Male patients with a higher frequency of nocturnal urinary episodes are more likely to benefit from alpha-blocker therapy for bothersome nocturia.

This retrospective study investigated the therapeutic effects of alpha-blockers on men with lower urinary tract symptoms (LUTS) to identify baseline variables that may predict therapeutic response in terms of nocturia improvement.

The study included 348 men with LUTS, including bothersome nocturia, treated with tamsulosin 0.4 mg at bedtime (h.s.) for 3 months. Responders were defined as patients with a decrease of ≥1 nocturia episodes/night after alpha-blocker therapy. Nocturnal urinary frequency, International Prostate Symptom Score (IPSS) voiding and storage scores, as well as the voiding to storage (V/S) ratio, prostate measurements, uroflowmetry, and post-void residual were determined at baseline and 1 and 3 months after alpha-blocker therapy.

The overall response rate was 44.8% (156/348). Nocturia improved in 60 patients (17.2%) reporting a reduction of ≥2 episodes/night and in 96 patients (27.6%) reporting a reduction of 1 episode/night. Total and storage IPSS scores, the IPSS V/S ratio and the number nocturia episodes were higher in responders than non-responders. IPSS storage subscores and nocturia episodes were significantly greater, whereas IPSS V/S ratio and maximum flow rate (Qmax ) were lower, in those with a reduction of ≥2 versus 1 episode/night. Multivariate analysis revealed that nocturia episodes and a lower V/S ratio were predictors of responders with an improvement of ≥2 episodes/night. The quality of life index improved significantly more in responders than non-responders.

Tamsulosin treatment (0.4 mg, h.s.) for 3 months not only improved voiding and storage symptoms, but also reduced nocturia episodes. Patients with more nocturia episodes may benefit more from alpha-blocker treatment in terms of reducing the number of nocturia episodes.

Lower urinary tract symptoms. 2018 Dec 12 [Epub ahead of print]

Cheng-Ling Lee, Hann-Chorng Kuo

Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.