Adding a diuretic to alpha-blocker therapy may be an effective second-line treatment for nocturia in some men with lower urinary tract symptoms (LUTS), according to researchers.
Jae-Seung Paick, MD, PhD, and collaborators at Seoul National University College of Medicine in Korea enrolled 72 LUTS sufferers with nocturia that persisted after four weeks of treatment with the alpha blocker terazosin. These men were placed on combination therapy consisting of 25 mg of hydrochlorothiazide, a diuretic, and 4 mg of terazosin once daily for four weeks. Fifty-three men completed the study. All except one had nocturnal polyuria at baseline.
Based on the International Prostate Symptom Score, seven men experienced a reduction of 50% or more in nocturia, seven had a 25%-49% reduction, and 31 had a 0%-24% reduction, the investigators reported in
Urology (2009;73:549-553). Nocturia increased in eight patients. Using the frequency-volume chart, 17 patients reported that their nocturia was reduced by half; five reported a reduction of 25%-49%, and 31 reported no response to treatment or an increase in nocturia. Following combination therapy, six (11.5%) of the 52 patients with nocturnal polyuria at baseline experienced resolution of this condition.
“Hydrochlorothiazide combined with terazosin was safe and effective in reducing nocturnal frequency for some men after failed terazosin therapy,” the authors wrote. “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.”