Desmopressin for the treatment of female storage lower urinary tract symptoms

Abstract

Female storage lower urinary tract symptoms are prevalent and bothersome. They are usually attributed to an overactive bladder and treated with antimuscarinics. Nevertheless, failure of conventional treatment to alleviate nocturia in particular and epidemiological data suggesting that nocturnal polyuria is the only or a contributing factor to nocturia, has attracted interest in decreasing nighttime urine production as a method of managing nocturia. A reduction in urine production could also, at least temporarily, delay daytime storage symptoms by delaying bladder filling. Therefore, desmopressin, the synthetic analogue or naturally occurring antidiuretic hormone, could have a role in the management of female frequency, urgency and urgency incontinence. This work aims to review data on the use of desmopressin in females with storage symptoms. Available evidence indicates that desmopressin is efficacious in reducing nighttime urine production and episodes of nocturia, resulting in fewer sleep interruptions. This translates into improved quality of life. Desmopressin is also effective in postponing micturition, urgency and incontinence for several hours after being taken on demand. The tolerability profile of desmopressin is good and significantly improved compared to historical figures due to the introduction of new oral formulations, tailoring the dose according to gender and age and adhering to instructions for fluid restriction before administration. The incidence of hyponatremia, desmopressin’s most important side-effect, is less than 3% in recent trials. The efficacy of desmopressin, combined with its improved safety profile, makes it an interesting method for treating female storage lower urinary tract symptoms.

Keywords: Lower urinary tract symptoms, Storage, Nocturia, Overactive bladder, Desmopressin, Female, Nocturnal polyuria

Core tip: Recent data suggest that desmopressin in its oral formulations offers significant improvements in nocturia as well as daytime storage symptoms in female patients. The treatment rationale for nocturia is that nocturnal polyuria due to inadequate antidiuresis is a major contributing factor to nocturia. In the case of daytime storage symptoms, desmopressin taken on demand can postpone their manifestation by delaying bladder filling. Desmopressin is well tolerated and the risk of hyponatremia is low with appropriate dosing, based on a lower minimum effective dose in females compared to males.