Efficacy and safety of desmopressin orally disintegrating tablets 25 and 50 µg in male patients with nocturia: A Japanese real-world multicenter clinical study.

OBJECTIVES: To clarify Japanese real-world clinical data on the use of desmopressin 25 and 50 µg orally disintegrating tablets (ODT) for male patients with nocturia and evaluate the predictive factors to improve nighttime frequency. METHODS: We retrospectively accumulated real-world clinical data from 27 institutions in Japan. Male patients with two or more episodes of nocturia who received desmopressin ODT for nocturnal polyuria (NP) from 2019 through 2021 were included. The primary endpoint was the change of nighttime frequency until 3 months after desmopressin administration. The secondary endpoints were to clarify the persistence rate, adverse events, and predictive factors of decreasing nighttime frequency. RESULTS: A total of 118 patients were eligible to participate in this study. The persistence rate of desmopressin on the Kaplan-Meier curve at week 12 was 51.3. The reason for discontinuation was mainly the occurrence of adverse events in 67 patients (56.8%), particularly hyponatremia in 7 patients (5.9%). Nighttime frequencies at baseline, - 1 month and 1 - 3 months after desmopressin administration were 4.1 ± 1.3, 2.9 ± 1.4 (P < .01), and 2.6 ± 1.3 (P < .01), respectively. The mean nighttime urine volume voided at baseline was significantly larger in patients whose nighttime frequency decreased by two or more times than in those with a decrease of less than two times. CONCLUSIONS: Desmopressin 25 and 50 µg ODT treatments are feasible for male patients with NP in Japanese real-world clinical practice. Patients with higher voided volumes, particularly in the nighttime, may have great benefit from desmopressin.

Effect of testosterone on intracavernous pressure elicited with electrical stimulation of the medial preoptic area and cavernous nerve in male rats.

We studied the effects of castration and testosterone (T) replacement on intracavernous pressure (ICP) elicited with electrical stimulation of the medial preoptic area (MPOA) and cavernous nerve (CN) in male rats. We measured the ICP during electrical stimulation of the MPOA and CN in castrated male rats with and without testosterone replacement. The experimental group consisted of 20-week-old male rats at 2 weeks (n=8), 4 weeks (n=8) and 8 weeks (n=8) after castration, and at 8 weeks after castration with T replacement (n=4). Intact 20-week-old rats (n=8) served as controls. The erectile response was expressed as the ICP/blood pressure (BP) ratio. The ICP/BP ratios during CN stimulation of the animals at 2, 4, and 8 weeks after castration were significantly lower than those of the intact animals. However, the erectile responses were not eliminated. In contrast to these peripherally evoked responses, erectile responses elicited by electrical stimulation of the MPOA were eliminated following castration. After testosterone replacement, both erectile responses were restored. Testosterone plays important roles in both the central and peripheral neural pathways for the maintenance and restoration of erectile capacity. The central control of erection shows more extensive changes following testosterone replacement than the peripheral control.

Erosion of a penile prosthesis due to an indwelling urethral catheter as a late complication.

A case of erosion of a penile prosthesis caused by indwelling of a catheter in the urethra is reported. A 73-year-old man had maintained sexual intercourse with penile prostheses (Jonas prosthesis, 19 cm) for 11 years without any complications until he developed cerebral infarction. One month after starting an indwelling urethral catheter in a neurosurgery clinic, the left-side penile prosthesis eroded from the area of the fossa navicularis, and was immediately removed. This type of complication is not unusual in patients with a neurogenic bladder. However, it is not well recognized in patients who suddenly develop a neurogenic bladder following a long-term uneventful period after the implantation of penile prostheses. Therefore, urologists should inform patients who receive this type of treatment that erosion of the prosthesis may develop when they need an indwelling urethral catheter as a late complication.