Efficacy of adding behavioural treatment or antimuscarinic drug therapy to α-blocker therapy in men with nocturia

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What's known on the subject? and What does the study add?Nocturia is a common and bothersome lower urinary tract symptom, particularly in men. Many single drug therapies have limited benefit.For men who have persistent nocturia despite alpha-blocker therapy, the addition of behavioural and exercise therapy is statistically superior to anticholinergic therapy.ObjectiveTo compare reductions in nocturia resulting from adding either behavioural treatment or antimuscarinic drug therapy to α-adrenergic antagonist (α-blocker) therapy in men.Patients and MethodsParticipants were men who had continuing urinary frequency >8 voids/day) and urgency after 4 weeks of α-blocker therapy run-in and who had ≥1 nightly episode of nocturia.Participants received individually titrated drug therapy (extended-release oxybutynin) or multicomponent behavioural treatment (pelvic floor muscle training, delayed voiding and urge suppression techniques).Seven-day bladder diaries were used to calculate reductions in mean nocturia.ResultsA total of 127 men aged 42–88 years with ≥1 nocturia episode per night were included in the study.There were 76 men who had a mean of ≥2 nocturia episodes.Among those with ≥1 nocturia episode, behavioural treatment reduced nightly nocturia by a mean of 0.97 episodes and was significantly more effective than drug therapy (mean reduction = 0.56 episodes; P = 0.01).Participants with ≥2 episodes nocturia at baseline also showed larger changes with behavioural treatment compared with antimuscarinic therapy (mean reduction = 1.26 vs 0.61; P = 0.008).ConclusionsBoth behavioural treatment and drug therapy reduced nocturia in men with ≥1 episode of nocturia/night when added to α-blocker therapy.These results were similar even when only those with ≥2 episodes of nocturia were considered.The addition of behavioural treatment was statistically better than bladder-relaxant therapy for nocturia.

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