夜尿是在泌尿科門診診間相當常見之主訴。而夜尿的盛行率亦隨著年齡增長而增加。頻繁的夜尿除了導致生活品質下降之外亦可能導致身體機能之惡化，可能進一步增加跌倒、骨折之風險。所以夜尿的治療是相當重要之課題，不僅可以改善病患之生活，也能減少因為跌倒而導致後續受傷的機會。這篇文章發表在美國重要的泌尿科期刊 (The Journal of Urology) 上，主要是研究desmopressin這個藥物對老年夜尿症患者之療效與安全性。Desmopressin這個藥物能夠減少腎臟製造出來的尿液，可以用來治療成人因夜間多尿所導致之夜尿症。

Desmopressin對於老年夜尿症的療效顯著且耐受性良好。文章建議起始劑量為0.1mg，服藥期間須定期監測血鈉的濃度，尤其是對於80歲及以上之年長病患或存在其他低鈉血症風險因素或潛在誘發因素的患者更為重要。低血鈉症的症狀會根據嚴重程度而有所不同，從輕微的無症狀到嚴重的抽搐、癲癇、步態不穩、反應遲鈍、意識混亂甚至昏迷，所以在使用上需要非常小心!

在治療的期間中，需要依照抽血結果、副作用去調整desmopressin的劑量，這樣有助於在治療的風險和益處中取得平衡。除此之外，此文章之研究族群是台灣中老年男性，跟平時在臨床上會接觸到的患者是高度相關，所以這篇文章提供了真實臨床使用的數據，相當值得醫師與民眾參考。

Purpose: We investigated the safety and effectiveness of oral desmopressin tablet (starting dose 0.1 mg) in older Taiwanese men with nocturnal polyuria and nocturia and compared results in those aged ≥ 80 years vs < 80 years.

Materials and Methods: Two hundred thirty-four Taiwanese men aged 60 years or older with nocturia (≥2 voids/night) and a nocturnal polyuria index of ≥ 33 were included. Patients received desmopressin 0.1 mg for up to 3 months. Effectiveness was evaluated at Month 1, and safety was assessed at Months 1, 2, and 3.

Results: Two hundred eight patients (88.9%) aged 60 to 95 years provided follow up data. Of the participants 70.1% completed the 3-month treatment period. Desmopressin was associated with significantly reduced median nocturnal voids/ night (<80 years: -2.0; ≥80 years: -3.0) and urine volume (<80 years: -705 mL; 80 years: -660 mL) and increased hours of undisturbed sleep (<80 years: 1.0 hours; ≥ 80 years: 2.0 hours; all P < .001). In total, 39/234 (16.7%) discontinued desmopressin due to hyponatremia (determined through serum sodium monitoring). Twenty-eight patients with serum sodium decreases to ≤ 135 mmoL/L continued treatment for the full 3 months with appropriate dose adjustments.

Conclusions: This study provides real-world evidence of effectiveness and safety of oral desmopressin in an older Asian male population, including a subgroup aged older than 80 years. A starting dose of 0.1 mg oral desmopressin, coupled with careful serum sodium monitoring and dose adjustment if required, was associated with significant improvement in all nocturia parameters and a high rate of continuation.