Nocturia is a common condition in the older population and its prevalence increases with age. Although the aetiology of nocturia may be multifactorial, a main cause in older men is benign prostatic hyperplasia/ bladder outlet obstruction (BPH/BOO). Impaired quality of sleep (S-QoL) associated with nocturia affects day time activity and quality of life (QoL) for both the men and their spouses. Waking up at night for voiding is also associated with a highly increased risk for falls and fractures in the elderly. Men with severe nocturia (> 3 voids per night) suffer even increased mortality rates (1).
   Most of the drugs for management of lower urinary tract symptoms of Benign Prostatic hyperplasia (LUTS/BPH) are focused on control of voiding symptoms and flow rate. Although nocturia is an important storage symptom, it is considered as associated condition, and thus treated with medications for LUTS or Over-active bladder (OAB), as alpha blockers and antimuscarinics. Unfortunately the response seems to be unsatisfactory (2).
  Desmopressin has been proven to be an effective treatment for nocturia for years. Desmopressin is a synthetic antidiuretic hormone analogue. It is currently approved for treatment of nocturnal polyuria (3).

    The aim of the present work is to study the efficacy and safety of desmopressin acetate add on alpha-blocker in improvement of quality of life (QoL) and quality of sleep (S-QoL) in treatment of refractory nocturia in men complaining of Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia

Thirty men aging from 53 to 72 years with the mean of 61.27 ± 6.25 years were enrolled in the present study. These men were complaining of refractory nocturia despite of receiving medical therapy for lower urinary tract symptoms of benign prostatic hyperplasia more than one month. Cases with diabetes mellites diabetes insipidus congestive heart failure, renal or hepatic insufficiency, as well as, cases on diuretics were excluded from the study. All cases were subjected to full clinical evaluation, International Prostatic Symptom Score (IPSS), renal function tests, serum electrolytes, as well as routine radiological work up. Oral Desmopressin (0.1 mg) was added to alpha-blocker (tamsulucin 0.4 mg) at bed time for three months. Monitoring of all cases was carried out with monthly IPSS, renal function tests, serum electrolytes, as well as, PSA.
    Evaluation of quality of life and quality of sleep was carried out using Quality of life (QoL) and sleep quality of life (S-QoL) the questionnaires (3).

Among the thirty men of the present series, the number of nocturnal voids decreased significantly (p < 0.001) from 4.63 ± 2.41 to 1.83 ± 0.75 after three months. IPSS decreased statistically significant (p < 0.001) from 13.97 ±     3.85 to 8.77 ± 2.70 after three months of Desmopressin add on. Moreover, Q-max improved insignificantly (p = 1.00) after three months of combination therapy, where it increased from 16.17 ±  2.45 to 17.40 ± 2.11. 
  In the present study, we reported highly significantly improvement of men's quality of life with add on desmopressin after three months follow up. Sleep/energy domain improved statistically significantly (p < 0.0003) from 64.91 ± 8.6 to 77.4 ± 11.7. Bother/concern domain, improved statistically (p < 0.0001) from 60.6 ± 21.5 to 79.1 ± 15.2. Furthermore, Sleep quality of life index (SQI) improved significantly (p < 0.002) from 9.2 ± 2.5 to 7.2 ± 3.2 after three months of follow up.
 On the other hand, serum sodium monitoring showed insignificantly change from144 ± 3.7 to 137 ± 2.5. Also, serum potassium monitoring showed no significant change after three months of desmopressin therapy (from 4.30 ± 0.6 to 3.9 ± 0.30). As regards PSA monitoring, it showed no significant change during the study period.

There is reported improvement of LUTS, in the form of improved IPSS, improved flow rate (Q-max), as well as significantly improvement of nocturia with adding oral desmopressin. The control of nocturia with desmopressin therapy reflected in improvement of sleep quality of life (S-QoL) and quality of life (QoL). No adverse effects were reported with oral desmopressin

Desmopressin administration seems to control nocturnal frequency leading to improving sleep pattern and quality of life with accepted safety

Abraham L, Hareendran A, Mills IW, Martin ML, Abrams P, Drake MJ, McDonagh RP and Noble JG: Development and validation of a quality of life measure for men with nocturia. Urology 2004: (63): 481-85
Kastler EC and Davidson K: Evaluation of quality of life and quality of sleep in daily practice. Eur Urol suppl 2007: (6): 276-84
Wang CJ, Lin YN, Huang SW et al: Low dose oral Desmopressin for nocturnal polyuria in patients with benign prostatic hyperplasia: a double blind placebo controlled randomized study. J Urol 2011; 185: 219-21