳入了 127 名年龄在 42-88 岁之间的男性患者，他们每晚至少有 1 次夜尿。其中 76 名患者的平均夜尿次数≥2 次。在有≥1 次夜尿的患者中，行为治疗使夜间夜尿次数平均减少 0.97 次，明显优于药物治疗（平均减少 0.56 次；P=0.01）。基线时有≥2 次夜尿的患者，与抗毒蕈碱药物治疗相比，行为治疗的效果也更大（平均减少 1.26 次 vs 0.61 次；P=0.008）。
结论：
在α-阻滞剂治疗的基础上，添加行为治疗或药物治疗均可减少男性患者的夜尿症。即使只考虑有≥2 次夜尿的患者，这些结果也是相似的。与膀胱松弛剂治疗相比，添加行为治疗在统计学上对夜尿症的治疗效果更好。
