Soonchunhyang Medical Science 20(1):18-23, June 2014 pissn: I eissn: ORIGINAL ARTICLE 전립선비대증환자에서알파차단제의야간뇨개선효과 이상욱 1, 이창호 2 1 순천향대학

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1 Soonchunhyang Medical Science 20(1):18-23, June 2014 pissn: I eissn: ORIGINAL ARTICLE 전립선비대증환자에서알파차단제의야간뇨개선효과 이상욱 1, 이창호 2 1 순천향대학교부천병원비뇨기과, 2 순천향대학교천안병원비뇨기과 The Effect of alpha-blocker Treatment for Nocturia with Benign Prostatic Hyperplasia Sang-Wook Lee 1, Changho Lee 2 1 Department of Urology, Soonchunhyang University Bucheon Hospital, Bucheon; 2 Department of Urology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea Objective: Nocturia is one of the most bothersome complaints in men with benign prostatic hyperplasia. It might be valuable to determine if alpha-blocker treatment for benigh prostatic hyperplasia can improve nocturia and the quality of life (QoL). The purpose of this study was to determine the efficacy of alpha blocker therapy in benigh prostatic hyperplasia patients with nocturia. Methods: From January 2004 to June 2006, 68 men ( 45 years) with lower urinary tract symptoms (LUTS: International Prostatic Symptom Score (IPSS) 12) and benign prostatic hyperplasia by transrectal ultrasonography ( 25 ml) and a maximal urine flow rate (Qmax 12) were selected for this study. The efficacy of alpha blocker treatment was assessed by analyzing IPSS, QoL, Qmax, and postvoid residual urine (PVR). The data for these parameters was acquired at baseline and after short-term (range, 4-6 weeks) and long-term (range, weeks) treatment. We analyzed the relationships between nocturia and other parameters, including age, prostate volume, Qmax, and PVR after alpha-blocker treatment. Results: Overall, 47 of the 68 patients (69.1%) completed the study. IPSS, QoL, Qmax, and PVR showed significantly improvement after alpha blocker treatment. The nocturia score improved 23.8% after long-term alpha blocker treatment. However, nocturia improvement was lowest among the seven individual symptom scores. Other clinical parameters, including patient age, prostate volume, Qmax, and PVR, were not significantly associated with nocturia; only the LUTS severity was associated with nocturia. Conclusion: Treatment with alpha-blocker can reduce nocturia in benigh prostatic hyperplasia patients and can improve QoL. Keywords: Nocturia; Prostatic hyperplasia; Adrenergic alpha-antagonists 서론야간뇨는수면장애를일으켜삶의질을저하시키는대표적인증상이다 [1]. 야간뇨로인한수면부족은피로도를증가시키고우울증이나심질환같은심각한건강상의이상을초래할수있으며, 낙상과골절이발생하여사망의원인이될수있다는보고도있다 [2,3]. Asplund [4] 는 3회이상의야간뇨를가진남성이그렇지않은남성에비해사망률이 1.9배높다고보고한바있다. 야간뇨는알코 올또는카페인등의과잉수분섭취와야간다뇨 (nocturnal polyuria), 방광용적감소등의다양한원인들로발생할수있고 [5], 전립선비대증또한야간뇨의주요한원인중하나로여겨진다. Blanker 등 [6] 은전립선비대증과야간뇨의연관성이높다고하였는데, 전립선비대증으로새롭게진단받은환자중 71.1% 에서 2회이상의야간뇨가관찰되었으며, 이비율은지역사회에서진단받는수치보다높다고보고한바있다. 일반적으로알파차단제는하부요로증상을동반한전립선비대 Correspondence to: Changho Lee Department of Urology, Soonchunhynag University Cheonan Hospital, Soonchunhyang University College of Medicine, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan , Korea Tel: , Fax: , leech@sch.ac.kr/leech@schmc.ac.kr Received: May 8, 2014 / Accepted after revision: May 9, Soonchunhyang Medical Research Institute This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( 18

2 알파차단제는전립선비대증환자의야간뇨를개선한다 이상욱외 증환자의약물치료에 1차적으로선택되는약제이다. 이에야간뇨를호소하는전립선비대증환자에서알파차단제의야간뇨개선여부및정도를알아보고자하였다. 대상및방법 2004년 1월부터 2006년 6월까지순천향대학교천안병원비뇨기과외래에 1회이상의야간뇨를동반한하부요로증상을호소하는 45세이상의남자환자를대상으로선정하였다. 최초방문시기본검사로병력청취, 혈압측정, 요검사, 혈액요소성질소 / 혈청크레아티닌 (blood urea nitrogen/creatinine), 국제전립선비대증증상표 (International Prostatic Symptom Score, IPSS) 를측정하였고, 정밀검사로경직장초음파검사와요류및배뇨후잔뇨검사그리고전립선특이항원검사를시행하였다. 이중중등도이상의하부요로증상 (IPSS 8), 경직장초음파에서전립선용적이 25 g 이상 (transrectal ultrasonography 25 ml), 요류검사에서최고요속이 12 ml/sec 이하 (maximal urine flow rate [Qmax] 12 ml/sec) 를통해전립선비대증으로진단한 68명을대상으로하였다. 방광결석또는방광종양환자, 조절되지않는당뇨, 고혈압, 요로감염, 뇌혈관질환으로신경인성방광환자, 항콜린성약물, 항이뇨호르몬제등방광기능에영향을줄수있는약물을복용하는환자, 경요도또는개복하전립선수술을시행받은환자등은대상환자에서제외하였다. 알파차단제는 tamsulosine 0.2 mg, doxazosin 4 mg, alfuzosin 10 mg 중한종류로 1일 1회씩 12-14주동안투여하였으며, 약물에따른차이는고려하지않았다. 약물투여전, 단기 (4-6 주 ), 중장기 (12-14주 ) 약물투여후에각각 IPSS, 요류검사와배뇨후잔뇨측정검사를시행하여투여전후의변화를확인하였다. 야간뇨의개선정도는 IPSS의 7번문항의호전정도로평가하였다. 대상환자를연령에따라고연령군 (65세이상 ) 과저연령군 (65세이하 ), 전립선의크기를 40 ml 이상과 40 ml 이하인군, 최고요속을 8 ml/sec 이상인군과 8 ml/sec 미만인군, 잔뇨량을 50 ml 미만, ml, 100 ml 이상인군으로각각나누어, 약물투여후야간뇨의개선정도가연령, 전립선용적, 최고요속및잔뇨와상관관계가있는지를조사하였다. 통계분석은 SPSS ver (SPSS Inc., Chicago, IL, USA) 을이용하였으며, 약물투여전, 단기 (4-6주) 알파차단제투여후, 중장기 (12-14 주 ) 알파차단제투여후각각에서 IPSS, 삶의질증상점수 (quality of life, QoL), Qmax, 배뇨후잔뇨 (postvoid residual urine) 를측정하였고, 차이를 paired-samples t-test를이용하여분석하였다. P-value 는 0.05 미만을통계적유의성의지표로삼았다. 결과 68명의대상환자중단기또는장기치료시에병원을방문하지않은 15명, 전립선조직검사상전립선종양으로진단된 3명, 기타 3 명을제외한 47명 (69.1%) 의의무기록을분석하였다. 총 47명환자의평균연령은 66.0±9.1세 ( 범위, 48-86세 ), 혈중전립선특이항원 (prostate specific antigen) 수치는 2.02±1.67 ng/ml, 전립선용적은 50.2±28.3 ml이었다 (Table 1). 알파차단제투여후 47명환자에서 IPSS 7번문항의야간뇨는 baseline과비교하였을때단기치료후 8.2%, 중장기치료후 23.1% 의호전이관찰되었으며단기치료와장기치료모두에서통계학적으로유의한차이가관찰되었다 (P< 0.05). IPSS는 baseline과비교하여단기치료후 24.3%, 장기치료후 52.7% 의호전이관찰되었다. 배출증상인 IPSS 1, 3, 5, 6과저장증상인 IPSS 2, 4, 7로나누었을때단기치료후각각 27.6%, 19.4%, 중장기치료후각각 58.2%, 44.6% 의통계적으로유의한차이의호전이관찰되었으며 (P<0.05), 배출증상이저장증상에비해보다많이호전되었다. QoL, 최고요속과배뇨후잔뇨량의경우에도단기, 장기치료후호전이관찰되었고통계적으로유의한차이가있었다 (Table 2, Fig. 1). IPSS의 7가지문항에따른호전정도를확인하였을때, IPSS 개별항목에서단기, 중장기치료후통계적으로유의한차이를보이는호전이관찰되었으나, 야간뇨는 IPSS의 7가지문항들중에서호전정도가가장낮았다 (Table 3, Fig. 2). 연령과전립선의크기, 최고요속, 배뇨후잔뇨량, 하부요로증상정도에따른야간뇨의개선효과를확인하였을때, 연령을 65세이상과이하로구분하면 65세이상인군에서는장기치료후에 26.1% 의야간뇨의호전이있었고, 65세이하인군에서는 19.71% 의야간뇨의호전이관찰되었으나양쪽군사이의유의한차이는보이지않았다 (P> 0.05). 경직장초음파검사를통해측정한전립선의크기를 40 ml 이상과이하로구분하여보았을때, 전립선의크기가 40 ml 이상인군에서는장기치료후에 23.4% 의야간뇨의개선이있었고, 40 ml 이하인군에서는 22.7% 의야간뇨의개선이관찰되었 Table 1. The characteristics of patients (n= 47) Characteristic Value Age (yr) 66.0± 9.1 (48-86) < Prostate specific antigen (ng/ml) 2.02± 1.67 Transrectal ultrasonography (ml) 50.2± < Values are presented as mean ± standard deviation (range), number, or mean ± standard deviation. Soonchunhyang Medical Science 20(1):

3 Lee SW, et al. alpha-blocker Can Reduce Nocturia in Benign Prostatic Hyperplasia 으나양쪽군사이의유의한차이는보이지않았다 (P>0.05). 요류 검사를통하여요속을 8 ml/sec 이상과이하로구분하였을때요 속이 8 ml/sec 이상인군에서는장기치료후 27.2% 의야간뇨의호 전이있었고, 8 ml/sec 이하인군에서는 14.9% 의야간뇨의호전이 관찰되었으나양쪽군사이에통계적으로의미있는차이는없었다 % of improvement IPSS Short Long IPSS 7 IPSS IPSS QoL Qmax PVR 1, 3, 5, 6 2, 4, 7 Fig. 1. Improvement rate of nocturia and clinical parameter after short and long term alpha blocker treatment. IPSS, International Prostatic Symptom Score; QoL, quality of life; Qmax, maximal urine flow rate; PVR, postvoid residual urine. (P>0.05). 배뇨후잔뇨량의경우 50 ml 미만과, ml, 100 ml 이상으로구분하여보았을때 50 ml 미만인경우와 100 ml 이 상의잔뇨를가진경우장기치료후각각 21.1%, 30% 로야간뇨의 의미있는호전을보였으나그외의경우에는호전정도에유의한 차이가없었다. 치료전중증의하부요로증상 (IPSS 20) 을가진 경우와중등도의하부요로증상 (IPSS<20) 으로구분하여보았을 때중증의하부요로증상을가진군에서장기치료후 27.5% 로야 간뇨의호전이보여중등도의하부요로증상을가진군의 14.3% 보 % of improvement Short Long IPSS 1 IPSS 2 IPSS 3 IPSS 4 IPSS 5 IPSS 6 IPSS 7 Fig. 2. Comparison of improvement rate between seven individual symptoms. The rate of improvement for nocturia was the lowest among the seven individual symptom score. P< IPSS, International Prostatic Symptom Score. Table 2. Comparison of the clinical parameters between baseline, short, and long term treatment Variable Baseline After treatment After treatment Short (4-6 wk) Improvement rate vs. baseline (%) Long (12-14 wk) Improvement rate vs. baseline (%) IPSS 21.74± ± ± IPSS ± ± ± IPSS 1, 3, 5, ± ± ± IPSS 2, 4, ± ± ± Quality of life 4.38± ± ± Maximal flow rate 7.59± ± ± Postvoid residual urine 81.55± ± ± Values are presented as mean± standard deviation or %. P< IPSS, International Prostatic Symptoms Score. Table 3. Impact of alpha blocker therapy on IPSS Variable Baseline Short term treatment Long term treatment Score Improvement rate vs. baseline (%) P-value Score Improvement rate vs. baseline (%) P-value IPSS 1 (emptying) 3.04± ± < ± < 0.01 IPSS 2 (frequency) 3.06± ± < ± < 0.01 IPSS 3 (intermittency) 3.11± ± < ± < 0.01 IPSS 4 (urgency) 2.55± ± < ± < 0.01 IPSS 5 (weak stream) 4.04± ± < ± < 0.01 IPSS 6 (hesistancy) 2.79± ± < ± < 0.01 IPSS 7 (nocturia) 3.04± ± < ± < 0.01 Values are presented as mean± standard deviation or %. P< IPSS, International Prostatic Symptoms Score Soonchunhyang Medical Science 20(1):18-23

4 알파차단제는전립선비대증환자의야간뇨를개선한다 이상욱외 Table 4. The Comparison between nocturia (IPSS 7) and other parameters, including age, prostate volume, Qmax, and PVR after long term alpha blocker treatment Variable Baseline Long P-value Age (yr) 65 (n= 24) 3.33± ± 1.14 < 0.01 < 65 (n= 23) 2.74± ± Transrectal ultrasonography (ml) 40 (n= 22) 3.08± ± 1.11 < 0.01 < 40 (n= 25) 3.00± ± Qmax (ml/sec) 8 (n= 22) 2.83± ± < 8 (n= 25) 3.14± ± PVR (ml) < 50 (n= 23) 2.85± ± (n= 13) 3.00± ± > 100 (n= 11) 3.33± ± 0.87 < 0.01 IPSS 20 (n= 28) 3.36± ± 1.20 < 0.01 < 20 (n= 19) 2.58± ± Values are presented as mean± standard deviation. P< IPSS, International Prostatic Symptoms Score; Qmax, maximal flow rate; PVR, postvoid residual urine. 다통계적으로의미있는호전이관찰되었다 (P< 0.05) (Table 4, Fig. 3). 고찰 야간뇨는국제요실금학회 (International Continence Society) 에 의하면 야간에배뇨를위하여한번또는그이상일어나는것 으 로정의된다 [7]. 배뇨전에는수면상태이어야하며배뇨후에도수 면으로돌아가야한다. Schatzl 등 [8] 은성인남성의 9-14% 에서 2 회이상의야간뇨가있 으며, 30 대이하에서는 3.4% 이고 60 대이상에서는 32.4% 로증가한 다고보고하였다. 일반적으로노인에서 2 회이상의야간뇨는 24-45% 정도로나타나는데남성과여성의차이는보이지않는다 [9,10]. 야간뇨는야간다뇨, 방광의저장능력저하, 수면장애, 환자 나이의증가등의다양한인자들이단일혹은복합적으로작용하 여발생할수있다. 이중전립선비대증으로새롭게진단된환자의 약 70% 에서 2 회이상의야간뇨를보이고있어전립선비대증이야 간뇨의중요한원인으로여겨진다 [6]. 전립선비대증은방광출구폐 색을유발하거나기능적방광용적저하에따른배뇨량의감소와 증가하는배뇨횟수로인한방광과민성을증가시킨다 [11]. 이로인 해하부요로증상을동반한전립선비대증환자에서야간뇨, 빈뇨, 급박뇨등의저장증상이발생하게된다. 전립선비대증은방광근의 다양한알파아드레날린수용체가작용하여전립선평활근의활성 % of improvement P= <65 Age P= <40 TRUS 을유지하여방광출구폐색을일으키게된다. 이중전립선비대증 환자에서알파 1a 선택적아드레날린차단제를투여했을때배뇨 증상의호전정도와비교하여저장증상은호전정도가낮다 [12]. 이와반대로 tamsulosin 과같은알파 1a/1d 아드레날린선택적차 단제는배뇨증상과더불어저장증상도호전시키게된다 [13]. 이러 한연구결과는방광근의알파 1d 아드레날린수용체아형이하부 요로증상을동반한전립선비대증환자에서야간뇨와같은배뇨증 상과연관되어있음을나타낸다. P=0.350 P=0.438 P= <8 Qmax < PVR 20 <20 IPSS Fig. 3. The improvement rate between nocturia (IPSS 7) and other parameters, including age, prostate volume, Qmax, and PVR after long term alpha blocker treatment. P< TRUS, transrectal ultrasonography; Qmax, maximal flow rate; PVR, postvoid residual urine; IPSS, International Prostatic Symptoms Score. 야간뇨의원인이되는전립선비대증의치료는약물치료와수술 적치료가대표적으로야간뇨에대한치료의효과는다양하게보 고되고있다. 수술적치료의경우경요도전립선절제술이대표적인 데, Bruskewitz 등 [14] 은전립선비대증으로진단받고경요도전립선 절제술을시행하여도 38% 의환자에서하루에 2 회이상의야간뇨 가지속된다고보고하였다. 약물치료에는알파차단제를포함한다 양한약물들의야간뇨에대한효과가보고되고있다. 그러나항이 뇨호르몬제의경우저나트륨혈증과수분저류의위험성이증가할 수있으므로고령환자의치료에는주의를필요로하고 [15], 항콜린 제의경우에도방광출구폐색이있을때는약물사용에상대적인 금기증이있다 [16]. 전립선비대증을동반한야간뇨환자에서 1 차 치료제로사용되는알파차단제의경우에는약물의안전성과유효 성에대해보고되고있다. Johnson 등 [17] 은 terazosin 을 12 개월동 안치료하였을때하루한번이상의야간뇨를호소하는환자에서 는 0.7 회정도의야간뇨횟수의감소가있으며, 2 회이상의야간뇨 를호소하는환자에서는 39% 에서절반이상이야간뇨횟수의감 소가있고부작용이없음을보고한바있다. 국내에서는 Joung 등 [18] 이 tamsulosin 을 1 일 1 회씩 12 주동안투약하여야간뇨를호소 Soonchunhyang Medical Science 20(1):

5 Lee SW, et al. alpha-blocker Can Reduce Nocturia in Benign Prostatic Hyperplasia 하는전립선비대증환자에서야간뇨의호전을보고한바있다. 통상적으로알파차단제는전립선에존재하는평활근을이완하고방광경부의근육장력을감소시켜서배뇨증상을호전시키므로전립선비대증을동반한야간뇨환자에서 1차치료제로사용되고있다. 저자들은야간뇨를호소하는전립선비대증환자에서알파차단제를단독투여를하면서단기 (4-6주) 와장기 (12-14 주 ) 투약후에 IPSS, QoL을추적조사하였을때야간뇨에대한치료효과와삶의질의향상을확인할수있었다. 또한치료전에중증의하부요로증상을가지고있는경우가그렇지않은경우와비교하여치료후에야간뇨의개선정도가높음을확인하였다. 하지만 IPSS의 7가지문항들가운데야간뇨와관련된 IPSS 7번의개선의정도가가장낮게확인되고있고이는 Homma 등 [19] 이보고한바와동일하다. 이를통해야간뇨가전립선비대증에의한하부요로의이상뿐아니라여러가지복합적인원인으로발생할수있음을알수있다. Weiss 등 [20] 의연구에따르면 200명의야간뇨환자중야간뇨의원인으로야간중방광용적감소가 57% 로주원인으로확인되었고, 방광용량감소와야간중다뇨의혼합형태가 36%, 야간중다뇨가 7% 로나타났다. 국내에서는 Kim 등 [21] 이성인야간뇨의원인으로야간다뇨가 67.1% 로주원인을차지하고그외과민성방광, 다뇨등의관련성을보고하였다. 이와같이야간뇨의치료를계획할때에는다양한원인들을고려해야한다. 야간다뇨를동반한야간뇨의경우수면전수분축적방지와수면동안수분의생성을억제하여수분을축적한후수면이끝난후배출하는방법을고려할수있다. 이를위해수면전커피, 술등의섭취를제한하고항이뇨호르몬제의투여를고려할수있는데저나트륨혈증의과거력이있거나신부전, 울혈성심부전, 간경화환자의경우에는투여에신중을기해야한다. 과민성방광이나방광의저장능력저하로인한야간뇨를호소하는경우에는항콜린제의투여를고려할수있고 [1], 다뇨의경우에는일차적으로수분섭취를제한해야한다. 따라서야간뇨를호소하는전립선비대증환자에서는일차적으로알파차단제를사용하고환자의배뇨일지를분석하여야간다뇨, 과민성방광에의한방광저장능력저하, 다뇨등으로구분하여수분섭취제한과항이뇨호르몬제, 항콜린제의추가투여를고려할수있다. 연구과정에서환자의배뇨일지를분석하여다뇨, 야간다뇨, 방광용적감소군을확인하고, 이에따른알파차단제의치료효과를분석하려하였으나, 대상환자들의불완전한배뇨일지작성으로인하여분석을할수없었다. 그러나알파차단제를이용하여하부요로증상을동반한전립선비대증환자에서야간뇨와삶의질개선을확인할수있었던점에서본연구의의미를찾을수있다고생각한다. 하부요로증상을호소하는전립선비대증환자에서알파차단제는야간뇨를개선하고, 이는삶의질향상에도움을줄수있음을확인하였다. 또한보다많은하부요로증상을호소한환자에서야간뇨의개선정도가높음을알수있었다. 본연구에서는알파차단 제의약물간의차이는고려하지않았으나, 개별약물의효과를구 체적으로확인하기위해서는지속적인임상확인을통한추가적인 연구가필요할것으로생각된다. REFERENCES 1. Weiss JP, Blaivas JG. Nocturia. J Urol 2000;163: Bonnet MH, Arand DL. Clinical effects of sleep fragmentation versus sleep deprivation. Sleep Med Rev 2003;7: Akerstedt T, Nilsson PM. Sleep as restitution: an introduction. J Intern Med 2003;254: Asplund R. Mortality in the elderly in relation to nocturnal micturition. BJU Int 1999;84: Nam SG, Moon DG, Kim JJ. Efficacy of desmopressin in treatment of adult nocturia. Korean J Urol 2004;45: Blanker MH, Bohnen AM, Groeneveld FP, Bernsen RM, Prins A, Ruud Bosch JL. Normal voiding patterns and determinants of increased diurnal and nocturnal voiding frequency in elderly men. J Urol 2000;164: Van Kerrebroeck P, Abrams P, Chaikin D, Donovan J, Fonda D, Jackson S, et al. The standardization of terminology in nocturia: report from the standardization subcommittee of the International Continence Society. BJU Int 2002;90 Suppl 3: Schatzl G, Temml C, Schmidbauer J, Dolezal B, Haidinger G, Madersbacher S. Cross-sectional study of nocturia in both sexes: analysis of a voluntary health screening project. Urology 2000;56: Swithinbank LV, Donovan J, James MC, Yang Q, Abrams P. Female urinary symptoms: age prevalence in a community dwelling population using a validated questionnaire. Neurourol Urodyn 1997;16: Brieger GM, Yip SK, Hin LY, Chung TK. The prevalence of urinary dysfunction in Hong Kong Chinese women. Obstet Gynecol 1996;88: Weiss JP, Blaivas JG, Stember DS, Chaikin DC. Evaluation of the etiology of nocturia in men: the nocturia and nocturnal bladder capacity indices. Neurourol Urodyn 1999;18: Price D. Potential mechanisms of action of superselective alpha(1)-adrenoceptor antagonists. Eur Urol 2001;40 Suppl 4: Djavan B. Lower urinary tract symptoms/benign prostatic hyperplasia: fast control of the patient s quality of life. Urology 2003;62(3 Suppl 1): Bruskewitz RC, Larsen EH, Madsen PO, Dorflinger T. 3-year followup of urinary symptoms after transurethral resection of the prostate. J Urol 1986; 136: Andersson KE. The pharmacological treatment of nocturia. BJU Int 2002;90 Suppl 3: Paick JS, Ku JH, Shin JW, Yang JH, Kim SW. alpha-blocker monotherapy in the treatment of nocturia in men with lower urinary tract symptoms: a prospective study of response prediction. BJU Int 2006;97: Johnson TM 2nd, Jones K, Williford WO, Kutner MH, Issa MM, Lepor H. Changes in nocturia from medical treatment of benign prostatic hyperplasia: secondary analysis of the Department of Veterans Affairs Cooperative Study Trial. J Urol 2003;170: Joung JY, Park JK, Park CH, Lee JG, Chung BH, Hong SJ, et al. The role of alpha 1 (A) adrenoceptor antagonist tamsulosin for the treatment of patients with benign prostatic hyperplasia: the effect on lower urinary tract symptoms and nocturia. Korean J Urol 2006;47: Homma Y, Yamaguchi T, Kondo Y, Horie S, Takahashi S, Kitamura T Soonchunhyang Medical Science 20(1):18-23

6 알파차단제는전립선비대증환자의야간뇨를개선한다 이상욱외 Significance of nocturia in the International Prostate Symptom Score for benign prostatic hyperplasia. J Urol 2002;167: Weiss JP, Blaivas JG, Stember DS, Brooks MM. Nocturia in adults: etiology and classification. Neurourol Urodyn 1998;17: Kim ET, Lee SI, Lee KS. The etiology and classification of nocturia in adults. Korean J Urol 2001;42: Soonchunhyang Medical Science 20(1):

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페링야간뇨소책자-내지-16 야간뇨의진단과치료 - 실제적접근 - Reference 1. Choo MS, Ku JH, Park CH et al. Prevalence of Nocturia in a Korean Population Aged 40 to 89 Years. Neurourol Urodyn 2008; 27:60-64. 2. Weiss JP. Prevalence