Han Julia, Jung Jae Hung, Bakker Caitlin J, Ebell Mark H, Dahm Philipp
Department of Urology, University of Florida, PO Box 100247, Room N205, Gainesville, Florida, USA, 32610.
Cochrane Database Syst Rev. 2017 Oct 21;10(10):CD012059. doi: 10.1002/14651858.CD012059.pub2.
Nocturia is the bothersome symptom of awakening one or more times per night to void. Desmopressin is a commonly used medication for treating nocturia.
To assess the effects of desmopressin as compared to other interventions in the treatment of nocturia in men.
We performed a comprehensive search of medical literature with no restrictions on the language of publication or publication status. The date of the latest search of all databases was August 2017.
We included randomized or quasi-randomized trials. Inclusion criteria were men with nocturia defined as one or more voids per night. Trials of children, adults with primary or secondary enuresis or underlying distinct disorders were excluded.
Two review authors independently classified studies and abstracted data from the included studies. We performed statistical analyses using a random-effects model and interpreted data according to the Cochrane Handbook for Systematic Reviews of Interventions.
We included 14 studies with 2966 randomized men across five comparisons. Desmopressin versus placebo: based on short-term follow-up (up to three months), desmopressin may have a similar effect on the number of nocturnal voids (mean difference (MD) -0.46, 95% confidence interval (CI) -0.94 to 0.01; low-quality evidence). We are uncertain about the effect of desmopressin on major adverse events at short-term follow-up (risk ratio (RR) 0.97, 95% CI 0.10 to 9.03; very low-quality evidence). For intermediate-term follow-up (three to 12 months), desmopressin may reduce the number of nocturnal voids in an appreciable number of participants (MD -0.85, 95% CI -1.17 to -0.53; low-quality evidence). Desmopressin may result in little or no difference in major adverse events at intermediate-term follow-up (RR 3.05, 95% CI 0.13 to 73.39; low-quality evidence). We found no evidence on quality of life. Subgroup analyses suggest a larger effect with oral, higher-dose formulations of desmopressin and in men with documented nocturnal polyuria. Desmopressin versus behavior modification: there were no data regarding the effect on the number of nocturnal voids, quality of life, or major adverse events. Desmopressin versus alpha-blocker: based on short-term follow-up, desmopressin likely has a similar effect on the number of nocturnal voids (MD 0.30, 95% CI -0.20 to 0.80; moderate-quality evidence) and quality of life (MD 0.00, 95% CI -0.35 to 0.35; moderate-quality evidence). There were no major adverse events in either study group. Desmopressin plus alpha-blocker versus alpha-blocker alone: based on short-term follow-up, combination therapy likely results in a small, unimportant reduction in the number of nocturnal voids (MD -0.47, 95% CI -0.73 to -0.21; moderate-quality evidence) and quality of life (MD -0.29, 95% CI -0.51 to -0.07; moderate-quality evidence). The risk of major adverse events may be similar (RR 0.30, 95% CI 0.01 to 7.32; low-quality evidence). Desmopressin plus alpha-blocker versus alpha-blocker plus an anticholinergic: based on short-term follow-up, combination therapy likely results in little or no difference in the number of nocturnal voids (MD -0.43, 95% CI -0.97 to 0.11; moderate-quality evidence). We found no evidence on quality of life. There were no major adverse events in either study group.
AUTHORS' CONCLUSIONS: Desmopressin may reduce the number of nocturnal voids in an appreciable number of participants compared to placebo in intermediate-term (three to 12 months) follow-up without increase in major adverse events. We found no evidence to compare its effects to behavior modification. The effect on the number of nocturnal voids is likely similar to that of alpha-blockers short-term with very infrequent major adverse events. There appears to be no added benefit in the combined use of desmopressin with an alpha-blocker or an anticholinergic. The findings of this review were limited by short-term follow-up, study limitations, and imprecision.
夜尿症是指每晚因排尿而醒来一次或多次的令人烦恼的症状。去氨加压素是治疗夜尿症常用的药物。
评估去氨加压素与其他干预措施相比治疗男性夜尿症的效果。
我们对医学文献进行了全面检索，对出版物语言或出版状态没有限制。所有数据库的最新检索日期为2017年8月。
我们纳入了随机或半随机试验。入选标准为患有夜尿症的男性，定义为每晚排尿一次或多次。排除儿童、原发性或继发性遗尿症或潜在明显疾病的成年人的试验。
两位综述作者独立对研究进行分类，并从纳入的研究中提取数据。我们使用随机效应模型进行统计分析，并根据《Cochrane干预措施系统评价手册》解释数据。
我们纳入了14项研究，共2966名随机分组的男性，涉及五项比较。去氨加压素与安慰剂：基于短期随访（长达三个月），去氨加压素对夜间排尿次数可能有类似的效果（平均差（MD）-0.46，95%置信区间（CI）-0.94至0.01；低质量证据）。我们不确定去氨加压素在短期随访中对主要不良事件的影响（风险比（RR）0.97，95%CI 0.10至9.03；极低质量证据）。对于中期随访（三至十二个月），去氨加压素可能会使相当数量的参与者夜间排尿次数减少（MD -0.85，95%CI -1.17至-0.53；低质量证据）。去氨加压素在中期随访中可能导致主要不良事件几乎没有差异（RR 3.05，95%CI 0.13至73.39；低质量证据）。我们没有发现关于生活质量的证据。亚组分析表明，口服、高剂量配方的去氨加压素以及记录有夜间多尿的男性中效果更大。去氨加压素与行为矫正：没有关于对夜间排尿次数、生活质量或主要不良事件影响的数据。去氨加压素与α受体阻滞剂：基于短期随访，去氨加压素对夜间排尿次数（MD 0.30，95%CI -0.20至0.80；中等质量证据）和生活质量（MD 0.00，95%CI -0.35至0.35；中等质量证据）可能有类似的效果。两个研究组均未出现主要不良事件。去氨加压素加α受体阻滞剂与单独使用α受体阻滞剂：基于短期随访，联合治疗可能会使夜间排尿次数有小幅、不重要的减少（MD -0.47，95%CI -0.73至-0.21；中等质量证据）和生活质量（MD -0.29，95%CI -0.51至-0.07；中等质量证据）。主要不良事件的风险可能相似（RR 0.30，95%CI 0.01至7.32；低质量证据）。去氨加压素加α受体阻滞剂与α受体阻滞剂加抗胆碱能药物：基于短期随访，联合治疗可能导致夜间排尿次数几乎没有差异（MD -0.43，95%CI -0.97至0.11；中等质量证据）。我们没有发现关于生活质量的证据。两个研究组均未出现主要不良事件。
与安慰剂相比，在中期（三至十二个月）随访中，去氨加压素可能会使相当数量的参与者夜间排尿次数减少，且不会增加主要不良事件。我们没有发现将其效果与行为矫正进行比较的证据。对夜间排尿次数的影响在短期内可能与α受体阻滞剂相似，主要不良事件极少。去氨加压素与α受体阻滞剂或抗胆碱能药物联合使用似乎没有额外益处。本综述的结果受到短期随访、研究局限性和不精确性的限制。
