Przydacz Mikolaj, Chlosta Marcin, Dudek Przemyslaw, Cudnoch-Jedrzejewska Agnieszka, Zgliczynski Wojciech, Dobruch Jakub, Antoniewicz Artur, Chlosta Piotr
Department of Urology, Jagiellonian University Medical College, Cracow, Poland.
Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland.
Cent European J Urol. 2020;73(4):498-505. doi: 10.5173/ceju.2020.0283. Epub 2020 Nov 2.
Desmopressin is an effective and safe therapy for nocturia caused by nocturnal polyuria. However, many physicians are unsure about the proper diagnosis of nocturnal polyuria and the identification of patients who may benefit from desmopressin treatment. Therefore, to support urologists in their routine clinical practice, the aim of this study was to provide a comprehensive paradigm for diagnosing nocturnal polyuria with recommendations for the use of desmopressin.
A multidisciplinary group of experts reviewed the available literature. Findings were compiled into a practice-based approach for workup and treatment.
We designed the nocturia diagnostic pathway to confirm nocturnal polyuria, identify possible causes of nocturnal polyuria, and classify patients with indications and contraindications for desmopressin therapy. A bladder diary remains a basic diagnostic tool. Underlying conditions that may lead to nocturnal polyuria include mainly cardiac insufficiency, arterial hypertension, chronic kidney failure, obstructive sleep apnea, peripheral edema, and excessive fluid intake at night. Treatment for nocturia caused by nocturnal polyuria is based on conservative management and pharmacotherapy, but pharmacological treatment should not precede a prior attempt at conservative treatment. Before administration of desmopressin, patients should be assessed for serum sodium concentration and carefully educated about the symptoms of hyponatremia. Older individuals or persons with risk factors for the development of hyponatremia should be checked regularly for hyponatremia during desmopressin therapy.
People with nocturia due to nocturnal polyuria should be evaluated carefully before initiating desmopressin treatment. Patients treated with desmopressin should be followed for both clinical efficacy and treatment-related adverse effects.
去氨加压素是治疗夜间多尿所致夜尿症的一种有效且安全的疗法。然而，许多医生对于夜间多尿的正确诊断以及确定可能从去氨加压素治疗中获益的患者并不确定。因此，为了在日常临床实践中支持泌尿外科医生，本研究的目的是提供一个用于诊断夜间多尿的综合范例，并给出使用去氨加压素的建议。
一个多学科专家小组回顾了现有文献。研究结果被整理成一种基于实践的检查和治疗方法。
我们设计了夜尿症诊断路径，以确认夜间多尿、确定夜间多尿的可能原因，并对去氨加压素治疗有适应证和禁忌证的患者进行分类。膀胱日记仍然是一种基本的诊断工具。可能导致夜间多尿的潜在病症主要包括心脏功能不全、动脉高血压、慢性肾衰竭、阻塞性睡眠呼吸暂停、外周水肿以及夜间过量饮水。夜间多尿所致夜尿症的治疗基于保守管理和药物治疗，但药物治疗不应先于保守治疗的尝试。在给予去氨加压素之前，应评估患者的血清钠浓度，并就低钠血症的症状对患者进行仔细教育。老年个体或有发生低钠血症风险因素的人在去氨加压素治疗期间应定期检查是否发生低钠血症。
因夜间多尿而出现夜尿症的患者在开始去氨加压素治疗前应进行仔细评估。接受去氨加压素治疗的患者应随访临床疗效和治疗相关不良反应。
