The Effect of Diclofenac Sodium on Nocturia Caused by Benign Prostatic Hyperplasia

Ebadzadeh, Mohammadreza; Sharifian Amiri, Rayka; Jalili, Arsalan; Sarrafinejad, Afshin; Zanganeh, Hamed; Ketabchi, Aliassghar

doi:10.22062/jkmu.2019.89522

Document Type : Original Article

Authors

¹ Assistant Professor, Department of Urology, Clinical Research Center, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran

² Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

³ Department of Stem Cell and Developmental Biology, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran

⁴ Assistant Professor of Medical Informatics, Medical Informatics Research Center, Institute of Futures Studies in Health. Kerman University of Medical Sciences, Kerman, Iran

⁵ Medical Practitioner, Kerman University of Medical Sciences, Kerman, Iran

⁶ Associated Professor of Urology, Physiology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran

https://doi.org/10.22062/jkmu.2019.89522

Abstract

Background: Nocturia is a common cause of night awakenings which bothers many patients with urinary tract diseases. NSAIDs can improve nocturia by decreasing urine production and modify the altered neural pathways between bladder and CNS. The aim of this study was to evaluate the efficacy of NSAID in the treatment of nocturia secondary to BPH. Seventy-one patients complaining of BPH with LUTS that was prominent with nocturia entered this study.
Methods: Between January 2013 and March 2014, 71 men aged 50-85, complaining of BPH with LUTS that was prominent with nocturia (voiding more than 2 times at night) entered this prospective study. All patients received 100 mg Diclofenac Na suppository for 30 days at night (9pm). The main outcomes included night-time frequency; IPSS, prostate volume and PSA were recorded before and after study. Statistical analysis was performed using the paired t-test, Pearson’s correlation and Wilcoxon rank test.
Results: In our study, 88.7 % of patients had an acceptable response to Diclofenac Na. Prostate size showed a significant reduction after one month treatment with diclofenac Na. There were no serious adverse effects.
Conclusion: In our study Diclofenac Na can improve symptoms of BPH and can be used for the treatment of nocturia secondary to BPH.

Keywords

References

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2. Bergman AM, Sih AM, Weiss JP. Nocturia: an overview of evaluation and treatment. Bladder 2015; 2(2):e13.

3. Abdel Rahman TT, El Gaafary MM. Nocturia among elderly men living in a rural area in Egypt, and its impact on sleep quality and health‐related quality of life. Geriatr Gerontol Int; 14(3):613-9.

4. Patel A, Hasak S, Cassell B, Ciorba MA, Vivio EE, Kumar M, et al. Effects of disturbed sleep on gastrointestinal and somatic pain symptoms in irritable bowel syndrome. Aliment Pharmacol Ther 2016; 44(3):246-58.

5. Abete P, Cherubini A, Di Bari M, Vigorito C, Viviani G, Marchionni N, et al. Does comprehensive geriatric assessment improve the estimate of surgical risk in elderly patients? An Italian multicenter observational study. Am J Surg 2016; 211(1):76-83.

6. Aristide G, Weinstein M, Nair GB. Nocturia in obstructive sleep apnea-hypopnea syndrome: an underappreciated symptom. Current Respiratory Medicine Reviews 2013; 9(3):217-24.

7. Gormley EA, Lightner DJ, Faraday M, Vasavada SP, American Urological Association; Society of Urodynamics, Female Pelvic Medicine. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol 2015; 193(5):1572-80.

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9. Corcos J, Mac Diarmid S, Heesakkers J. Overactive Bladder: Practical Management. US: John Wiley & Sons; 2015.

10. Bae WJ, Bae JH, Kim SW, Chung BH, Kim JH, Kim CS, et al. Desmopressin add-on therapy for refractory nocturia in men receiving α-blockers for lower urinary tract symptoms. J Urol 2013; 190(1):180-6.

11. Toyama M, Yamamoto M, Yoshda K, Maeda T, Nakayama T. Poster Session: PS 0149; Neurology: The Impact of Non-Motor Symptoms on Qol in Japanese Patients with Parkinsons Disease: A Cross-Sectional Study. Essentials of Primary Care j. 2014; 2014(1):84.

12. Nimeh T, Alvarez P, Mufarreh N, Lerner LB. Nocturia: current evaluation and treatment for urology. Curr Urol Rep 2015; 16(9):66.

13. Soloway MS, Weiss JP, Wein AJ. Nocturia. Current Urology Reports 2016; 17:77.

14. Nimeh T, Alvarez P, Mufarreh N, Lerner LB. Nocturia: current evaluation and treatment for urology. Curr Urol Rep 2015; 16(9):66.

15. Skokan A, Newman DK. Behavioral Intervention for Lower Urinary Tract Symptoms in Older Adults. In: Guzzo T, Drach G, Wein A. Primer of Geriatric Urology. New York: Springer; 2016.

16. Tai BT, Tai TT, Chang YJ, Huang KH. Factors associated with remission of primary nocturnal enuresis and changes of parental perception towards management strategies: a follow-up study. J Pediatr Urol 2017; 13(1):44.e1-9.

17. Johnson TM 2nd, Vaughan CP, Goode PS, Bliwise DL, Markland AD, Huisingh C, et al. Pilot results from a randomized trial in men comparing alpha-adrenergic antagonist versus behavior and exercise for nocturia and sleep. Clin Ther 2016; pii: S0149-2918(16)30742-1.

18. Shekarchi B, Zamani M. Nocturia: a bothersome urological symptom in the elderly. Clin Interv Aging 2016; 11:1463-65.

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23. Han J, Sukumar S, Bakker CJ, Ebell MH, Dahm P. Desmopressin for Treating Nocturia in Men with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia. US: John Wiley & Sons; 2016.

24. Cornu JN, Abrams P, Chapple CR, Dmochowski RR, Lemack GE, Michel MC, et al. A contemporary assessment of nocturia: definition, epidemiology, pathophysiology, and management—a systematic review and meta-analysis. Eur Urol 2012; 62(5):877-90.

25. Cantlay A, Ni Raghallaigh H. Benign prostatic hyperplasia. InnovAiT 2015; 8(4):238-45.

26. Sharifi SH, Mokarrar MH, Khaledi F, Yamini-Sharif R, Lashay A, Soltani MH. Does sildenafil enhance the effect of tamsulosin in relieving acute urinary retention? Int Braz J Urol 2014; 40(3):373-8.

27. Wilson JC, Murray LJ, Hughes CM, Black A, Anderson LA. Non-steroidal anti-inflammatory drug and aspirin use and the risk of head and neck cancer. Br J Cancer 2013; 108(5):1178-81.

28. Ishiguro H, Kawahara T. Nonsteroidal anti-inflammatory drugs and prostatic diseases. Biomed Res Int 2014; 2014:436123.

29. Mungadi IA, Mbibu HN, Eltahawy E, Abdulwahab-Ahmed A. Manual of Medical Treatment in Urology. New Delhi: Jaypee Brothers Medical Pub; 2013.

30. Kahokehr A, Vather R, Nixon A, Hill AG. Non‐steroidal anti‐inflammatory drugs for lower urinary tract symptoms in benign prostatic hyperplasia: systematic review and meta‐analysis of randomized controlled trials. BJU Int 2013; 111(2):304-11.

31. Sirab N, Robert G, Fasolo V, Descazeaud A, Vacherot F, de la Taille A, et al. Lipidosterolic extract of Serenoa repens modulates the expression of inflammation related-genes in benign prostatic hyperplasia epithelial and stromal cells. Int J Mol Sci 2013; 14(7):14301-20.

32. De Nunzio C, Presicce F, Tubaro A. Inflammatory mediators in the development and progression of benign prostatic hyperplasia. Nat Rev Urol 2016; 13(10):613-26.

33. Duffy JF, Scheuermaier K, Loughlin KR. Age-related sleep disruption and reduction in the circadian rhythm of urine output: contribution to nocturia? Curr Aging Sci 2016; 9(1):34-43.

34. Shao IH, Wu CC, Hsu HS, Chang SC, Wang HH, Chuang HC, et al. The effect of nocturia on sleep quality and daytime function in patients with lower urinary tract symptoms: a cross-sectional study. Clin Interv Aging 2016; 11:879-85.

35. Kim SH, Ho JN, Jin H, Lee SC, Lee SE, Hong SK, et al. Upregulated expression of BCL2, MCM7, and CCNE1 indicate cisplatin-resistance in the set of two human bladder cancer cell lines: T24 cisplatin sensitive and T24R2 cisplatin resistant bladder cancer cell lines. Investig Clin Urol 2016; 57(1):63-72.

36. Yeo JK, Choi H, Bae JH, Kim JH, Yang SO, Oh CY, et al. Korean clinical practice guideline for benign prostatic hyperplasia. Investig Clin Urol 2016; 57(1):30-44.

37. Weiss JP, Blaivas JG, Blanker MH, Bliwise DL, Dmochowski RR, Drake M, et al. The New England Research Institutes, Inc. (NERI) Nocturia Advisory Conference 2012: focus on outcomes of therapy. BJU Int 2013; 111(5):700-16.

38. Smith A, Wein A. Current pharmacotherapy of nocturia. Expert Opin Pharmacother 2013; 14(7):885-94.

39. Zurier RB. Prostaglandins, leukotrienes, and Related Compounds. In: Mackay IR, Rose NR, Diamond B, Davidson A. Encyclopedia of Medical Immunology. New York: Springer; 2014.

40. Akasaka H, Ruan KH. Identification of the two-phase mechanism of arachidonic acid regulating inflammatory prostaglandin E2 biosynthesis by targeting COX-2 and mPGES-1. Arch Biochem Biophys 2016; 603:29-37.

41. Mederle K, Meurer M, Castrop H, Höcherl K. Inhibition of COX-1 attenuates the formation of thromboxane A2 and ameliorates the acute decrease in glomerular filtration rate in endotoxemic mice. Am J Physiol Renal Physiol 2015; 309(4):F332-40.

42. Gordish KL, Beierwaltes WH. Resveratrol induces acute endothelium-dependent renal vasodilation mediated through nitric oxide and reactive oxygen species scavenging. Am J Physiol Renal Physiol; 306(5):F542-50.

43. Kahokehr A, Vather R, Nixon A, Hill AG. Non‐steroidal anti‐inflammatory drugs for lower urinary tract symptoms in benign prostatic hyperplasia: systematic review and meta‐analysis of randomized controlled trials. BJU Int 2013; 111(2):304-11.

44. Torkko KC, Wilson RS, Smith EE, Kusek JW, van Bokhoven A, Lucia MS. Prostate biopsy markers of inflammation are associated with risk of clinical progression of benign prostatic hyperplasia: findings from the MTOPS study. The Journal of urology 2015; 194(2):454-61.

45. Hypolite JA, Lei Q, Chang S, Zderic SA, Butler S, Wein AJ, et al. Spontaneous and evoked contractions are regulated by PKC-mediated signaling in detrusor smooth muscle: involvement of BK channels. Am J Physiol Renal Physiol 2013; 304(5):F451-62.

46. Hofer MJ, Campbell IL. Immunoinflammatory diseases of the central nervous system–the tale of two cytokines. Br J Pharmacol 2016; 173(4):716-28.

47. Coomans CP, Geerling JJ, van den Berg SA, van Diepen HC, Garcia-Tardón N, Thomas A, et al. The insulin sensitizing effect of topiramate involves KATP channel activation in the central nervous system. Br J Pharmacol 2013; 170(4):908-18.

48. Marshall SD, Raskolnikov D, Blanker MH, Hashim H, Kupelian V, Tikkinen KA, et al. Nocturia: current levels of evidence and recommendations from the international consultation on male lower urinary tract symptoms. Urology; 85(6):1291-9.

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51. Miller PS, Hill H, Andersson FL. Nocturia work productivity and activity impairment compared with other common chronic diseases. Pharmacoeconomics 2016; 34(12):1277-97.

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53. Liu TT, Grubisha MJ, Frahm KA, Wendell SG, Liu J, Ricke WA, et al. Opposing Effects of Cyclooxygenase-2 (COX-2) on Estrogen Receptor β (ERβ) response to 5α-reductase inhibition in prostate epithelial cells. J Biol Chem 2016; 291(28):14747-60.

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The Effect of Diclofenac Sodium on Nocturia Caused by Benign Prostatic Hyperplasia

References

References

1. Tikkinen KA, Johnson TM, Tammela TL, Sintonen H, Haukka J, Huhtala H, et al. Nocturia frequency, bother, and quality of life: how often is too often? A population-based study in Finland. Eur Urol 2010; 57(3):488-98.

2. Bergman AM, Sih AM, Weiss JP. Nocturia: an overview of evaluation and treatment. Bladder 2015; 2(2):e13.

3. Abdel Rahman TT, El Gaafary MM. Nocturia among elderly men living in a rural area in Egypt, and its impact on sleep quality and health‐related quality of life. Geriatr Gerontol Int; 14(3):613-9.

4. Patel A, Hasak S, Cassell B, Ciorba MA, Vivio EE, Kumar M, et al. Effects of disturbed sleep on gastrointestinal and somatic pain symptoms in irritable bowel syndrome. Aliment Pharmacol Ther 2016; 44(3):246-58.

5. Abete P, Cherubini A, Di Bari M, Vigorito C, Viviani G, Marchionni N, et al. Does comprehensive geriatric assessment improve the estimate of surgical risk in elderly patients? An Italian multicenter observational study. Am J Surg 2016; 211(1):76-83.

6. Aristide G, Weinstein M, Nair GB. Nocturia in obstructive sleep apnea-hypopnea syndrome: an underappreciated symptom. Current Respiratory Medicine Reviews 2013; 9(3):217-24.

7. Gormley EA, Lightner DJ, Faraday M, Vasavada SP, American Urological Association; Society of Urodynamics, Female Pelvic Medicine. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol 2015; 193(5):1572-80.

8. Payne CK. Men Have Bladders, Too. In: Potts JM. Men's Health. New York: Springer; 2016. p. 187-205.

9. Corcos J, Mac Diarmid S, Heesakkers J. Overactive Bladder: Practical Management. US: John Wiley & Sons; 2015.

10. Bae WJ, Bae JH, Kim SW, Chung BH, Kim JH, Kim CS, et al. Desmopressin add-on therapy for refractory nocturia in men receiving α-blockers for lower urinary tract symptoms. J Urol 2013; 190(1):180-6.

11. Toyama M, Yamamoto M, Yoshda K, Maeda T, Nakayama T. Poster Session: PS 0149; Neurology: The Impact of Non-Motor Symptoms on Qol in Japanese Patients with Parkinsons Disease: A Cross-Sectional Study. Essentials of Primary Care j. 2014; 2014(1):84.

12. Nimeh T, Alvarez P, Mufarreh N, Lerner LB. Nocturia: current evaluation and treatment for urology. Curr Urol Rep 2015; 16(9):66.

13. Soloway MS, Weiss JP, Wein AJ. Nocturia. Current Urology Reports 2016; 17:77.

14. Nimeh T, Alvarez P, Mufarreh N, Lerner LB. Nocturia: current evaluation and treatment for urology. Curr Urol Rep 2015; 16(9):66.

15. Skokan A, Newman DK. Behavioral Intervention for Lower Urinary Tract Symptoms in Older Adults. In: Guzzo T, Drach G, Wein A. Primer of Geriatric Urology. New York: Springer; 2016.

16. Tai BT, Tai TT, Chang YJ, Huang KH. Factors associated with remission of primary nocturnal enuresis and changes of parental perception towards management strategies: a follow-up study. J Pediatr Urol 2017; 13(1):44.e1-9.

17. Johnson TM 2nd, Vaughan CP, Goode PS, Bliwise DL, Markland AD, Huisingh C, et al. Pilot results from a randomized trial in men comparing alpha-adrenergic antagonist versus behavior and exercise for nocturia and sleep. Clin Ther 2016; pii: S0149-2918(16)30742-1.

18. Shekarchi B, Zamani M. Nocturia: a bothersome urological symptom in the elderly. Clin Interv Aging 2016; 11:1463-65.

20. Fukuta F, Masumori N. Natural History of Lower Urinary Tract Symptoms Secondary to BPH. Current Bladder Dysfunction Reports 2013; 8(2):166-73.

21. Cantrell MA, Baye J, Vouri SM. Tadalafil: a phosphodiesterase-5 inhibitor for benign prostatic hyperplasia. Pharmacotherapy 2013; 33(6):639-49.

22. Lee YJ, Jeong SJ, Byun SS, Lee JJ, Han JW, Kim KW. Prevalence and correlates of nocturia in community-dwelling older men: results from the korean longitudinal study on health and aging. Korean J Urol 2012; 53(4):263-7.

23. Han J, Sukumar S, Bakker CJ, Ebell MH, Dahm P. Desmopressin for Treating Nocturia in Men with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia. US: John Wiley & Sons; 2016.

24. Cornu JN, Abrams P, Chapple CR, Dmochowski RR, Lemack GE, Michel MC, et al. A contemporary assessment of nocturia: definition, epidemiology, pathophysiology, and management—a systematic review and meta-analysis. Eur Urol 2012; 62(5):877-90.

25. Cantlay A, Ni Raghallaigh H. Benign prostatic hyperplasia. InnovAiT 2015; 8(4):238-45.

26. Sharifi SH, Mokarrar MH, Khaledi F, Yamini-Sharif R, Lashay A, Soltani MH. Does sildenafil enhance the effect of tamsulosin in relieving acute urinary retention? Int Braz J Urol 2014; 40(3):373-8.

27. Wilson JC, Murray LJ, Hughes CM, Black A, Anderson LA. Non-steroidal anti-inflammatory drug and aspirin use and the risk of head and neck cancer. Br J Cancer 2013; 108(5):1178-81.

28. Ishiguro H, Kawahara T. Nonsteroidal anti-inflammatory drugs and prostatic diseases. Biomed Res Int 2014; 2014:436123.

29. Mungadi IA, Mbibu HN, Eltahawy E, Abdulwahab-Ahmed A. Manual of Medical Treatment in Urology. New Delhi: Jaypee Brothers Medical Pub; 2013.

30. Kahokehr A, Vather R, Nixon A, Hill AG. Non‐steroidal anti‐inflammatory drugs for lower urinary tract symptoms in benign prostatic hyperplasia: systematic review and meta‐analysis of randomized controlled trials. BJU Int 2013; 111(2):304-11.

31. Sirab N, Robert G, Fasolo V, Descazeaud A, Vacherot F, de la Taille A, et al. Lipidosterolic extract of Serenoa repens modulates the expression of inflammation related-genes in benign prostatic hyperplasia epithelial and stromal cells. Int J Mol Sci 2013; 14(7):14301-20.

32. De Nunzio C, Presicce F, Tubaro A. Inflammatory mediators in the development and progression of benign prostatic hyperplasia. Nat Rev Urol 2016; 13(10):613-26.

33. Duffy JF, Scheuermaier K, Loughlin KR. Age-related sleep disruption and reduction in the circadian rhythm of urine output: contribution to nocturia? Curr Aging Sci 2016; 9(1):34-43.

34. Shao IH, Wu CC, Hsu HS, Chang SC, Wang HH, Chuang HC, et al. The effect of nocturia on sleep quality and daytime function in patients with lower urinary tract symptoms: a cross-sectional study. Clin Interv Aging 2016; 11:879-85.

36. Yeo JK, Choi H, Bae JH, Kim JH, Yang SO, Oh CY, et al. Korean clinical practice guideline for benign prostatic hyperplasia. Investig Clin Urol 2016; 57(1):30-44.

37. Weiss JP, Blaivas JG, Blanker MH, Bliwise DL, Dmochowski RR, Drake M, et al. The New England Research Institutes, Inc. (NERI) Nocturia Advisory Conference 2012: focus on outcomes of therapy. BJU Int 2013; 111(5):700-16.

38. Smith A, Wein A. Current pharmacotherapy of nocturia. Expert Opin Pharmacother 2013; 14(7):885-94.

39. Zurier RB. Prostaglandins, leukotrienes, and Related Compounds. In: Mackay IR, Rose NR, Diamond B, Davidson A. Encyclopedia of Medical Immunology. New York: Springer; 2014.

40. Akasaka H, Ruan KH. Identification of the two-phase mechanism of arachidonic acid regulating inflammatory prostaglandin E2 biosynthesis by targeting COX-2 and mPGES-1. Arch Biochem Biophys 2016; 603:29-37.

41. Mederle K, Meurer M, Castrop H, Höcherl K. Inhibition of COX-1 attenuates the formation of thromboxane A2 and ameliorates the acute decrease in glomerular filtration rate in endotoxemic mice. Am J Physiol Renal Physiol 2015; 309(4):F332-40.

42. Gordish KL, Beierwaltes WH. Resveratrol induces acute endothelium-dependent renal vasodilation mediated through nitric oxide and reactive oxygen species scavenging. Am J Physiol Renal Physiol; 306(5):F542-50.

43. Kahokehr A, Vather R, Nixon A, Hill AG. Non‐steroidal anti‐inflammatory drugs for lower urinary tract symptoms in benign prostatic hyperplasia: systematic review and meta‐analysis of randomized controlled trials. BJU Int 2013; 111(2):304-11.

44. Torkko KC, Wilson RS, Smith EE, Kusek JW, van Bokhoven A, Lucia MS. Prostate biopsy markers of inflammation are associated with risk of clinical progression of benign prostatic hyperplasia: findings from the MTOPS study. The Journal of urology 2015; 194(2):454-61.

45. Hypolite JA, Lei Q, Chang S, Zderic SA, Butler S, Wein AJ, et al. Spontaneous and evoked contractions are regulated by PKC-mediated signaling in detrusor smooth muscle: involvement of BK channels. Am J Physiol Renal Physiol 2013; 304(5):F451-62.

46. Hofer MJ, Campbell IL. Immunoinflammatory diseases of the central nervous system–the tale of two cytokines. Br J Pharmacol 2016; 173(4):716-28.

47. Coomans CP, Geerling JJ, van den Berg SA, van Diepen HC, Garcia-Tardón N, Thomas A, et al. The insulin sensitizing effect of topiramate involves KATP channel activation in the central nervous system. Br J Pharmacol 2013; 170(4):908-18.

48. Marshall SD, Raskolnikov D, Blanker MH, Hashim H, Kupelian V, Tikkinen KA, et al. Nocturia: current levels of evidence and recommendations from the international consultation on male lower urinary tract symptoms. Urology; 85(6):1291-9.

50. Tyagi S, Perera S, Clarkson BD, Tadic SD, Resnick NM. Nocturnal polyuria in older women with urge urinary incontinence: role of sleep quality, time in bed, and medications used. J Urol 2016; 197(3 Pt 1):753-8.

51. Miller PS, Hill H, Andersson FL. Nocturia work productivity and activity impairment compared with other common chronic diseases. Pharmacoeconomics 2016; 34(12):1277-97.

52. Flamiatos JF, Beer TM, Graff JN, Eilers KM, Tian W, Sekhon HS, et al. Cyclooxygenase‐2 (COX‐2) inhibition for prostate cancer chemoprevention: double‐blind randomised study of pre‐prostatectomy celecoxib or placebo. BJU Int 2017; 119(5):709-16.

53. Liu TT, Grubisha MJ, Frahm KA, Wendell SG, Liu J, Ricke WA, et al. Opposing Effects of Cyclooxygenase-2 (COX-2) on Estrogen Receptor β (ERβ) response to 5α-reductase inhibition in prostate epithelial cells. J Biol Chem 2016; 291(28):14747-60.

Volume 26, Issue 4July and August 2019Pages 289-296

Volume 26, Issue 4
July and August 2019
Pages 289-296