Managing Nocturia After Prostate Surgery: Tips and Medication Insights - Urology

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Postoperative nocturia after prostate surgery?


Hello, doctor.
My father is 73 years old and underwent a transurethral resection of the prostate (TURP) on April 17.
Although he has recovered well, he still has to get up to urinate 3 to 4 times at night.
During his follow-up visit, the doctor mentioned that this is related to his hormone levels and prescribed Desmopressin 0.1 mg (PMS-Desmopressin) to be taken orally at night.
He only needs to take one tablet, and that night he only has to go to the bathroom once.
If he doesn't take the medication, he has to get up 3 to 4 times.
The doctor also prescribed a three-month supply of the medication.
Besides taking the medication, are there other methods my father can use to improve this condition? What are the potential side effects of taking this medication long-term?

Xiang Xiang, 40~49 year old female. Ask Date: 2023/06/15

Dr. Du Shixi reply Urology


Hello: Long-term use may be necessary, with few side effects, as long as the diet is normal.
For those with severe heart disease, a physician's evaluation is required.
A small number of individuals may experience low sodium levels due to poor dietary intake.
Wishing you good health.
You can refer to https://www.cth.org.tw/public/medi_news/c350fdac19f3057cf57d0f96f4b0cf12.pdf.

Reply Date: 2023/06/15

More Info


Managing nocturia, especially after prostate surgery, can be a challenging issue for many patients. Your father's experience of waking up multiple times at night to urinate is not uncommon, particularly following procedures like laser prostate surgery. This condition can significantly affect sleep quality and overall well-being.


Understanding Nocturia Post-Surgery
Nocturia, or the need to wake up at night to urinate, can be influenced by several factors, including hormonal changes, bladder function, and the effects of surgery. After prostate surgery, the bladder may become more sensitive, and the body's regulation of fluids can be altered. In your father's case, the doctor has prescribed Desmopressin, which is a synthetic hormone that helps reduce urine production at night. This medication is particularly effective for nocturia caused by conditions like diabetes insipidus or certain forms of nocturnal polyuria.


Medication Insights
Desmopressin works by mimicking the action of vasopressin, a hormone that helps the kidneys manage the amount of water in the body. By taking Desmopressin at night, your father can reduce the volume of urine produced, thus minimizing the need to wake up frequently. While it is generally well-tolerated, long-term use can lead to some side effects, including:
1. Water Retention: This can lead to hyponatremia (low sodium levels), which can be serious. Symptoms may include headache, nausea, and confusion.

2. Nasal Congestion: If administered as a nasal spray, it can cause nasal irritation.

3. Gastrointestinal Issues: Some patients may experience nausea or abdominal discomfort.

It’s essential for your father to have regular follow-ups with his healthcare provider to monitor for these potential side effects, especially if he is on the medication for an extended period.


Non-Medication Strategies
In addition to medication, there are several lifestyle modifications and strategies that can help manage nocturia:
1. Fluid Management: Encourage your father to monitor his fluid intake, especially in the evening. Reducing fluid consumption a few hours before bedtime can help decrease nighttime urination.


2. Bladder Training: This involves gradually increasing the time between urination during the day to help train the bladder to hold more urine.

3. Dietary Adjustments: Certain foods and drinks can irritate the bladder. Caffeine, alcohol, and spicy foods are common culprits. Reducing or eliminating these from his diet may help.

4. Pelvic Floor Exercises: Kegel exercises can strengthen the pelvic floor muscles, which may improve bladder control. However, it's essential to ensure that he is doing these exercises correctly.

5. Sleep Hygiene: Improving overall sleep quality can help him feel more rested, even if he does wake up at night. This includes maintaining a regular sleep schedule, creating a comfortable sleep environment, and avoiding screens before bed.

6. Medication Review: Some medications can contribute to nocturia. A review of all medications with a healthcare provider can identify any that may exacerbate the issue.


Conclusion
While Desmopressin can be effective in managing nocturia, it’s important to combine medication with lifestyle changes for the best results. Regular follow-ups with the healthcare provider will ensure that your father’s treatment plan is effective and safe. If he experiences any concerning symptoms or side effects, he should reach out to his doctor promptly. With a comprehensive approach, it is possible to significantly improve his quality of life and reduce the frequency of nighttime awakenings.

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