title: Efficacy of adding behavioural treatment or antimuscarinic drug therapy to α-blocker therapy in men with nocturia.
abstract: 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.
  
  
  OBJECTIVE
  To compare reductions in nocturia resulting from adding either behavioural treatment or antimuscarinic drug therapy to α-adrenergic antagonist (α-blocker) therapy in men.
  
  
  METHODS
  Participants 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.
  
  
  RESULTS
  A 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).
  
  
  CONCLUSIONS
  Both 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.
authors: Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Atlanta, GA 30033, USA. Ted.Johnson@va.gov
authors: Theodore M
authors: TM
authors: Johnson
authors: Alayne D
authors: AD
authors: Markland
authors: Patricia S
authors: PS
authors: Goode
authors: Camille P
authors: CP
authors: Vaughan
authors: Janet L
authors: JL
authors: Colli
authors: Joseph G
authors: JG
authors: Ouslander
authors: David T
authors: DT
authors: Redden
authors: Gerald
authors: G
authors: McGwin
authors: Kathryn L
authors: KL
authors: Burgio
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001521:Behavior Therapy / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D008333:Mandelic Acids / Q000008:administration & dosage; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D053158:Nocturia / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D014563:Urodynamics
chemical_list: D000317:Adrenergic alpha-Antagonists; D008333:Mandelic Acids; D018727:Muscarinic Antagonists; C005419:oxybutynin