Managing nocturia
http://www.100md.com
《英国医生杂志》
EDITOR—The goal of our article was to highlight briefly and thoroughly the underlying causes and treatment options for nocturia and present a useful algorithm for patients with the disorder. Matheson's comment about the term "nocturia" as a symptom rather than a condition highlights the difficulty in defining and categorising this often misunderstood and underdiagnosed disorder.
Doctors must determine the underlying causes of excess urine production at night and treat them appropriately. In clinical practice, the term "nocturia" is a diagnosis for which causes are determined and treatment appropriated to improve patients' quality of life. In our article we offer several treatment options, including restriction of fluids in the evening, time release diuretics, afternoon naps, elevation of the legs, compression stockings, antidiuretic hormone therapy, melatonin treatment, and sacral neuromodulation.
Although Walker asserts that our "claim of effectiveness" of melatonin is misleading, our intention was not to imply a categorical claim of effectiveness, but rather to offer melatonin as a possible option for patients with benign prostatic enlargement. The patient's symptoms and previously attempted treatments would indicate the appropriate course of treatment. For patients whose condition is seemingly recalcitrant to all medical treatment, sacral neuromodulation is a promising alternative.
Although Walker says that sacral neuromodulation is not a widely suitable or recognised treatment, it offers a source of hope for patients who have found relief difficult or impossible to obtain or sustain. One of us (SPM) has performed 150 sacral neuromodulation procedures in the past three years and has experienced a success rate better than 85% in patients with urgency, urge incontinence, and nocturia.
Doctors must determine the underlying causes of excess urine production at night and treat them appropriately. In clinical practice, the term "nocturia" is a diagnosis for which causes are determined and treatment appropriated to improve patients' quality of life. In our article we offer several treatment options, including restriction of fluids in the evening, time release diuretics, afternoon naps, elevation of the legs, compression stockings, antidiuretic hormone therapy, melatonin treatment, and sacral neuromodulation.
Although Walker asserts that our "claim of effectiveness" of melatonin is misleading, our intention was not to imply a categorical claim of effectiveness, but rather to offer melatonin as a possible option for patients with benign prostatic enlargement. The patient's symptoms and previously attempted treatments would indicate the appropriate course of treatment. For patients whose condition is seemingly recalcitrant to all medical treatment, sacral neuromodulation is a promising alternative.
Although Walker says that sacral neuromodulation is not a widely suitable or recognised treatment, it offers a source of hope for patients who have found relief difficult or impossible to obtain or sustain. One of us (SPM) has performed 150 sacral neuromodulation procedures in the past three years and has experienced a success rate better than 85% in patients with urgency, urge incontinence, and nocturia.