Prostat Radyofrekans Termoterapinin Alfa Bloker Tedaviye Dirençli Noktürisi Olan BPO' lu Yaşlı Hastalarda Etkinliği ve Güvenliği: Gözlemsel Çalışma
Amaç: Bu çalışmanın amacı yaşlı hastalarda bipolar radyofrekans prostat termoterapi yönteminin
nokturi şikayeti üzerine etkinliğini ve güvenliğini incelemektir.
Gereç ve Yöntemler: Altmış beş yaş üstü ve dirençli nokturi şikayeti olan 100 hastanın işlem sonrası
sonuçları incelendi. Hastaların, işlem öncesi Qmax, prostat volümleri, işeme sonrası rezidü miktarı,
IPSS skorları, nokturi frekansı ve Nocturia Quality of Life sorgulama formu kaydedilip işlem sonrası 3.
ay sonuçları ile karşılaştırıldı.
Bulgular: Nokturi sıklığı ortalama 4,1 (2-13) kez görülürken işlem sonrası bu sayı 2,1 (0-10)’ya geriledi
(p=0,002). N-QOL yaşam kalitesi formunda 1,70±0,7 oranında ve gece idrara çıkmanın vermiş olduğu
rahatsızlıklarda anlamlı iyileşme görüldü (p<0,001). Hastaların işlem öncesinde yaşam kalitesi indeksi
skoru ortalama 4,2 (1-4) iken üçüncü ayda 2,5 (1-5) olarak hesaplandı.
Sonuç: Bu tedavi yönteminin 65 yaş üzeri hastalarda nokturi açısından anlamlı derecede iyileşme, hastaların yaşam kalitelerine pozitif
yönde etki sağladığı görüldü. Yaşlı hastalarda yan etkisi olabilen veya kullanımı uygun olmayan tedavilere göre daha etkili ve güvenilir bir
yöntem olabileceği düşünülmektedir
Efficacy and Safety of Prostate Radiofrequency Thermotherapy in Elderly Patients with BPO and Nocturia Resistant to Alpha-Blocker Therapy: An Observational Study
Aim: The purpose of this study is to investigate the effectiveness of the prostate bipolar radiofrequency
thermotherapy method on the complaint of nocturia and its safety in elderly patients.
Material and Methods: The post-procedural results of 100 patients over the age of 65 with complaints of
refractory nocturia were examined. The patients' pre-procedural Qmax values, prostate volumes, postvoid
residual amounts, IPSS scores, frequency of nocturia, and associated quality of life questionnaire
scores were recorded and compared with the results at the 3rd month after the procedure.
Results: The pre-procedural and post-procedural nocturia frequencies of the patients were consecutively
4.1 (2-13) times and 2.1 (0-10)times (p=0.002). There were significant improvements in the N-QOL
scores of the patients by 1.70±0.7 and in their discomfort caused by voiding at night (p<0.001). The
mean QOL score of the patients before the procedure was 4.2 (1-4), whereas it was calculated as 2.5
(1-5) 3 months after the procedure.
Conclusion: It was observed that this treatment method provided a significant improvement in terms
of nocturia in patients over the age of 65 and a positive effect on their quality of life. It is thought that it
can be a more effective and safer method in comparison to treatments that can have side effects or are
not suitable for elderly patients.
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- 1. Barkin J. Nocturia: diagnosis and management for the primary
care physicians. Can J Urol 2016; 23: 16-19.
- 2. Xue Z, Lin Y, Jiang Y, Wei N, Bi J. The evaluation of nocturia in
patients with lower urinary tract symptoms suggestive of benign
prostatic hyperplasia and the analysis of the curative effect
after medical or placebo therapy for nocturia: a randomized
placebo-controlled study. BMC Urol 2018; 18: 115.
- 3. Wolff DT, Adler KA, Weinstein CS, Weiss JP. Managing
Nocturia in Frail Older Adults. Drugs Aging 2021; 38: 95-109.
- 4. Osman NI, Chapple CR, Wein AJ. Nocturia: Current concepts
and future perspectives. Acta Physiol (Oxf) 2013;207:53-65.
- 5. Pesonen JS, Cartwright R, Vernooij RWM, Aoki Y, Agarwal
A, Mangera A, Markland AD, Tsui JF, Santti H, Griebling TL,
Pryalukhin AE, Riikonen J, Tähtinen RM, Vaughan CP, Johnson
TM 2nd, Auvinen A, Heels-Ansdell D, Guyatt GH, Tikkinen
KAO. The Impact of Nocturia on Mortality: A Systematic Review
and Meta-Analysis. J Urol 2020;203:486-495.
- 6. Bae JH, Kim SW, Chung BH, Kim JH, Kim CS, Lee HM, Lee
KS, Yoo TK, Kim SI, Byun SS, Lee JY. Desmopressin add-on
therapy for refractory nocturia in men receiving α-blockers for
lower urinary tract symptoms. J Urol 2013;190:180-186.
- 7. van Doorn B, Bosch JL. Nocturia in older men. Maturitas
2012;71:8-12.
- 8. Diri MA, Gul M. Bipolar prostate thermotherapy for the
improvement of chronic prostatitis symptoms and ejaculation
problems. Aging Male 2020;23:1004-1008.
- 9. Benli E, Yuce A, Nalbant I, Cirakoglu A, Yazici I. Can
transurethral thermotherapy save elderly patients with benign
prostatic obstruction and high ASA score? Aging Male
2020;23:1316-1320.
- 10. Chow PM, Chuang YC, Hsu KCP, Shen YC, Hsieh AW, Liu
SP. Impacts of nocturia on quality of life, mental health, work
limitation, and health care seeking in China, Taiwan and South
Korea (LUTS Asia): Results from a cross-sectional, populationbased
study. J Formos Med Assoc 2022;121:285-293.
- 11. Kim KH, Ko YH, Song PH, Kim TH, Kim BS. The prostatic
urethral angle can predict the response to alpha adrenoceptor
antagonist monotherapy for treating nocturia in men with
lower urinary tract symptom: A multicenter study. Prostate Int
2016;4:30-35.
- 12. Dani H, Esdaille A, Weiss JP. Nocturia: aetiology and treatment
in adults. Nat Rev Urol 2016;13:573-583.
- 13. Kupelian V, Fitzgerald MP, Kaplan SA, Norgaard JP, Chiu GR,
Rosen RC. Association of nocturia and mortality: results from
the Third National Health and Nutrition Examination Survey. J
Urol 2011;185:571-577.
- 14. Mobley DF, Baum N. Etiology, evaluation, and management
of nocturia in elderly men and women. Postgrad Med
2014;126:147-153.
- 15. Eisenhardt A, Schneider T, Cruz F, Oelke M. Consistent
and significant improvement of nighttime voiding frequency
(nocturia) with silodosin in men with LUTS suggestive of BPH:
pooled analysis of three randomized, placebo-controlled,
double-blind phase III studies. World J Urol 2014;32:1119-
1125.
- 16. Levin RM, Monson FC, Haugaard N, Buttyan R, Hudson
A, Roelofs M, Sartore S, Wein AJ. Genetic and cellular
characteristics of bladder outlet obstruction. Urol Clin North Am
1995;22:263-283.
- 17. Kim KS, Choi SW, Bae WJ, Kim SJ, Cho HJ, Hong SH, Lee
JY, Hwang TK, Kim SW. Efficacy of a vaporization-resection
of the prostate median lobe enlargement and vaporization of
the prostate lateral lobe for benign prostatic hyperplasia using
a 120-W GreenLight high-performance system laser: the effect
on storage symptoms. Lasers Med Sci 2015;30:1387-1393.
- 18. Wagg A, Andersson KE, Cardozo L, Chapple C, Kirby
M, Kelleher C, Lose G, Milsom I. Nocturia: morbidity and
management in adults. Int J Clin Pract 2005;59:938-945.
- 19. Kim JC, Cho KJ, Lee JG, Seo JT, Kim DY, Oh SJ, Lee KS,
Choo MS, Lee JZ. Efficacy and Safety of Desmopressin
Add-On Therapy for Men with Persistent Nocturia on
α-Blocker Monotherapy for Lower Urinary Tract Symptoms: A
Randomized, Double-Blind, Placebo Controlled Study. J Urol
2017;197:459-464.
- 20. Yokoyama O, Tsujimura A, Akino H, Segawa N, Tamada
S, Oguchi N, Kitagawa Y, Tsuji H, Watanabe A, Inamoto
T, Shimizu N, Fujiuchi Y, Katsuoka Y, Azuma H, Matsuda
T, Namiki M, Uemura H, Okuyama A, Nonomura N, Fuse
H, Nakatani T. Add-on anticholinergic therapy for residual
nocturia in patients with lower urinary tract symptoms receiving
α1-blocker treatment: a multi-centre, prospective, randomised
study. World J Urol 2015;33:659-667.
- 21. Kakizaki H, Lee KS, Yamamoto O, Jong JJ, Katou D, Sumarsono
B, Uno S, Yamaguchi O. Mirabegron Add-on Therapy to
Tamsulosin for the Treatment of Overactive Bladder in Men
with Lower Urinary Tract Symptoms: A Randomized, Placebocontrolled
Study (MATCH). Eur Urol Focus 2020;6:729-737.
- 22. Oelke M, Roehrborn CG, D’Ancona C, Wilson TH, Castro
R, Manyak M. Nocturia improvement in the combination of
Avodart(®) and tamsulosin (CombAT) study. World J Urol
2014;32:1133-1140.
- 23. Kujubu DA, Aboseif SR. An overview of nocturia and the
syndrome of nocturnal polyuria in the elderly. Nat Clin Pract
Nephrol 2008;4:426-435.
- 24. Deng W, Zhang C, Jiang H, Li Y, Zhu K, Liu X, Chen L,
Liu W, Guo J, Zhou X, Fu B, Wang G. Transvesical versus
posterior approach to retzius-sparing robot-assisted radical
prostatectomy: a retrospective comparison with a 12-month
follow-up. Front Oncol 2021;11:641887.
- 25. Johnson TM 2nd, Markland AD, Goode PS, Vaughan CP,
Colli JL, Ouslander JG, Redden DT, McGwin G, Burgio KL.
Efficacy of adding behavioural treatment or antimuscarinic
drug therapy to α-blocker therapy in men with nocturia. BJU Int
2013;112:100-108.
- 26. Weiss JP, Blaivas JG, Bliwise DL, Dmochowski RR, Dubeau
CE, Lowe FC, Petrou SP, Van Kerrebroeck PE, Rosen RC,
Wein AJ. The evaluation and treatment of nocturia: a consensus
statement. BJU Int 2011;108:6-21.
- 27. de Wildt MJ, Wagrell L, Larson TR, Eliasson T. Clinical results
of microwave thermotherapy for benign prostatic hyperplasia. J
Endourol 2000;14:651-656.
- 28. Weiss JP, Juul KV, Wein AJ. Management of nocturia: the
role of antidiuretic pharmacotherapy. Neurourol Urodyn
2014;33:S19-S24.