Professional Documents
Culture Documents
2008,
,
www.rjptonline.org
ISSN 0974-3618
REVIEW ARTICLE
ABSTRACT:
Nocturia, is the most troublesome lower urinary tract symptoms Nocturia affects the patients by various ways with respect
to quality of life, sleep patterns and increased mortality. Overproduction of urine at night time is the main cause of
Nocturia because of the decreased secretion of anti-diuretic hormone (arginine vasopressin) also called (AVP).various
treatment available for the treatment of nocturia such as anticholinergics and vasopressin analogues. Desmopressin is a
synthetic replacement for anti-diuretic hormone, the hormone that reduces urine production during sleep. It may be taken
nasally, intravenously or as a pill.
KEY WORDS : Nocturia, Overproduction of urine at night
INTRODUCTION:
Nocturia, defined as awaking to void during the night1,
is the most troublesome lower urinary tract symptoms
(LUTS) 2, 3. The incidence increases with age.4 It has
been shown to rise from 30% to 60% in a population
with mean age of 49 years to 60% to 90% in a
population aged 60 to 80 years.5 In woman these
symptoms are often considered to result from aging,
childbirth or just being a woman6. Nocturia affects
the patients by various ways with respect to quality of
life, sleep patterns, and increased mortality 7.
Pathological categories
There are three categories for nocturia i.e. nocturnal
poly uria, low nocturnal bladder capacity or a
combination of nocturnal polyuria and low functional
bladder capacity. Overproduction of urine at night time
is the main cause of nocturia.because of the decreased
secretion
of
antidiuretic
hormone
(arginine
vasopressin) also called (AVP) 8,9.
Nocturia is not a trivial complaint and can affect
several aspects of a patients state of health. Even
rising once-nightly to void is bothersome for many
people. The standardization committee of the
international continence society (ICS) is currently
developing a world wide definition of nocturia and
comprehensive framework to improve the diagnosis
and treatment of this condition.
Received on 12.11.2008
Accepted on 15.12.2008
Modified on 10.12.2008
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M echanis m of Nocturia
Although in many cases nocturia may be caused by
bladder dysfunction (for example inflammation or
prostatic obstruction) or sleep apnea,18 simple
overproduction of urine during the night is another
common etiology.6 There are three broad categories of
pathophysiology which account for nocturia, which
refer to as noctural polyuria, low noctural bladder
capacity and mixed nocturia (a combination of noctural
polyuria and noctural bladder capacity). These
categories are generated through interpretation of a
single 24- hour voiding diary in which each voided
volume is tabulated with corresponding time as to
whether voiding was within hours awake or asleep.
Polyuria defined as 24-hour urine output greater than
2,500 ml19 may cause nocturia through generally
increased urine production when noctural urine output
exceeds functional bladder capacity as it is does with
noctural polyuria. However, polyuria and nocturnal
polyuria are not mutually inclusive.
Nocturnal polyuria
The nocturnal polyuria syndrome was defined by
asplund as increased urine output during the night.
However, in contrast to diabetes insipidus (when intake
and output are increased), 24-hour urine production
remains normal ,indicating a variation in normal
Anti-cholinergics
Drugs in this category act by blocking the parasympathetic
nerves that control voiding or by exerting a direct
spasmolytic effect on the detrucer muscle of the bladder.
Thus, they target bladder dysfunction rather than imbalance
between nocturnal urine production and bladder capacity.
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Oxybutynin
Oxybutynin is used for the treatment of urinary
frequency, urgency and incontinence, characteristics
features of overactive or irritable bladder. It is
associated with a high incidence of unpleasant side
effects and the dosage needs to be carefully assessed,
particularly in the elderly. Tolterodine- tolterodine is a
bladder- selective agent with similar activity to
oxybutynin. It is equally effective, but better tolerated,
thanoxybutynin in the treatment of overactive bladder.
Tricyclic antidepressants
The mode of action of TCAS in the treatment of
nocturia is unclear due to narrow therapeutic window
and their toxicity following overdose.
Flavoxate hydrochloride
It is a smooth muscle relaxant with antimuscarinic
effects. It is used for symptomatic relief of pain and
urinary frequency associated with inflammatory
disorders of the urinary tract.
Desmopressin
It is a synthetic replacement for anti-diuretic hormone,
the hormone that reduces urine production during
sleep. It may be taken nasally, intravenously, or as a
pill. Doctors prescribe Desmopressin30 most frequently
for treatment of diabetes insipidus or bedwetting.
formula C46H64 N14O12S2, mol.mass 1069.22g/mol.
Desmopressin has also been shown to cause a
significant decrease in nocturnal urinary volumes.31
CONCLUSION:
Impact of nocturia on quality of life produces the miserable
incidences. Nocturia is not only detrimental to the quality of
sleep and well being but is also related to increased
mortality and risk of falling at night particularly in the
elderly. Desmopressin significantly prolonged the duration
of sleep until the first nocturnal void, which is an important
indicator of quality of life. There are the various treatments
available for nocturia but safest and proper treatment
according to dug profile is Desmopressin. Because of
mechanism of action related to AVP levels. Other drug
shows its usefulness on other problems like nocturia due to
bladder disorders.
REFERENCES:
Chemistry of Desmopressin
Two structural changes, which increase the stability
and action of desmopressin, distinguish it from
vasopressin deamination p of l-arginin at the molecule
and substitution of L-arginin at position 8 with the
enantiomer d-arginine. The desmopressin molecule is,
therefore polarized with a basic amino acid at position
8 and alipophilic n-terminal31.
Mechanism of Action
Vasopressin receptors found in the kidney, liver, brain,
pituitary gland, aortic smooth muscle and platelets.
These receptor are divided into sub types:
1.
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