deamino-arginine-vasopressin and Urination-Disorders

Nocturia is a bothersome urologic symptom and is defined as awakening from sleep once or more times to void. The condition is highly prevalent in men and women and increases in prevalence with age. Impact on quality of life is substantial as is the associated morbidity and mortality.. A PubMed literature search was undertaken to identify evidence for the currently available and utilized pharmacotherapy options for the treatment of nocturia. Available pharmacologic treatments include desmopressin, α-blockers, antimuscarinics, and other less commonly utilized therapies. Desmopressin is generally found to have high-level evidence to support its use for the indication of nocturnal polyuria, a form of nocturia caused by excessive nighttime urine production. α-blockers and antimuscarinics are generally recommended in the setting of benign prostatic hypertrophy in men and overactive bladder in both men and women.. Clinical trials addressing nocturia often report statistically significant results that do not translate to clinically significant reductions in nighttime voids. As a result, the clinical utility of these agents has been called into question. Further drug development and clinical trials specifically focused on nocturia are needed. Furthermore, improved patient-focused assessment tools to measure the impact on symptom reduction, improvement in sleep quality, and improvement in quality of life are important in understanding what matters most to patients and what outcomes translate to patient satisfaction with care.

Topics: Adrenergic alpha-Antagonists; Age Factors; Antidiuretic Agents; Deamino Arginine Vasopressin; Humans; Muscarinic Antagonists; Nocturia; Prevalence; Quality of Life; Sleep Wake Disorders; Urination Disorders

In voiding disorders in childhood, after a precise diagnosis, treatment can be provided. Aspecific hygienic and dietetic measures are the basis of care in all micturating disorders and frequently must be established to allow a precise diagnosis. In case of enuresis, restriction of beverage and diuretic foods is recommended in the evening. Other treatments for enuresis should be proposed to motivated children. In the polyuric form of enuresis, the treatment is desmopressin (DDAVP) and in the form with low bladder capacity, alarms or a combination of these 2 treatments. In dysfunctional voiding, after caring for the secondary causes, and depending on the characteristics of the disorder, the first-step treatment is pelvic floor rehabilitation with or without anticholinergic therapy. Other medical treatments are used in a second step. Isolated urethral instability remains controversial.

Topics: Behavior Therapy; Child; Child, Preschool; Combined Modality Therapy; Conditioning, Classical; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Infant; Male; Pelvic Floor Disorders; Referral and Consultation; Surveys and Questionnaires; Urination Disorders; Water Deprivation

Abnormalities of micturition occur in many different diseases, have a variety of causes and take several forms. This review will focus exclusively on those abnormalities in which antidiuretic therapy may be of benefit. These conditions are primarily characterized by an increase in the total amount of urine produced (polyuria) or a circadian shift in the control of urine production and/or voiding (nocturnal enuresis, nocturia).

Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Humans; Nocturnal Enuresis; Polyuria; Quality of Life; Urination Disorders; Water

Topics: Aged; Aged, 80 and over; Amantadine; Cerebral Infarction; Cholinergic Antagonists; Cognition Disorders; Deamino Arginine Vasopressin; Diagnosis, Differential; Donepezil; Humans; Indans; Levodopa; Piperidines; Quality of Life; Serotonin Agents; Urination Disorders

Desmopressin, a synthetic antidiuretic hormone analogue, is the only drug currently approved for the treatment of nocturia associated with nocturnal polyuria or multiple sclerosis (MS). Compared with vasopressin, desmopressin has a longer lasting and more potent antidiuretic effect and is devoid of vasopressor and uterotonic effects. In two large, randomised, double-blind phase III trials in adults with nocturia associated with nocturnal polyuria, 3 weeks of oral desmopressin therapy was significantly more effective than placebo in reducing the mean number of nocturnal voids and in normalising the rate of nocturnal urine production. Beneficial effects of desmopressin on nocturia were maintained and increased in patients completing 10 or 12 months of further treatment in a nonblind extension of short-term trials. In randomised, double-blind trials in MS patients with nocturia, nasal desmopressin reduced the mean number of nocturnal voiding episodes by 31-54%. In both patient populations, desmopressin increased the initial sleep period or mean maximum period of uninterrupted sleep by approximately 2 hours, an outcome significantly greater than that achieved with placebo. In trials of < or =6 weeks duration in adults with nocturia, desmopressin was generally well tolerated. Most desmopressin-related adverse events were transient and mild or moderate in severity. Clinically significant hyponatraemia was reported in approximately 5% and required withdrawal from studies in < or =3% of patients.

Topics: Adult; Deamino Arginine Vasopressin; Humans; Urination Disorders

Older adults often cite nocturia as one of the most bothersome lower urinary tract symptoms (LUTS). We investigated the efficacy and safety of intranasal desmopressin in the treatment of nocturia due to nocturnal polyuria on 12 patients (ten men, two women) ranging in age from 53 to 77 years (mean 67 years). All patients experienced more than two episodes of nocturia per night, and had a nocturnal urine volume greater than 35% of the daily voided volume, measured using a 3-day voiding diary with a frequency-volume chart. They began taking intranasal desmopressin (10 microg) at bedtime. When compared with the baseline data, the nocturnal urine volume, (928 +/- 307 versus 469 +/- 251 ml, p = 0.0007) and nocturnal frequency (4.8 +/- 2.0 versus 2.8 +/- 1.8, p = 0.0009) were significantly decreased. The daytime urine volume (1,008 +/- 458 versus 930 +/- 419 ml, p = 0.49) did not change significantly. The unine osmolarity (420 +/- 143 versus 598 +/- 158 mOsm/kg, p = 0.0065), and urine sodium levels (100 +/- 32 versus 140 +/- 60 mEq/l, p = 0.007) increased significantly, whereas the serum sodium levels (141 +/- 3 versus 135 +/- 7 mEq/l, p = 0.048) decreased significantly. Among the 12 patients, 5 (41.6%) patients reported side effects, including headache in 1, edema in 1 and hyponatremia in 3. The patient with edema discontinued medication, but the other 4 patients continued their medication and the side effects subsided. In conclusion, desmopressin is an effective treatment for adult patients complaining of nocturia due to nocturnal polyuria. One should be aware of the potential side effects including hyponatremia.

Topics: Administration, Intranasal; Aged; Deamino Arginine Vasopressin; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Polyuria; Urination Disorders; Urodynamics

Nocturia is an increasingly prevalent and bothersome urinary symptom associated with considerable impact and morbidity in later life. Nocturnal frequency is associated with a number of underlying pathologies, both related and unrelated to the lower urinary tract. Following careful assessment, diagnosis and management, the condition is amenable to amelioration, if not complete cure in the majority of cases. This paper outlines the epidemiology, underlying pathophysiology and diseases associated with nocturia and reviews current treatment strategies.

Topics: Adrenergic alpha-Antagonists; Adult; Aged; Aged, 80 and over; Deamino Arginine Vasopressin; Diuretics; Female; Humans; Male; Middle Aged; Quality of Life; Urinary Bladder Neck Obstruction; Urination Disorders

Nocturia is a common condition in the elderly that profoundly influences general health and quality of life. It appears to predict a higher risk of death. One consequence of nocturia is sleep deterioration, with increased daytime sleepiness and loss of energy and activity. Accidents, e.g. falls, are increased both at night and during the day in elderly persons with nocturia. Nocturia is caused by nocturnal polyuria, reduced voided volumes, or a combination of the two. Nocturnal polyuria can be caused by numerous diseases, e.g. diabetes insipidus, diabetes mellitus, congestive heart failure, and sleep apnoea. A disorder of the vasopressin system, with very low or undetectable vasopressin levels at night, is manifested as an increased nocturnal urine output, which in the most extreme cases reaches 85% of the 24-h diuresis: the prevalence of low or undetectable vasopressin levels at night has been estimated to be 3-4% in those aged >or= 65 years. Treatment of nocturia may include avoiding excessive fluid intake and use of diuretic medication in the afternoon rather than the morning, oral desmopressin at bedtime in cases of nocturnal polyuria, and antimuscarinic agents in the case of overactive bladder or impaired storage capacity of the bladder.

Topics: Age Factors; Aged; Circadian Rhythm; Deamino Arginine Vasopressin; Diuresis; Health Status; Humans; Life Style; Polyuria; Renal Agents; Sleep Wake Disorders; Syndrome; Urination Disorders

The purpose of this review is to make urologists aware of the fact that nocturia among elderly men has a multifactorial aetiology and does not always depends on bladder outlet obstruction. After diagnosis of the underlying cause, specific treatments can be offered to the patient, one of which is transurethral resection of the prostate. Nocturia, defined as waking up at night to void, is a very common and bothersome symptom, affecting >50% of both men and women aged >60 years. Nocturnal polyuria is one reason for nocturia. Recent studies have shown that this condition can now be treated successfully with desmopressin acetate, a synthetic analogue of arginine vasopressin, which for many years has been used in the treatment of enuresis in children.

Topics: Deamino Arginine Vasopressin; Diagnosis, Differential; Female; Humans; Male; Polyuria; Prostatectomy; Renal Agents; Urinary Bladder Neck Obstruction; Urination Disorders

To estimate the incidence of hyponatremia in older adults who use nasal or oral desmopressin to treat nocturia.. A systematic review and meta-analysis of cohort studies and randomised controlled trials of the use of nasal or oral desmopressin for older adults with nocturia. The incidence of hyponatremia was estimated by a random effects model for binomial data.. Seventy-five papers were identified by the literature review of which 14 were reports of randomised trials or cohort studies. Seven studies reported the incidence of hyponatremia. The pooled estimate for the incidence of hyponatremia was 7.6% (95% CI 3.7-15.1).. Hyponatremia is a relatively common adverse effect of the use of desmopressin for the treatment of nocturia and caution and regular monitoring should be part of the use of this management option for nocturia in older adults.

Topics: Administration, Intranasal; Administration, Oral; Aged; Clinical Trials as Topic; Deamino Arginine Vasopressin; Humans; Hyponatremia; Incidence; Renal Agents; Risk Assessment; Urination Disorders

Adequate sleep is a basic requirement for good health. Adults generally require 7 to 8 hours of sleep per night. Sleep deprivation is associated with a decreased ability to perform tasks controlled by the frontal lobe, such as planning, concentration, motor performance, and high-level intellectual skills. Constant poor-quality sleep can also cause excessive daytime sleepiness, depression, and immune function compromise. In addition, continued sleep disruption has been associated with an increased risk for mortality.

Topics: Behavior Therapy; Deamino Arginine Vasopressin; Female; Humans; Male; Mandelic Acids; Quality of Life; Renal Agents; Rest; Sleep; Sleep Wake Disorders; Urination Disorders; Urine

Topics: Activities of Daily Living; Deamino Arginine Vasopressin; Humans; Polyuria; Renal Agents; Sleep Wake Disorders; Urination Disorders

Topics: Adult; Aged; Clinical Trials, Phase III as Topic; Deamino Arginine Vasopressin; Humans; Hyponatremia; Middle Aged; Renal Agents; Risk Factors; Treatment Outcome; Urination Disorders

Topics: Deamino Arginine Vasopressin; Humans; Renal Agents; Urination Disorders

Nocturia is a common and troublesome symptom in otherwise healthy elderly men and women. Nocturnal polyuria (an excessive nighttime urine output) has been documented to be a common finding in healthy men with lower urinary tract symptoms. It is also a presenting feature of various medical conditions, such as renal failure, hypercalcemia and diabetes. Fluid balance therapy is an option in those whose nocturia is secondary to nocturnal polyuria. If a reduction in fluid intake fails to reduce nocturnal frequency a variety of drug treatments may be beneficial. Several studies have confirmed the efficacy of intranasal DDAVP, a synthetic analog of antidiuretic hormone, in both healthy patients and those with neuropathic bladders, although fluid overload and hyponatremia are potential side effects. Other drug treatments include early evening diuretics, such as frusemide or bumetanide. More recently imipramine has shown therapeutic benefit in young adults with enuresis, and might prove to be useful in the elderly with nocturnal polyuria.

Topics: Adult; Aged; Deamino Arginine Vasopressin; Diuretics; Drinking; Female; Humans; Imipramine; Incidence; Male; Sulfonamides; Urination Disorders

Topics: Deamino Arginine Vasopressin; Enuresis; Humans; Multiple Sclerosis; Randomized Controlled Trials as Topic; Renal Agents; Urinary Bladder, Neurogenic; Urination Disorders

Aging often disturbs the normal circadian rhythm of urine production. The nocturia commonly seen with aging may result from the loss of nighttime vasopressin production or release that develops by childhood. Restoring the nocturnal increase in vasopressin can have a dramatic clinical response: improved quality of life and less risk of nighttime falls in carefully selected and accurately diagnosed patients.

Topics: Aged; Aging; Arginine Vasopressin; Circadian Rhythm; Deamino Arginine Vasopressin; Female; Humans; Male; Middle Aged; Polyuria; Renal Agents; Sleep; Urination Disorders

Bedwetting is present in 5 to 7% of children aged 7 to 8 years. The history of the disorder and the examination of the child are of main importance. This is usually the first step to identify nocturnal enuresis, bladder or urethral instability and other voiding dysfunctions. Therapeutic failure is often related to an inadequate analysis of the disorder. For nocturnal enuresis, the best results are obtained with alarms and/or desmopressine; bladder instability usually requires oxybutinine chlorydrate and urethral instability can be treated with biofeedback therapy. The management of other voiding dysfunctions depends on urodynamic assessment.

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Mandelic Acids; Urination Disorders

Wetting and voiding dysfunction in children represent a wide spectrum of disorders ranging from uncomplicated nocturnal enuresis, which is not associated with significant uropathology, to more complicated functional voiding dysfunction, which, in the worst of cases, can result in severe deterioration of both bladder and renal function. A complete understanding and thorough evaluation of these clinical entities allow a classification that lends itself to rational and tailored therapy. Optimal response rates can be achieved only with a disciplined and well-defined approach to the evaluation and management of these children.

Topics: Antidepressive Agents, Tricyclic; Behavior Therapy; Child; Child, Preschool; Cholinergic Antagonists; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Toilet Training; Urination Disorders

To investigate the pharmacokinetic profile of oral desmopressin in elderly patients with nocturia, and to analyse any possible correlation between the absorption and clinical effect.. In all, 32 patients were screened to determine the baseline number of nocturnal voids and the nocturia index; of these, 24 fulfilled the inclusion criteria and were enrolled for a pharmacokinetic evaluation of oral desmopressin 400 microg. A double-blind, randomized, placebo-controlled, crossover-effect evaluation period was then used to test the association between the absorption of desmopressin and pharmacodynamic effect. Serial plasma samples were collected for 8 h for a pharmacokinetic analysis of desmopressin. The pharmacodynamics after an equivalent oral dose before bedtime were assessed by measuring changes in the number of nocturnal voids, time to first nocturnal void and nocturnal diuresis, from placebo to active treatment.. There was a linear relationship between plasma desmopressin at 2 h after dosing and the area under the plasma concentration curve from 0 to infinity (Pearson's rho 0.923, P < 0.001). Women had a significantly higher plasma desmopressin concentration than men (P = 0.0012) and more adverse events. There was no correlation between plasma desmopressin at 2 h after dosing and the within-patient response in any of the effect variables. Generally, the number of nocturnal voids and nocturnal diuresis were half that with placebo. The time to the first nocturnal void was almost doubled compared with placebo.. There seems to be a relationship between gender, plasma level of desmopressin and the incidence of adverse events. Plasma desmopressin at 2 h after dosing cannot be used to predict the pharmacodynamic response, although desmopressin lowers the nocturnal diuresis and the number of nocturnal voids.

Topics: Absorption; Administration, Oral; Aged; Area Under Curve; Cross-Over Studies; Deamino Arginine Vasopressin; Double-Blind Method; Female; Humans; Male; Renal Agents; Urination Disorders

To our knowledge we report the first long-term use of desmopressin for nocturia. Patients previously responding to desmopressin in short-term studies were enrolled in this long-term open label study.. Patients received treatment for 10 or 12 months with the optimal desmopressin dose (0.1, 0.2 or 0.4 mg orally at bedtime). Patients were followed a further month without treatment. Of the patients completing the short-term study 132 males (92%) and 117 females (83%) were recruited, and 95 (72%) and 87 (75%), respectively, completed long-term treatment.. The mean number of nocturnal voids was decreased in males and females throughout the study (1.3 to 1.6 and 1.2 to 1.3) compared with baseline (3.1 and 2.9, respectively). After followup the number of voids increased after treatment cessation. From baseline to 12 months the mean duration of the first sleep period gradually increased in males (157 to 288 minutes) and females (142 to 310 minutes). After followup the mean duration of the first sleep period decreased, confirming that it was a treatment related benefit. Desmopressin was well tolerated with few males (14%) or females (10%) withdrawing due to adverse events. Most adverse events were mild (44%) or moderate (44%) in severity. Four males experienced serious drug related adverse events, namely dizziness in 1, cardiac failure, headache and vomiting in 2, and chest pain and hypertension in 1. A female experienced 4 serious drug related adverse events, that is hyponatremia, headache, nausea and vertigo. Two patients had clinically significant hyponatremia.. This long-term study shows that desmopressin is a generally well tolerated and effective treatment for nocturia.

Topics: Adult; Aged; Aged, 80 and over; Deamino Arginine Vasopressin; Female; Humans; Male; Middle Aged; Quality of Life; Urination; Urination Disorders

The purpose of this study was to investigate the efficacy and safety of oral desmopressin in the treatment of nocturia in women.. Women aged 18 years or older with nocturia (>or=2 voids per night with a nocturia index score >1) received desmopressin (0.1 mg, 0.2 mg, or 0.4 mg) during a 3-week dose-titration period. After a 1-week washout period, patients who responded in this period received desmopressin or placebo in a double-blind fashion for 3 weeks.. In double-blind phase, 144 patients were randomly assigned to groups (desmopressin, n=72; placebo, n=72). For desmopressin, 33 (46%) patients had a 50% or greater reduction in nocturnal voids against baseline levels compared with 5 (7%) patients receiving placebo (P<.0001). The mean number of nocturnal voids, duration of sleep until the first nocturnal void, nocturnal diuresis, and ratios of nocturnal per 24 hours and nocturnal per daytime urine volumes changed significantly in favor of desmopressin versus placebo (P<.0001). In the dose-titration phase headache (22%), nausea (8%), and hyponatremia (6%) were reported. Two deaths occurred, although neither could be directly associated with the study drug.. Oral desmopressin is an effective and well-tolerated treatment for nocturia in women.

Topics: Adult; Aged; Deamino Arginine Vasopressin; Double-Blind Method; Female; Headache; Humans; Hyponatremia; Middle Aged; Nausea; Renal Agents; Urination Disorders

To investigate the efficacy and safety of oral desmopressin in the treatment of nocturia in men.. Men aged >/=18 years with verified nocturia (>or=two voids/night) and nocturnal urine production greater than their maximum functional bladder capacity were recruited. A 3-week dose-titration phase established the optimum desmopressin dose (0.1, 0.2 or 0.4 mg). After a 1-week 'washout' period, patients who responded in the dose-titration period were randomized to receive the optimal dose of desmopressin or placebo in a double-blind design for 3 weeks.. In all, 151 patients entered the double-blind period (86 treated with desmopressin, 65 with placebo). In the desmopressin group 28 (34%) patients and in the placebo group two (3%) patients (P<0.001) had fewer than half the number of nocturnal voids relative to baseline; the mean number of nocturnal voids decreased from 3.0 to 1.7 and from 3.2 to 2.7, respectively, reflecting a mean decrease of 43% and 12% (P<0.001). The mean duration of the first sleep period increased by 59% (from 2.7 to 4.5 h) in the desmopressin group, compared with an increase of 21% (from 2.5 to 2.9 h) in the placebo group (P<0.001). The mean nocturnal diuresis decreased by 36% (from 1.5 to 0.9 mL/min) in the desmopressin group and by 6% (from 1.7 to 1.5 mL/min) in the placebo group (P<0.001). The mean ratio of night/24-h urine volume decreased by 23% and 1% (P<0.001), and the mean ratio of night/day urine volume decreased by 27% and increased by 3% (P<0.001) for the desmopressin and placebo groups, respectively. In the double-blind treatment period, similar numbers of patients had adverse events; 15 (17%) patients in the desmopressin and 16 (25%) patients in the placebo group. Most adverse events were mild. Serum sodium levels were <130 mmol/L in 10 (4%) patients and this occurred during dose-titration.. Orally administered desmopressin is an effective and well-tolerated treatment for nocturia in men.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Deamino Arginine Vasopressin; Double-Blind Method; Humans; Male; Middle Aged; Renal Agents; Treatment Outcome; Urination Disorders

To evaluate the decrease in nocturnal diuresis, nocturnal polyuria and the safety of oral desmopressin in elderly subjects with nocturia.. After being identified using a population-based questionnaire, subjects were included in the study if they; (i) were healthy and free from medication with possible influence on the diuresis or voiding pattern; (ii) had an increased nocturnal frequency (>/=2 nocturnal voids/night, as reported before screening); (iii) had a nocturnal urinary output of >/=0.9 mL/min; (iv) completed and responded to an initial dose-titration study. Twelve men and five women (mean age 67.7 years, sd 4.6 years) met these criteria and were treated with oral desmopressin or placebo at bedtime for 2 weeks on each medication in a randomized, double-blind, crossover design.. Subjects treated with desmopressin had a significantly reduced nocturnal diuresis of 0.59 mL/min compared with those on placebo (95% confidence interval, CI, 0.33-0.85). The 24-h diuresis was unaffected by desmopressin treatment. Patients treated with desmopressin had fewer micturitions at night than had those on placebo (1.1 and 1.7, respectively; P<0.001; mean difference=0.59; 95% CI, 0.32-0.85). The reduction in nocturnal diuresis was dependent on the baseline level of night-time diuresis (r=0.886; r2=0.785; P<0.0001) and the nocturnal part of the baseline 24 h-diuresis (r=0.708; r2=0.502; P<0.001). After desmopressin treatment was withdrawn, diuresis returned to the levels before treatment. The time from falling asleep to first awakening was improved by 1.4 h in patients treated with desmopressin. There was no change in body weight or ankle circumference during desmopressin treatment. Overall, the treatment was well tolerated and no serious adverse events were observed.. Desmopressin was effective in reducing nocturnal diuresis and nocturnal voids in polyuric elderly subjects, with no significant adverse events or inconvenience to the patient. The length of uninterrupted sleep was also improved.

Topics: Administration, Oral; Aged; Deamino Arginine Vasopressin; Double-Blind Method; Female; Humans; Male; Middle Aged; Polyuria; Renal Agents; Urination Disorders

The aim of this study was to determine the efficacy of intranasal desmopressin in the treatment of nocturnal polyuria in men with benign prostatic hyperplasia (BPH). Twelve men with BPH were treated with intranasal desmopressin at bedtime for nocturnal polyuria. All patients underwent video-urodynamic evaluation. The number of nocturia episodes was the dependent variable. Exclusion criteria included nephrolithiasis, active urinary tact infection, and history of myocardial infarction, congestive heart failure, and angina. Ten of 12 patients improved with the intranasal desmopressin therapy. Nocturia episodes decreased from a median of 3.6 +/- 0.5 episodes/night before treatment to 1.8 +/- 1.1 episodes/night 3 months after therapy (p = .01). The American Urological Association symptom index decreased from 19 +/- 6 before treatment to 12 +/- 6 after therapy (p = .02). Hyponatremia did not occur. We conclude that intranasal desmopressin is a promising therapy for nocturnal polyuria in selected BPH patients.

Topics: Administration, Intranasal; Aged; Deamino Arginine Vasopressin; Drug Administration Schedule; Follow-Up Studies; Humans; Male; Middle Aged; Pilot Projects; Prostatic Hyperplasia; Renal Agents; Treatment Outcome; Urination Disorders; Urodynamics

Twenty two patients with multiple sclerosis, complaining of frequency of day time micturition, completed a double blind crossover trial of desmopressin (DDAVP nasal spray) versus placebo. There was a significant decrease in micturition frequency in the 6 hour post-treatment period from 3.1 voids after placebo to 2.4 voids and a significant reduction in urinary volume after desmopressin. Eighty per cent of patients preferred the active treatment phase. Mean 24 hour urinary volume did not differ between active and placebo treatments and patients did not complain of increased night time frequency. Transient symptoms of hyponatraemia occurred in one patient but these resolved within 48 hours of stopping desmopressin. There were otherwise no side effects and mean serum sodium concentrations of the group remained unchanged throughout the study. The clinical indications for prescribing daytime desmopressin are discussed and the importance of patient compliance stressed.

Topics: Adolescent; Adult; Aged; Cross-Over Studies; Deamino Arginine Vasopressin; Double-Blind Method; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Patient Compliance; Renal Agents; Sodium; Treatment Outcome; Urination Disorders

Neurogenic bladder affects up to 80% of patients with multiple sclerosis (MS) and, in 50% of these patients, it is a significant cause of disability. The current management of neurogenic bladder, based on fluid restriction, anticholinergic agents, intermittent self-catheterization, and, in some cases, surgical intervention, often fails to relieve all symptoms. Furthermore, anticholinergic drugs have significant adverse effects and may be medically contraindicated. Nocturia is a particularly disabling symptom of neurogenic bladder; by disrupting sleep patterns, it aggravates the chronic fatigue of MS, imposes serious demands on caregivers, and can lead to institutionalization. To evaluate a novel approach to the symptomatic management of nocturia in patients with MS, we have conducted a trial of desmopressin acetate (1-desamino-8-D-arginine vasopressin), a synthetic analogue of antidiuretic hormone.. To evaluate the efficacy and short-term safety of desmopressin therapy in the symptomatic treatment of nocturia in patients with MS.. Seventeen patients were enrolled in a double-blind, crossover trial of desmopressin administered at bedtime. Patients with both relapsing-remitting and chronic-progressive forms of MS were admitted. Night time voiding diaries were maintained for the 6 weeks of the trial; similarly, serum electrolyte levels and plasma osmolality were measured twice weekly and urinalyses and urine cultures were performed weekly during the trial.. Desmopressin reduced the percentage of nights with nocturia in patients from 97% to 66%. The average number of episodes of nocturia per night in patients decreased from 2.35 to 1.09 and the maximum hours of sleep uninterrupted by nocturia increased from 3.74 to 5.77. These results were highly significant. Four of the 17 patients discontinued participation in the study after developing asymptomatic or minimally symptomatic hyponatremia.. Desmopressin was found effective; no tolerance and only minimal adverse effects have been observed. Our results suggest that desmopressin, either alone or in combination with other therapeutic modalities, is effective in the symptomatic management of nocturia in patients with MS. The only adverse effect attributed to desmopressin was hyponatremia, which occurred in 4 of 17 patients and appeared to be dose related.

Topics: Adult; Aged; Cross-Over Studies; Deamino Arginine Vasopressin; Double-Blind Method; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Renal Agents; Urinary Bladder, Neurogenic; Urination Disorders

To examine the safety and efficacy of desmopressin in three doses given to women with multiple sclerosis to treat nocturia with or without enuresis.. Eight women with clinically confirmed multiple sclerosis and nocturia with or without enuresis were entered as in-patients into an open, nonrandomized, placebo-controlled study of incremental doses of 20, 40 and 60 micrograms desmopressin. Urinary and serum sodium, plasma arginine vasopressin and urine osmolality were monitored every 4 h for 24 h. A single dose of placebo or desmopressin was given during each of four 24-h periods.. There was a significant decrease in nocturnal urinary volumes and a significant increase in nocturnal urinary osmolalities in patients taking desmopressin when compared with those taking a placebo, but there was no difference among the desmopressin doses. There was no significant difference in serum sodium level between the desmopressin doses. However, at the end of the 24-h period with the 60 micrograms dose, serum sodium was decreased significantly.. Neither a significant decrease in nocturnal urinary volumes nor an increase in urinary osmolality was achieved by doses of desmopressin > 20 micrograms. A dose of 60 g was associated with a decreased serum sodium level at the end of the 24-h period but there was no biochemical hyponatraemia. Because there were no benefits and a possibility of clinical hyponatraemia with higher doses, doses of > 20 micrograms desmopressin cannot be recommended.

Topics: Adult; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Female; Humans; Hyponatremia; Middle Aged; Multiple Sclerosis; Osmolar Concentration; Renal Agents; Sodium; Urination; Urination Disorders

To assess whether the synthetic vasopressin analogue desmopressin [1-desamino 8-D-arginine vasopressin] is efficacious and safe in the management of nocturia +/- enuresis in patients with multiple sclerosis.. Twenty-two women and 11 men, under 65 years of age, with clinically definite multiple sclerosis and nocturnal frequency +/- enuresis were entered into the study. A two week placebo run-in, to establish normal voiding patterns, followed by a double-blind, placebo-controlled, cross-over study of 20 micrograms intranasal desmopressin at night-time was carried out.. Desmopressin caused a significant decrease in nocturnal urinary frequency, nocturnal urinary volume and the percentage of total daily urine passed at night. There was no significant fall in plasma sodium with desmopressin although there were two cases of asymptomatic hyponatraemia.. Desmopressin is an efficacious and safe treatment for nocturia +/- enuresis in patients with multiple sclerosis.

Topics: Adult; Cross-Over Studies; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Urination Disorders

Bed wetting or nocturnal enuresis is a common problem among children. It is either monosymptomatic or may be associated with a voiding disorder. Many factors may contribute towards enuresis such as developmental delay, heredity, inappropriate nocturnal anti diuretic hormone secretion and reduced bladder capacity. Any child presenting with bed-wetting should be evaluated for any underlying bladder dysfunction before labeling as monosymptomatic enuresis. The evaluation consists of structured bowel and bladder history, detailed clinical examination, frequency volume record and appropriate investigations. The frequency volume diary is an indispensible component of evaluation and helps in establishing diagnosis and tailoring therapy. The treatment of monosymptomatic enuresis consists of positive psychological support, alarms and medication (desmopressin/ anticholinergics/ imiprammine). Children with features of underlying bladder dysfunction, anatomical anomalies and neurological disorders should be referred to a pediatrician without delay. The outcome of therapy is usually rewarding but varies, depending on the underlying etiology, motivation, compliance and family support. The cure rates with alarms are better than with desmopressin in monosymptomatic enuresis. Timely and appropriate therapy yields better outcomes. Thus, a thorough, scientific and evidence based approach is essential in children presenting with bed-wetting.

Topics: Adolescent; Algorithms; Behavior Therapy; Child; Child, Preschool; Cholinergic Antagonists; Deamino Arginine Vasopressin; Diagnosis, Differential; Female; Humans; Imipramine; Male; Nocturnal Enuresis; Referral and Consultation; Social Support; Urination Disorders

Lower urinary tract dysfunction in multiple sclerosis is common and is highly amenable to treatment. Individuals may have bladder storage and/or voiding dysfunction. The risk of progression to renal failure is low and hence lower urinary tract dysfunction should be considered medically manageable in most individuals. Evaluation begins with history taking and is supplemented by using a bladder diary. Ultrasonography is used to assess the degree of incomplete bladder emptying, and for assessing upper urinary tract damage. Incomplete bladder emptying is most often managed by clean intermittent self-catheterization and should be initiated if post-void residual urine is greater than 100 mls. Storage symptoms are most often managed using antimuscarinic medications. Other options include desmopressin or detrusor muscle injection of botulinum toxin type A. There are specific situations where specialist urology services should be involved.

Topics: Algorithms; Antidiuretic Agents; Botulinum Toxins, Type A; Community Health Nursing; Deamino Arginine Vasopressin; Humans; Multiple Sclerosis; Muscarinic Antagonists; Neuromuscular Agents; Nursing Assessment; Referral and Consultation; Risk Factors; Self Care; Urinary Bladder, Overactive; Urinary Catheterization; Urinary Tract Infections; Urination Disorders; Urodynamics

To explore the incidence, severity, time course, and risk factors of clinically significant hyponatremia in desmopressin treatment for nocturia.. Data from three multi-center phase III trials were pooled. Hyponatremia was categorised as borderline (134-130 mmol/L) or significant (<130 mmol/L). Risk factors were explored with logistic regression and subgroup analysis performed to explore threshold values for contra-indication.. In total 632 patients (344 men, 288 women) were analyzed. During dose-titration, serum sodium concentration below normal range was recorded in 95 patients (15%) and 31 patients (4.9%) experienced significant hyponatremia. The risk increased with age, lower serum sodium concentration at baseline, higher basal 24-hr urine volume per bodyweight and weight gain at time of minimum serum sodium concentration. Age was the best single predictor. Elderly patients (>or=65 years of age) with a baseline serum sodium concentration below normal range were at high risk (75%). Limiting treatment in elderly with normal basal serum sodium concentration to those below 79 years and with a 24-hr urine output below 28 ml/kg would reduce the risk from 8.1% to 3.0% at the cost of 34% fulfilling the contra-indication.. The majority of nocturia patients tolerate desmopressin treatment without clinically significant hyponatremia. However, the risk increases with increasing age and decreasing baseline serum sodium concentration. Treatment of nocturia in elderly patients with desmopressin should only be undertaken together with careful monitoring of the serum sodium concentration. Patients with a baseline serum sodium concentration below normal range should not be treated.

Topics: Adult; Aged; Databases, Factual; Deamino Arginine Vasopressin; Female; Humans; Hyponatremia; Logistic Models; Male; Middle Aged; Randomized Controlled Trials as Topic; Renal Agents; Risk Factors; Sodium; Urination Disorders

Nocturia is a common bothersome condition. An ad hoc group of interested clinicians from a variety of backgrounds has developed draft guidelines for the assessment and management of this condition in primary care in New Zealand. The guidelines propose four steps in the assessment and management: clinical evaluation; simple investigations; assignment of a provisional diagnosis; and management based on the provisional diagnosis. For nocturnal polyuria-associated nocturia, the draft guidelines recommend that: lifestyle measures should be used as part of the management; if a patient complaining of nocturia has other features of overactive bladder, then bladder retraining and/or anticholinergics can be used; hypnosedatives should not be used to treat nocturia in older adults because of the increased risk of falls; loop diuretics given in the afternoon should be considered for the treatment; and desmopressin can be considered in the management of nocturnal polyuria associated nocturia but that it should be used cautiously in people aged over 65 because of the risk of hyponatraemia. A draft algorithm based on international guidelines is presented.

Topics: Adolescent; Adult; Aged; Aging; Antidiuretic Agents; Deamino Arginine Vasopressin; Diuretics; Female; Humans; Male; Middle Aged; Muscarinic Antagonists; New Zealand; Polyuria; Primary Health Care; Urinary Bladder Diseases; Urinary Incontinence; Urination Disorders

Topics: Aged; Deamino Arginine Vasopressin; Humans; Male; Prostatic Hyperplasia; Renal Agents; Urination; Urination Disorders

Lately, desmopressin (dDAVP) administered orally has been demonstrated to be an effective alternative in the management of nocturia in adults. Although the safety profile of dDAVP is well known, much of the experience originates from studies in enuretic children and younger adults, and it may not be readily extrapolated to elderly patients. In order to identify factors associated with an increased risk of hyponatremia in elderly patients treated with dDAVP for nocturia, we analysed spontaneous reports accrued from clinical practice in Denmark and Sweden.. Following a selection procedure, the study base comprised 15 case reports. From the included reports, information was sought on concurrent diseases, concomitant medications and other factors that may predispose elderly patients to hyponatremia when treated with desmopressin.. The median age amongst the cases was 81 years (range 61-93 years) and 80% were females. For seven of the patients, the hyponatremia occurred during the first 3 weeks of treatment. The symptoms presented by the patients led to hospitalisation in all but one case. Among patients with information available on concomitant medication, half of them were treated with cyclooxygenase inhibitors. An excessive fluid intake could only be ascertained in one case; all 15 patients eventually recovered.. In elderly patients treated with dDAVP for nocturia, an increased risk of hyponatremia exists in the first weeks of treatment. Compared with younger subjects, risk factors other than excessive intake of fluid appear to contribute to this adverse drug reaction.

Topics: Age Factors; Aged; Aged, 80 and over; Deamino Arginine Vasopressin; Denmark; Female; Humans; Hyponatremia; Incidence; Male; Middle Aged; Renal Agents; Retrospective Studies; Risk Factors; Sweden; Time Factors; Urination Disorders

The present study aims to evaluate the effect of desmopressin treatment on urine output, density and glomerular filtration rate (GFR) in patients with posterior urethral valve (PUV) and the factors affecting the response to this treatment.. A total of 68 PUV patients who were followed-up after valve ablation were examined with the fluid intake, urine output and GFR. Sixteen patients who were polyuric (a urine output more than 30 ml/kg/day) and had hypoosmolar urine (urinary density of 1015 or lower) included in the study. Blood chemistry and serum ADH level were studied. Following 5 days of observation, patients were given DDAVP perorally with a dosage of 0.4 mg/day, two equal doses per day. After 7 days and after a 3 month period of treatment, voiding characteristics, day-time and night-time urine densities and also GFR have been re-evaluated.. The mean age was 6.8 years (range 2 to 11 years). The mean age at valve ablation was 20.7 months (range 5 months to 6 years). The mean daily urine output during first week and at the third month of the treatment had decreased significantly (p=0.004 and p=0.006). There was increase in night-time and day-time urine density in 10 patients (62%) and in 13 patients (81%) respectively at the third month evaluation. Increments in urine density were statistically significant for the third month evaluation. Nine (56%) patients had ADH levels within normal (<7 pcg/ml) levels and 7 patients had higher levels. There was no statistically significant difference between pretreatment and posttreatment micturation characteristics. However patients with voiding dysfunction responded better to DDAVP treatment.. Desmopressin treatment improves polyuria in PUV patients. The responses are better particularly in PUV patients with significant bladder dysfunction. This supports the harmful role of polyuria on bladder dysfunction. The DDAVP treatment improves the day-time and night-time in PUV patients. Combination of DDAVP treatment with overnight catheterization may be a good alternative that needs to be evaluated by further prospective randomized studies.

Topics: Antidiuretic Agents; Child; Child, Preschool; Deamino Arginine Vasopressin; Follow-Up Studies; Glomerular Filtration Rate; Humans; Infant; Male; Polyuria; Urination Disorders; Urine; Urodynamics; Vasopressins

A 30-year-old man known to have a factor-IX deficiency was presented at the emergency department with unexplained coma. After immediate treatment with factor IX, a CT-scan of the brain revealed no intracerebral haemorrhage. However, blood tests showed severe hyponatraemia, low serum osmolarity and high urine-sodium excretion consistent with the Syndrome of Inappropriate Antiduretic Hormone Secretion (SIADH). Therapy with hypertonic saline was instituted resulting in a gradual rise in the serum-sodium concentration. The cause of the hyponatraemia however remained unclear. After repeat history taking the patient mentioned the use of desmopressin for nocturia. Hyponatraemia as a complication of desmopressin use occurs in 8% of adult patients treated for nocturia. Direct availability of a patient's drug history, by means of an electronic record for instance, could avoid unnecessary tests and delay in diagnosis.

Topics: Adult; Coma; Deamino Arginine Vasopressin; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Saline Solution, Hypertonic; Urination Disorders

To evaluate the effect of desmopressin on nocturia, based on patients' subjective scoring of nocturia, as desmopressin is widely used to treat nocturnal enuresis and nocturnal polyuria.. We investigated a specific subgroup of 28 men with benign prostate obstruction and nocturia who were treated with desmopressin. Patients with nocturnal polyuria were excluded. All the patients were refractory to treatment with antimuscarinics or anticholinergics, e.g. oxybutynin, tolterodine, and propantheline bromide. We assessed the effect of desmopressin using a quantitative nocturia score and analysed its synergistic effect with alpha-blockers.. The mean frequency of nocturia was 6.1 before desmopressin and most (86%) patients had an improvement in nocturia within 1-12 weeks of treatment with desmopressin. There was a 43% reduction in nocturia after using desmopressin (P < 0.001). The correlation coefficient between the number of nocturnal voids and the reduction in nocturia after treatment with desmopressin was 0.756, indicating that the more severe the nocturia, the more effective was desmopressin.. Desmopressin is effective for refractory nocturia in elderly men with no nocturnal polyuria, and has limited side-effects.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Antidiuretic Agents; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Humans; Male; Middle Aged; Prostatic Hyperplasia; Regression Analysis; Treatment Outcome; Urination Disorders

Topics: Aged; Deamino Arginine Vasopressin; Female; Humans; Middle Aged; Renal Agents; Urination Disorders

Topics: Adult; Age Factors; Aged; Deamino Arginine Vasopressin; Female; Humans; Male; Middle Aged; Renal Agents; Risk Factors; Time Factors; Urination Disorders

Topics: Adult; Age Factors; Deamino Arginine Vasopressin; Female; Humans; Male; Patient Satisfaction; Placebos; Randomized Controlled Trials as Topic; Renal Agents; Sex Factors; Sleep; Time Factors; Urination Disorders

To investigate the short-term safety of desmopressin in elderly patients with nocturia, with special focus on the risk of hyponatraemia, and to assess the short-term effects on urine output, sleep and voiding patterns.. Patients (72) were recruited from a study using frequency-volume charts, which in turn was preceded by a questionnaire study. Each patient took one 0.2 mg desmopressin tablet at bedtime for three consecutive nights and kept a frequency-volume chart. Serum sodium was assessed in the morning after the first and the third dose. Patients with a mean serum sodium level during treatment deviating more than five units from baseline were considered sensitive to change in serum sodium. Potential predictors for sodium sensitivity and response were investigated with logistic and multiple regression.. All 72 enrolled patients completed the trial; no serious adverse events occurred and no adverse events of severe intensity were recorded. Six patients were sensitive to change in serum sodium. The risk (odds ratio, 95% confidence interval) increased with increasing age (1.3, 1.1-1.6), concomitant cardiac disease (10.0, 0.9-105.8) and increasing baseline 24-h urine output (1.2, 1.0-1.5). Patients sensitive to change in serum sodium were pharmacological responders and desmopressin had a greater effect on their 24-h diuresis, indicating that the drug effect was not limited to the night only.. Desmopressin was well tolerated in elderly patients with nocturia, but the results suggest that serum sodium should be measured before and after a few days of treatment.

Topics: Aged; Aged, 80 and over; Deamino Arginine Vasopressin; Female; Humans; Hyponatremia; Male; Regression Analysis; Renal Agents; Sleep; Sodium; Urination; Urination Disorders

To clarify whether combination treatment with desmopressin (DDAVP) and thiazide was clinically effective in a patient with congenital nephrogenic diabetes insipidus (CNDI), we evaluated the treatment in a 7-year-old boy with CNDI who had demonstrated a partial response to DDAVP.. Both volume of urine and the presence of nocturia were determined during treatment.. Neither the usual therapy of a low-salt diet and a thiazide nor intranasal therapy with a large dose of DDAVP was effective. However, combination treatment resulted in a decrease in urinary volume and the disappearance of nocturia.. DDAVP coupled with thiazide may be useful for CNDI in patients who have shown a partial response to DDAVP.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus, Nephrogenic; Diuresis; Diuretics; Drug Therapy, Combination; Humans; Infant; Male; Renal Agents; Sodium Chloride Symporter Inhibitors; Treatment Outcome; Trichlormethiazide; Urination Disorders

Topics: Arousal; Child; Deamino Arginine Vasopressin; Diabetes Insipidus, Nephrogenic; Enuresis; Humans; Male; Renal Agents; Urination Disorders

To evaluate the efficacy of desmopressin treatment in patients 65 years old and older with nocturia and to determine whether baseline urodynamic characteristics influenced the outcome of treatment.. Patients with nocturia three or more times a night and nocturnal polyuria refractory to medication were treated with oral desmopressin 0.1 mg at bedtime for 4 weeks. Data from urodynamic studies and a voiding diary, nocturnal urine volume, urine specific gravity, serum sodium and potassium level, and quality of life index were measured at baseline, 4 weeks, and 4 weeks after discontinuation of treatment.. A total of 30 patients (25 men and 5 women) were enrolled in the study. The mean age was 75.4 +/- 6.6 years. Five patients (16.7%) reported side effects, including hyponatremia in one. Twenty patients (66.7%) reported a good response with both reduced nocturnal frequency (5.2 +/- 1.16 times versus 2.24 +/- 1.12 times a night, P = 0.000) and urine volume (955.6 +/- 255.9 mL versus 522.8 +/- 210.5 mL, P <0.0001). Two patients (6.7%) had improved nocturnal frequency, and 3 patients (10%) reported no effect at all. After discontinuing the medication for 4 weeks, 13 patients (52%) had improved symptoms compared with baseline and 6 (24%) remained at their post-treatment frequency of nocturia. Urodynamic studies revealed that 15 patients had detrusor instability and 17 had a cystometric capacity of 250 mL or less. No significant difference was found in the success rate relative to the urodynamic results.. Desmopressin is safe and effective in the treatment of severe nocturia in patients 65 years old and older.

Topics: Administration, Oral; Aged; Aged, 80 and over; Deamino Arginine Vasopressin; Drug Administration Schedule; Female; Humans; Male; Prospective Studies; Renal Agents; Urination Disorders

Topics: Deamino Arginine Vasopressin; Humans; Male; Polyuria; Renal Agents; Urination Disorders

Early morning urine osmolality was tested in two urinary specimens, one taken immediately upon awakening and the other approximately 30 min thereafter, in 52 enuretic and 15 non-enuretic children. In a follow-up study, using the same study population, urine osmolality and volume were measured sequentially at 3-h intervals at 19.00, 22.00, 01.00, 04.00 and 07.00 h. Thereafter, all enuretics were treated by intranasal DDAVP for a 6-month period. There were no differences in urinary osmolality between enuretic and non-enuretic children when comparing the two early morning specimens. Nor were there any differences between groups in urine osmolalities at 19.00, 01.00 and 07.00 h. In contrast, at 04.00 h, urine osmolality was significantly lower in 17 of 52 enuretics [designated as ADH-negative (ADH-)] compared to the remaining enuretics [designated as ADH-positive (ADH+)] and non-enuretic children (610 +/- 251 vs 995 +/- 195 and 1089 +/- 195 mosmol/kg H2O, respectively, p < 0.05). This decreased osmolality was paralleled by an increase in urine production during the time period 01.00-04.00 (83 +/- 24 vs 52 +/- 18 and 45 +/- 22 ml, respectively, p < 0.05). At the end of the 6-month period of DDAVP treatment, the percentage response was similar between the ADH- and ADH+ enuretics (79% vs 75%). However, the time taken to achieve a response was quicker in the ADH- subjects. These data suggest the existence of a subgroup of enuretics whose underlying pathophysiology is the development of nocturnal polyuria probably due to a relative night-time ADH deficiency. Nocturnal sequential monitoring of urinary osmolality, as described above, allows identification of this subgroup.

Topics: Child; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Osmolar Concentration; Polyuria; Renal Agents; Time Factors; Urination Disorders; Urine; Vasopressins

Evaluating in patients with benign prostatic hyperplasia (BPH), the effects of a synthetic analog of vasopressin (Desmopressin) in the nycturia.. 20 patients with BPH, with a mean age of 68 years that they referred marked nycturia of 4 to 10 voiding episodes in the night, they were subject treatment with Desmopressin 20 mcg given intranasally before bedtime.. The nycturia diminishes in the patient, the volume of evacuated urine diminishes but in the night that in the day. They were not observed side effects.. The desmopressin is an alternative but in the aid to the patient with BPH that they presented a marked nycturia.

Topics: Aged; Aged, 80 and over; Deamino Arginine Vasopressin; Drug Evaluation; Humans; Male; Middle Aged; Prostatic Hyperplasia; Time Factors; Urination Disorders; Urodynamics

Topics: Aged; Aging; Animals; Chronotherapy; Circadian Rhythm; Deamino Arginine Vasopressin; Humans; Mammals; Middle Aged; Renal Agents; Urination Disorders

The benefit of desmopressin (DDAVP) in the treatment of the urinary symptoms of multiple sclerosis has until now only been shown in short crossover studies of up to 6 weeks. We report 19 patients who have used the drug for an average of 2 years and 4 months, 18 of whom confirmed continued dramatic benefit without any obvious change in dosage used or efficacy and with few side effects. Ten of the 19 patients had also used DDAVP during daytime for special occasions with notable success. This is the first study to suggest that DDAVP is safe and effective in long term use in MS.

Topics: Adult; Aged; Deamino Arginine Vasopressin; Female; Follow-Up Studies; Humans; Male; Medical Records; Middle Aged; Multiple Sclerosis; Renal Agents; Retrospective Studies; Time Factors; Urination Disorders

Topics: Administration, Intranasal; Aged; Deamino Arginine Vasopressin; Humans; Male; Urination Disorders

Voiding problems, and in particular nocturnal enuresis, can usually be evaluated and managed without resorting to complex procedures or invasive tests. A good history with attention to toilet habits and the possible presence of infection can help distinguish patients who may have significant organic pathologic conditions who require further investigation. Wetting alarms are effective with a low recidivism rate but are noisy. DDAVP is effective, works rapidly, and is discrete but has a higher recidivism rate. Treatment is aimed at correcting any poor toilet habits and using the appropriate alarm device or medication.

Topics: Behavior Therapy; Child; Deamino Arginine Vasopressin; Enuresis; Humans; Renal Agents; Urinary Bladder, Neurogenic; Urinary Tract Infections; Urination Disorders; Urodynamics

Topics: Aged; Aging; Circadian Rhythm; Deamino Arginine Vasopressin; Humans; Male; Prostatic Hyperplasia; Renal Agents; Urination Disorders; Vasopressins

Topics: Adult; Clozapine; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Mandelic Acids; Parasympatholytics; Prevalence; Psychotic Disorders; Urination Disorders

The mechanism of increased nocturnal urine production in adult patients complaining of nocturia has seldom been reported. The objective of this clinical study is to investigate the circadian rhythm of both urine production and plasma arginine-vasopressin (AVP) level, and the efficacy of intranasal instillation of 1-deamino-8-D-arginine-vasopressin (DDAVP) in adult patients complaining of nocturia. Eight patients (seven men, one woman) who ranged in age from 44 to 77 years (mean 64.1 years) were examined. Three of them suffered from Shy-Drager syndrome, and no patient had shown any improvement of symptoms in spite of administration of anti-cholinergic agents and restriction of water intake. Nocturnal urine volume was more than bladder capacity in all patients, and no patient showed normal elevation of nocturnal plasma AVP level. Intranasal administration of DDAVP of 5 or 10 micrograms revealed marked decrease in nocturia, and nocturnal urine volume (p < 0.01). There were mild side effects (headache, nasal obstruction, and hyponatremia) not requiring any treatment. In conclusion, DDAVP is a safe and effective treatment for adult patients complaining of nocturia due to hyperproduction of nocturnal urine and inappropriate nocturnal secretion of AVP.

Topics: Administration, Intranasal; Adult; Aged; Arginine Vasopressin; Circadian Rhythm; Deamino Arginine Vasopressin; Female; Humans; Male; Middle Aged; Shy-Drager Syndrome; Urination Disorders

This study describes changes in diuresis during a two-month treatment with 40 micrograms desmopressin (Minirin) in a group of elderly persons with increased nocturnal diuresis and decreased ADH secretion. The average age of the men (n = 7) was 72 +/- 4 years and of the women (n = 14) 73 +/- 6 years. Nocturnal diuresis decreased after one and two months by 21% and 20% in the men and by 36% and 34% in the women, respectively. Half of the change persisted among the women but not among the men one month after the treatment. The decrease in nocturnal diuresis was greatest among those who, before the treatment, had a large part of their diuresis during the night. Diuresis during the day changed only insignificantly. Body weight did not change during treatment, nor did blood pressure, osmolality, sodium or potassium in serum. Sleep improved during treatment. In one case, side-effects were observed, with a feeling of swelling in the body and decreased diuresis in the morning.

Topics: Administration, Intranasal; Aged; Atrial Natriuretic Factor; Circadian Rhythm; Deamino Arginine Vasopressin; Diuresis; Female; Humans; Long-Term Care; Male; Urination Disorders; Vasopressins

Enuresis affects 5 to 10% of primary-school age children. Nocturnal enuresis, or bedwetting, is often familial and boys are mainly concerned; daytime micturitions are normal, without urine loss or urinary tract infection. Hygienic rules associated with desmopressin or, in some cases, tricyclic antidepressant agents, alarm procedures or psychotherapy, result in a 70% success rate after 1 year. Bladder instability consists of diurnal and nocturnal disturbances, mainly in girls with recurrent urinary tract infections; affected children experience pollakiuria, urine loss and voiding emergencies. Urodynamic assessment of daytime enuresis is of major interest, mainly when dysuria is present. The treatment of non complicated bladder instability needs reeducation, i.e. biofeedback and/or administration of oxybutynin chlorhydrate.

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Parasympatholytics; Surveys and Questionnaires; Urination Disorders; Urodynamics

Sixteen women with multiple sclerosis who complained of nocturia completed a double-blind cross-over trial of Desmopressin (DDAVP) and placebo. Nocturia was reduced from a mean of 2.55 voids to 2.01 with placebo and to 1.28 with Desmopressin (p less than 0.01, for the difference between placebo and Desmopressin). Side effects were minor, and equally distributed between treatment and placebo.

Topics: Arginine Vasopressin; Deamino Arginine Vasopressin; Double-Blind Method; Female; Humans; Multiple Sclerosis; Urination Disorders

A double-blind study of nocturia due to benign prostatic hypertrophy is reported. The 21 patients received 0.2 ml of an antidiuretic hormone analogue, desamino-D-arginine vasopressin (Minirin) intranasally prior to evening bedtime. Though the frequency of nocturnal micturition fell in 13 patients, only 7 were considered to give a good clinical response. This drug can be tried in patients with benign prostatic hypertrophy if nocturia is distressing and the patient is unsuitable or disinclined for surgery.

Topics: Administration, Intranasal; Deamino Arginine Vasopressin; Double-Blind Method; Humans; Male; Middle Aged; Prostatic Hyperplasia; Urination Disorders