Effect of combined systematized behavioral modification education program with desmopressin in patients with nocturia: a prospective, multicenter, randomized, and parallel study.

Abstract

PURPOSE: The aims of this study were to investigate the efficacy of combining the

systematized behavioral modification program (SBMP) with desmopressin therapy and

to compare this with desmopressin monotherapy in the treatment of nocturnal

polyuria (NPU). METHODS: Patients were randomized at 8 centers to receive

desmopressin monotherapy (group A) or combination therapy, comprising

desmopressin and the SBMP (group B). Nocturia was defined as an average of 2 or

more nightly voids. The primary endpoint was a change in the mean number of

nocturnal voids from baseline during the 3-month treatment period. The secondary

endpoints were changes in the bladder diary parameters and questionnaires scores,

and improvements in self-perception for nocturia. RESULTS: A total of 200

patients were screened and 76 were excluded from the study, because they failed

the screening process. A total of 124 patients were randomized to receive

treatment, with group A comprising 68 patients and group B comprising 56

patients. The patients' characteristics were similar between the groups.

Nocturnal voids showed a greater decline in group B (-1.5) compared with group A

(-1.2), a difference that was not statistically significant. Significant

differences were observed between groups A and B with respect to the NPU index

(0.37 vs. 0.29, P=0.028), the change in the maximal bladder capacity (-41.3 mL

vs. 13.3 mL, P<0.001), and the rate of patients lost to follow up (10.3% [7/68]

vs. 0% [0/56], P=0.016). Self-perception for nocturia significantly improved in

both groups. CONCLUSIONS: Combination treatment did not have any additional

benefits in relation to reducing nocturnal voids in patients with NPU; however,

combination therapy is helpful because it increases the maximal bladder capacity

and decreases the NPI. Furthermore, combination therapy increased the persistence

of desmopressin in patients with NPU.