Desmopressin - Reviews in Urology

"Enuresis nocturna is a widespread problem among children, with up to 25% of all children possibly suffering from this condition. Several therapeutic modalities are currently available. This article reviews current state-of-the-art therapies, highlights current literature, and provides an update on recent developments within the field of enuresis nocturna. [Rev Urol. 2011;13(1):1-5 doi: 10.3909/riu0498]"

Desmopressin Enuresis nocturna Alarm therapy Imipramine Reboxetine Giggle incontinence Methylphenidate Pelvic floor muscle exercise

Volume 20, Number 1 Review Articles

Nocturia: Evaluation and Current Management Strategies

Management Update

Doug F Milam Melissa R Kaufman Sophia Delpe Joshua A Cohn Casey G Kowalik Alan J Wein W Stuart Reynolds Roger R Dmochowski

Nocturia is a complex condition that not only significantly affects quality of life, but may be an indicator of systemic disease. Initial assessment includes a detailed history and physical examination and completion of a frequency volume chart to help identify underlying causes, such as sleep disorders, bladder storage disorders, and polyuria. Treatment with alpha-blockers or antimuscarinic medications may help if the underlying cause is determined to be benign prostatic hyperplasia or overactive bladder, respectively. Treatment options for nocturnal polyuria have been limited to behavioral therapy and off-label use of timed diuretics and desmopressin. Desmopressin acetate nasal spray (Noctiva™, Avadel Pharmaceuticals, Chesterfield, MO) was approved by the US Food and Drug Administration in 2017 for the treatment of nocturia due to nocturnal polyuria in adults who awaken at least twice nightly and has shown efficacy in reducing nocturnal voids by $50% in up to 49% of patients in clinical trials. [Rev Urol. 2018;20(1):1–6 doi: 10.3909/riu0797] © 2018 MedReviews®, LLC

Benign prostatic hyperplasia Nocturia Desmopressin Nocturnal polyuria Overactive bladder

Volume 21, Number 2 Review Articles

Nocturia in Patients With Multiple Sclerosis

Management Review

Carrie Lyn Sammarco Robert W Charlson Jonathan E Howard Benjamin M Brucker Lana Zhovtis Ryerson Jean-Nicolas Cornu Gérard Amarenco Lauren B Krupp Xavier Gamé Benoit Peyronnet W Stuart Reynolds Roger R Dmochowski

The prevalence of nocturia in patients with multiple sclerosis (MS) is high, ranging from 20.9% to 48.8% in this population. Its underlying pathophysiology is complex and different from the non-neurogenic population. In the MS population, the pathophysiology may involve neurogenic lower urinary tract dysfunction (NLUTD) such as detrusor overactivity (NDO), detrusor-sphincter dyssynergia, or detrusor underactivity resulting in reduced bladder capacity. Nocturnal polyuria is also a significant contributor to the pathogenesis of nocturia in MS patients and may be the result of specific mechanisms such as nocturnal hypertension through autonomic cardiovascular dysfunction or lack of diurnal variation of antidiuretic hormone production (ADH) due to demyelinating lesions of the spinal cord. Nocturia might be particularly burdensome in MS patients by contributing to fatigue, a common and highly debilitating symptom in this population. There is likely a complex and multidirectional relationship between nocturia, other sleep disorders, and fatigue in the MS population that has yet to be explored. The assessment of nocturia in MS should rely upon a thorough history and physical examination. Urinalysis should be done to rule out urinary tract infection, a frequency-volume chart might help elucidating the underlying mechanisms, and post-void residual volume may be of interest to screen for urinary retention that could be asymptomatic in MS patients. Other tests such as urodynamics or polysomnography are indicated in selected patients. The treatment should be tailored to the underlying cause. The first steps involve behavioral interventions and treatment of cofactors. When possible, the predominant mechanism should be addressed first. In case of predominant NDO, antimuscarinics and beta-3 agonists should be offered as a first-line treatment and intradetrusor injections of botulinum toxin as a second-line treatment. In cases of incomplete bladder emptying, clean-intermittent self-catheterization is often used as part of multiple other interventions. In cases of nocturnal polyuria, desmopressin may be offered, inclusive of use of newer formulations (desmopressin acetate nasal spray, desmopressin orally disintegrated tablet) in countries where they are approved. [Rev Urol. 2019;21(2/3):63–73] © 2019 MedReviews®, LLC

Nocturia Multiple sclerosis Fatigue Desmopressin Nocturnal polyuria voiding diary

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