Nocturia: Little progression at 1 year in men with BPH

In a secondary analysis of a trial that recruited men 45 to 80 years of age with symptoms suggestive of BPH (AUA Symptom Index score ≥8) who attended outpatient clinics at 31 participating Veterans Affairs medical centers, researchers determined the average nocturia frequency. The study comprised 305 men who were allocated to placebo in a double-blind, randomized, controlled trial.

The participants made six visits over 1 year of follow-up; visits were at weeks 2, 4, 13, 26, 39, and 52. At each visit, participants reported their nocturia habits over the past week using an AUA-SI nocturia question. Eighty-four percent of the patients reported information at all six time points.

At baseline, 25% of men reported one void per night, 34% reported two voids per night, 27% reported three voids per night, and 9% reported four voids per night.

The mean nocturia episodes were 2.2 voids per night (SD 1.1) at baseline and 2.1 voids/night (SD 1.1) at 1 year. No significant differences in episodes were found at any of the weeks (p≥.399 for all), and no significant trend was found (p=.542); however, there was considerable fluctuation in nocturia over 1 year.

"Men who had one or two voids per night in the beginning were more stable over the follow-up year, while the men who had more frequent voiding episodes per night at baseline showed more fluctuation over time. Approximately half of the men with three or four episodes at baseline had improvement in episodes, and relatively few had worsening at 1 year," Dr. Tikkinen reported.

Research may facilitate decision-making

Dr. Tikkinen, currently a senior researcher at McMaster University, Hamilton, Ontario, says he believes that accurate estimates of the progression/remission for nocturia would facilitate decision-making about the initiation of therapeutic options. Understanding potential fluctuations of nocturia is also important for research, in particular to shed light on incident nocturia.

"Nocturia is multifactorial and not an easy problem to deal with," said session co-chair Matthias Oelke, MD, vice-chair, section head of functional urology at Hannover Medical School, Hannover, Germany. "Factors affecting nocturia can be behavioral, hormonal, or related to drug intake, heart, lung, prostate, or bladder disease, or associated with metabolic syndrome."

Dr. Tikkinen explained that although these data are from the placebo arm of a randomized trial, the results show a fluctuation that may be related to the effects of multifactorial influences on nocturia.

"A possible limitation of the study is the use of placebo," commented session co-chair Stavros Gravas, MD, assistant professor of urology at the University of Thessaly School of Medicine, Larissa, Greece. "It is uncertain just how much placebo effect there is in the study, if at all. After all, this is not a population without an indication."