PubMed Health⌕ Search

Biomedical subjects

J P Norgaard

Publications and source records attributed to J P Norgaard.

9 recordsLinked to original sources
PubMed2006

Desmopressin treatment in nocturia; an analysis of risk factors for hyponatremia.

AIMS: To explore the incidence, severity, time course, and risk factors of clinically significant hyponatremia in desmopressin treatment for nocturia. METHODS: Data from three multi-center phase III trials were pooled. Hyponatremia was categorised as borderline (134-130 mmol/L) or significant (<130 mmol/L). Risk factors were explored with logistic regression and subgroup analysis performed to explore threshold values for contra-indication. RESULTS: In total 632 patients (344 men, 288 women) were analyzed. During dose-titration, serum sodium concentration below normal range was recorded in 95 patients (15%) and 31 patients (4.9%) experienced significant hyponatremia. The risk increased with age, lower serum sodium concentration at baseline, higher basal 24-hr urine volume per bodyweight and weight gain at time of minimum serum sodium concentration. Age was the best single predictor. Elderly patients (>or=65 years of age) with a baseline serum sodium concentration below normal range were at high risk (75%). Limiting treatment in elderly with normal basal serum sodium concentration to those below 79 years and with a 24-hr urine output below 28 ml/kg would reduce the risk from 8.1% to 3.0% at the cost of 34% fulfilling the contra-indication. CONCLUSIONS: The majority of nocturia patients tolerate desmopressin treatment without clinically significant hyponatremia. However, the risk increases with increasing age and decreasing baseline serum sodium concentration. Treatment of nocturia in elderly patients with desmopressin should only be undertaken together with careful monitoring of the serum sodium concentration. Patients with a baseline serum sodium concentration below normal range should not be treated.

Adult↗
PubMed2004

Antidiuresis: a new concept in managing female daytime urinary incontinence.

OBJECTIVE: To investigate the efficacy of desmopressin nasal spray on daytime urinary incontinence in women. PATIENTS AND METHODS: A multicentre, multinational, randomized, double-blind, placebo-controlled, cross-over exploratory study of women (aged 18-80 years) complaining of severe daytime urinary incontinence was conducted in three centres (King's College Hospital; Boras County Hospital and Skejby Hospital). Seventy-five patients were screened of whom 64 were randomized. In all, 60 women received study medication (safety population) and 57 completed the study. The intention-to-treat population comprised 59 patients and there were 41 in the per protocol analysis. The primary efficacy endpoint was the number of periods with no leakage for 4 h after dosing. Women were instructed to take the drug at a time of their choosing, but >/= 4 h before bedtime. Secondary efficacy variables included the time to first void or incontinence episode, volume leaked per incontinence episode, total volume voided and number of periods with no leakage. All measurements were made over 7 days on desmopressin and 3 days on placebo. RESULTS: There was a higher mean (sd) incidence of periods with no leakage in the first 4 h on desmopressin, at 62 (35)%, than on placebo, at 48 (40)%, and during the first 8 h, at 55 (37)% vs 40 (41)%. There was also a higher frequency of dry days on desmopressin than on placebo; 36% of patients had no leakage on virtually all treatment days (6 or 7) for 4 h after dosing. At 4-8 h the incidence of periods with no leakage on desmopressin was 68 (35)% vs 63 (41)% on placebo, and thereafter the incidence was similar. The time from dosing to first incontinence episode was longer on desmopressin, at 6.3 (2.5) h, vs 5.2 (3.3) h, whilst the volume leaked per incontinence episode was lower on desmopressin than placebo. The total volume voided was consistently lower on desmopressin, at 1180 (58) mL vs 1375 (57) mL, over the 24-h period after administration. There were no serious or severe adverse events reported. Seven women (11%) withdrew from the study, of whom five did not attend for the final visit and two (3%) because of mild adverse events. CONCLUSIONS: The results of this exploratory study suggest that desmopressin is an effective and safe treatment in women with daytime urinary incontinence, and allows them to choose when they need treatment, thus improving motivation, which may aid compliance with therapy.

Administration, Intranasal↗
PubMed2003

Differences between nocturics and non-nocturics in voiding patterns: an analysis of frequency-volume charts from community-dwelling elderly.

OBJECTIVE: To evaluate differences between elderly people with and without nocturia (waking up in the night to void) in terms of voiding habits, urine production and voided volumes. SUBJECTS AND METHODS: Nocturics or= two voids/night) and non-nocturics (< one void/night) were recruited from a questionnaire survey. Subjects were asked to complete a 3-day frequency-volume chart, including time and volume of each void, and their bedtime and waking time. Diaries from 108 non-nocturics and 116 nocturics were analysed. The number of voids, urine production, largest and average voided volumes were analysed using repeated-measures analysis of variance models, controlling for variables such as age, gender, body weight and gender-diagnosis interaction. RESULTS: Nocturnal urine volume was higher in nocturics than in non-nocturics. The difference between the groups was larger among the men (estimated difference 384 mL) than among the women (227 mL), but highly statistically significant (P < 0.001) in both genders. Among the men the diurnal urine and 24-h urine volumes were significantly higher in nocturics (difference, diurnal 131 mL, 24-h 462 mL, both P < 0.001). In the women the diurnal urine volume was lower in nocturics than in non-nocturics (difference 147 mL P = 0.0022) with no difference detected in 24-h urine volume. The largest voided volume was significantly less in nocturics than in non-nocturics; the difference was larger in women (128 mL, P < 0.001) than in men (42 mL, P = 0.0027). The average voided volume was 85 mL less (P < 0.001) in nocturics. The overlap between the groups in nocturnal urine and voided volumes was substantial and several significant covariates identified. The ratio between nocturnal urine volume and largest voided volume was the most statistically significant predictor of the number of nocturnal voids. CONCLUSION: Elderly nocturics had a higher nocturnal urine production and lower volume per void than non-nocturics. Differences between nocturics and non-nocturics in urine production and largest voided volume did not follow the same pattern in men and women. Nocturia was a result of a mismatch between nocturnal urine volume and largest voided volume, rather than abnormal values in either. The treatment of nocturia should be directed at one or both of these factors, depending on the findings from the 3-day frequency-volume chart of the individual.

Aged↗
PubMed2003

Desmopressin in elderly patients with nocturia: short-term safety and effects on urine output, sleep and voiding patterns.

OBJECTIVE: To investigate the short-term safety of desmopressin in elderly patients with nocturia, with special focus on the risk of hyponatraemia, and to assess the short-term effects on urine output, sleep and voiding patterns. PATIENTS AND METHODS: Patients (72) were recruited from a study using frequency-volume charts, which in turn was preceded by a questionnaire study. Each patient took one 0.2 mg desmopressin tablet at bedtime for three consecutive nights and kept a frequency-volume chart. Serum sodium was assessed in the morning after the first and the third dose. Patients with a mean serum sodium level during treatment deviating more than five units from baseline were considered sensitive to change in serum sodium. Potential predictors for sodium sensitivity and response were investigated with logistic and multiple regression. RESULTS: All 72 enrolled patients completed the trial; no serious adverse events occurred and no adverse events of severe intensity were recorded. Six patients were sensitive to change in serum sodium. The risk (odds ratio, 95% confidence interval) increased with increasing age (1.3, 1.1-1.6), concomitant cardiac disease (10.0, 0.9-105.8) and increasing baseline 24-h urine output (1.2, 1.0-1.5). Patients sensitive to change in serum sodium were pharmacological responders and desmopressin had a greater effect on their 24-h diuresis, indicating that the drug effect was not limited to the night only. CONCLUSION: Desmopressin was well tolerated in elderly patients with nocturia, but the results suggest that serum sodium should be measured before and after a few days of treatment.

Aged↗
PubMed2003

Nocturia and associated morbidity in a community-dwelling elderly population.

OBJECTIVE: To investigate the association between nocturia and selected concomitant diseases and medications in a community-dwelling elderly population. SUBJECTS AND METHODS: Data were obtained with a validated questionnaire mailed to all inhabitants aged >or= 65 years in Tierp, Sweden. Descriptive statistics on age, gender, concomitant diseases and medications were calculated for non-nocturics (subjects reporting a mean of < 1 void/night), intermediate (reporting a mean of 1-2 voids/night) and nocturics (reporting a mean of >or= 2 voids/night). Correlations between the number of nocturnal voids/week and concomitant diseases/medications were investigated with logistic regression, controlling for age and gender. RESULTS: Of the 4264 questionnaires sent, 67% (2866) were returned, of which 73% (2081) were fully evaluable on nocturia and incorporated in the analysis. Of these, 62% reported >or= 1 void/night and 29%>or= 2 voids/night. The median (range) age of the respondents was 74 (65-99) years. The prevalence of nocturia increased with age and men reported more nocturia than women. The nocturic group had the highest percentage of reported disease and medication on each question. In the logistic regression, controlling for age and gender, there was no significant correlation between the number of nocturnal voids and hypertension, angina pectoris or diabetes mellitus, nor with treatment of these diseases. Neither was there any correlation for congestive heart failure, snoring, use of diuretics or hypnotics. There were highly statistically significant correlations (P < 0.001) between the increase in number of nocturnal voids and incontinence, daytime urge and nocturnal thirst. The increase in number of nocturnal voids was negatively correlated with good sleep and with feeling in good health (P < 0.001). CONCLUSION: There was no correlation between the number of nocturnal voids and a known and treated hypertension, angina pectoris, congestive heart failure or diabetes mellitus. The number of nocturnal voids was highly correlated with urge and incontinence.

Age Distribution↗
PubMed1994

Total transurethral resection versus minimal transurethral resection of the prostate--a 10-year follow-up study of urinary symptoms, uroflowmetry and residual volume.

OBJECTIVE: To assess the long-term results of total transurethral resection (T-TURP) and minimal transurethral resection of the prostate (M-TURP) in patients with obstructive symptoms caused by benign prostatic hyperplasia. PATIENTS AND METHODS: Between September 1979 and September 1980, 167 patients were studied: 83 were randomized to T-TURP and 84 to M-TURP. The patients were examined pre-operatively and 6 and 12 months post-operatively. Ten years post-operatively they were invited to attend for further examination, including uroflowmetry, determination of residual volume and evaluation of subjective symptoms. RESULTS: At the 10-year follow-up 39 patients were found to have died and 47 were lost to follow-up. Twelve patients had undergone repeat TURP and seven had been treated for urethral stricture. Thus 33 T-TURP and 29 M-TURP patients underwent detailed examination. Significant relief in obstructive and irritative symptoms was seen in both groups. The improvement in maximum flow rate remained stable throughout the follow-up period, with no significant differences between the two groups. Post-void residual urine decreased throughout follow-up, with minor differences between the groups. CONCLUSION: M-TURP is recommended as an alternative to T-TURP.

Adult↗