Alpha-blocker plus diuretic combination therapy as second-line treatment for nocturia in men with LUTS: a pilot study.

摘要

OBJECTIVES: To determine the efficacy of a diuretic agent, hydrochlorothiazide, as second-line therapy after failed alpha-blocker therapy for men with nocturia. METHODS: The study inclusion criteria were a < 25% reduction in nocturia using the International Prostate Symptom Score question 7, a < 25% reduction in nocturia using the frequency-volume chart, and/or nocturia > or = 2ight (according to the frequency-volume chart) after 4 weeks of terazosin therapy. A total of 72 patients were entered into the study and treated with 25 mg of hydrochlorothiazide and 4 mg of terazosin once daily for 4 weeks. Of the 72 eligible men, 53 completed the study. RESULTS: No serious side effects occurred among the treated patients. Using the International Prostate Symptom Score, a reduction of > or = 50%, 25%-49%, 0%-24% and an increase in nocturia was observed in 7, 7, 31, and 8 patients, respectively. Using the frequency-volume chart, 17 patients reported reduced nocturia by more than one half, 5 reported a reduction of 25%-49%, and 31 reported no response to treatment or an increase in nocturia. At baseline, all except for 1 patient had nocturnal polyuria (nocturnal polyuria index > 33%), and, after the combination therapy, the nocturnal polyuria had resolved in 6 (11.5%) of the 52 patients with nocturnal polyuria at baseline. CONCLUSIONS: Hydrochlorothiazide combined with terazosin was safe and effective in reducing nocturnal frequency for some men after failed terazosin therapy. Our findings suggest that the use of a diuretic agent, such as hydrochlorothiazide, might be a reasonable second-line treatment option for these patients, especially for those with nocturnal polyuria.