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Desmopressin 25 and 50 μg oral lyophilisates (Noqdirna®; Nocdurna®) in nocturia due to nocturnal polyuria in adults: a profile of its use. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-018-0480-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Oelke M, De Wachter S, Drake MJ, Giannantoni A, Kirby M, Orme S, Rees J, van Kerrebroeck P, Everaert K. A practical approach to the management of nocturia. Int J Clin Pract 2017; 71:e13027. [PMID: 28984060 PMCID: PMC5698733 DOI: 10.1111/ijcp.13027] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/11/2017] [Indexed: 12/11/2022] Open
Abstract
AIM To raise awareness on nocturia disease burden and to provide simplified aetiologic evaluation and related treatment pathways. METHODS A multidisciplinary group of nocturia experts developed practical advice and recommendations based on the best available evidence supplemented by their own experiences. RESULTS Nocturia is defined as the need to void ≥1 time during the sleeping period of the night. Clinically relevant nocturia (≥2 voids per night) affects 2%-18% of those aged 20-40 years, rising to 28%-62% for those aged 70-80 years. Consequences include the following: lowered quality of life; falls and fractures; reduced work productivity; depression; and increased mortality. Nocturia-related hip fractures alone cost approximately €1 billion in the EU and $1.5 billion in the USA in 2014. The pathophysiology of nocturia is multifactorial and typically related to polyuria (either global or nocturnal), reduced bladder capacity or increased fluid intake. Accurate assessment is predicated on frequency-volume charts combined with a detailed patient history, medicine review and physical examination. Optimal treatment should focus on the underlying cause(s), with lifestyle modifications (eg, reducing evening fluid intake) being the first intervention. For patients with sustained bother, medical therapies should be introduced; low-dose, gender-specific desmopressin has proven effective in nocturia due to idiopathic nocturnal polyuria. The timing of diuretics is an important consideration, and they should be taken mid-late afternoon, dependent on the specific serum half-life. Patients not responding to these basic treatments should be referred for specialist management. CONCLUSIONS The cause(s) of nocturia should be first evaluated in all patients. Afterwards, the underlying pathophysiology should be treated specifically, alone with lifestyle interventions or in combination with drugs or (prostate) surgery.
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Affiliation(s)
- Matthias Oelke
- Department of UrologyUniversity of MaastrichtMaastrichtThe Netherlands
| | | | | | - Antonella Giannantoni
- Department of Surgical and Biomedical Sciences, Urology and Andrology UnitUniversity of PerugiaPerugiaItaly
| | - Mike Kirby
- The Centre for Research in Primary and Community CareThe University of Hertfordshire and The Prostate CentreLondonUK
| | - Susan Orme
- Department of Geriatric MedicineBarnsley Hospital NHS Foundation Trust HospitalBarnsleyUK
| | | | | | - Karel Everaert
- Department of UrologyGhent University HospitalGhentBelgium
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Cohn JA, Kowalik CG, Reynolds WS, Kaufman MR, Milam DF, Dmochowski RR, Wein AJ. Desmopressin acetate nasal spray for adults with nocturia. Expert Rev Clin Pharmacol 2017; 10:1281-1293. [DOI: 10.1080/17512433.2017.1394185] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Joshua A. Cohn
- Department of Urology, Einstein Healthcare Network, Philadelphia, PA USA
| | - Casey G. Kowalik
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - W. Stuart Reynolds
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melissa R. Kaufman
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Douglas F. Milam
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Roger R. Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alan J. Wein
- Division of Urology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Denys MA, Decalf V, Kumps C, Petrovic M, Goessaert AS, Everaert K. Pathophysiology of nocturnal lower urinary tract symptoms in older patients with urinary incontinence. Int J Urol 2017; 24:808-815. [DOI: 10.1111/iju.13431] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/09/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Veerle Decalf
- Department of Urology; Ghent University Hospital; Ghent Belgium
| | - Candy Kumps
- Department of Urology; Ghent University Hospital; Ghent Belgium
| | - Mirko Petrovic
- Department of Geriatrics; Ghent University Hospital; Ghent Belgium
| | | | - Karel Everaert
- Department of Urology; Ghent University Hospital; Ghent Belgium
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Weidlich D, Andersson FL, Oelke M, Drake MJ, Jonasson AF, Guest JF. Annual direct and indirect costs attributable to nocturia in Germany, Sweden, and the UK. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:761-771. [PMID: 27678109 PMCID: PMC5486451 DOI: 10.1007/s10198-016-0826-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/25/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Our aim was to estimate the prevalence-based cost of illness imposed by nocturia (≥2 nocturnal voids per night) in Germany, Sweden, and the UK in an average year. METHODS Information obtained from a systematic review of published literature and clinicians was used to construct an algorithm depicting the management of nocturia in these three countries. This enabled an estimation of (1) annual levels of healthcare resource use, (2) annual cost of healthcare resource use, and (3) annual societal cost arising from presenteeism and absenteeism attributable to nocturia in each country. RESULTS In an average year, there are an estimated 12.5, 1.2, and 8.6 million patients ≥20 years of age with nocturia in Germany, Sweden, and the UK, respectively. In an average year in each country, respectively, these patients were estimated to have 13.8, 1.4, and 10.0 million visits to a family practitioner or specialist, ~91,000, 9000, and 63,000 hospital admissions attributable to nocturia and 216,000, 19,000, and 130,000 subjects were estimated to incur a fracture resulting from nocturia. The annual direct cost of healthcare resource use attributable to managing nocturia was estimated to be approximately €2.32 billion in Germany, 5.11 billion kr (€0.54 billion) in Sweden, and £1.35 billion (€1.77 billion) in the UK. The annual indirect societal cost arising from both presenteeism and absenteeism was estimated to be approximately €20.76 billion in Germany and 19.65 billion kr (€2.10 billion) in Sweden. In addition, in the UK, the annual indirect cost due to absenteeism was an estimated £4.32 billion (€5.64 billion). CONCLUSIONS Nocturia appears to impose a substantial socioeconomic burden in all three countries. Clinical and economic benefits could accrue from an increased awareness of the impact that nocturia imposes on patients, health services, and society as a whole.
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Affiliation(s)
- Diana Weidlich
- Catalyst Health Economics Consultants, 34b High Street, Northwood, Middlesex, HA6 1BN, UK
| | - Fredrik L Andersson
- Ferring Pharmaceuticals, Copenhagen, Denmark
- Center for Medical Technology Assessment (CMT), Linköping University, Linköping, Sweden
| | - Matthias Oelke
- Department of Urology, Hanover Medical School, Hannover, Germany
| | | | - Aino Fianu Jonasson
- Division of Obstetrics and Gynaecology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Julian F Guest
- Catalyst Health Economics Consultants, 34b High Street, Northwood, Middlesex, HA6 1BN, UK.
- Faculty of Life Sciences and Medicine, King's College, London, UK.
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ROVNER ES, RAYMOND K, ANDRUCZYK E, JUUL KV. Low-dose Desmopressin and Tolterodine Combination Therapy for Treating Nocturia in Women with Overactive Bladder: A Double-blind, Randomized, Controlled Study. Low Urin Tract Symptoms 2017; 10:221-230. [DOI: 10.1111/luts.12169] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/07/2016] [Accepted: 01/15/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Eric S. ROVNER
- Department of Urology, Medical University of South Carolina; Charleston South Carolina USA
| | | | - Eugene ANDRUCZYK
- Clinical Research of Philadelphia, LLC; Philadelphia Pennsylvania USA
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Epstein M, Blaivas J, Wein AJ, Weiss JP. Nocturia treatment outcomes: Analysis of contributory frequency volume chart parameters. Neurourol Urodyn 2017; 37:186-191. [DOI: 10.1002/nau.23272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/24/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Matthew Epstein
- Department of UrologySUNY Downstate College of MedicineBrooklynNew York
| | - Jerry Blaivas
- Department of UrologySUNY Downstate College of MedicineBrooklynNew York
- Department of UrologyWeill Cornell Medical CollegeNew YorkNew York
| | - Alan J. Wein
- Department of UrologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvania
| | - Jeffrey P. Weiss
- Department of UrologySUNY Downstate College of MedicineBrooklynNew York
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Denys MA, Bruneel E, Van Laecke S, Nørgaard JP, Everaert K. Pitfalls and opportunities in multidisciplinary research about nocturia in adults. Acta Clin Belg 2017; 72:2-5. [PMID: 27164325 DOI: 10.1080/17843286.2016.1177276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Describe current shortcomings in clinical research on the treatment of nocturia in adults, and suggest new directions for future studies in this field. METHODS A literature search was conducted using the keywords 'nocturia,' 'nocturnal polyuria,' 'sleep,' and 'hypertension.' RESULTS Nocturia, or waking up at night to void, is a highly prevalent and bothersome lower urinary tract symptom (LUTS) affecting up to 40% of adults. Since the majority of patients are diagnosed with nocturnal polyuria (NP) as one of the underlying causes, it is not surprising that the effect of treatments for overactive bladder (OAB) and bladder outlet obstruction (BOO) are disappointing with regard to nocturia. Therefore, we suggest to conduct studies in which nocturic patients are treated according to the underlying pathophysiology: (1) antimuscarinics or β3-agonists for OAB symptoms, (2) α-blockers or 5α-reductase inhibitors in men with BOO caused by enlarged prostates, (3) desmopressin or diuretics for NP, (4) continuous positive airway pressure in nocturic patients with obstructive sleep apnea, and (5) all its combinations in case of combined pathophysiology. Not only the effect on treatment efficacy or side effects needs to be assessed, but also the impact on related comorbidities such as sleep disorders, hypertension, and endocrine functions such as blood glucose regulation. CONCLUSION Future research needs to subtype nocturic patients in order to adapt treatment according to the underlying cause.
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Affiliation(s)
| | - Elke Bruneel
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Jens Peter Nørgaard
- Ferring, Global Scientific Affairs Urology, Ferring International PharmaScience Centre, Copenhagen, Denmark
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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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; 197:753-758. [PMID: 27678299 DOI: 10.1016/j.juro.2016.09.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE Nocturia is common and bothersome in older adults, especially those who are also incontinent. Since nocturnal polyuria is a major contributor, we examined factors associated with nocturnal polyuria in this population to identify those possibly amenable to intervention. MATERIALS AND METHODS We analyzed baseline data from 2 previously completed studies of urge urinary incontinence. The studies involved 284 women (mean age ± SD 72.9 ± 7.9 years) who also completed 3-day voiding diaries. Participants with a nocturnal polyuria index greater than 33% were categorized as having nocturnal polyuria (nocturnal polyuria index = nocturnal urinary volume per 24-hour urine volume). Associations between nocturnal polyuria and various demographic, clinical and sleep related parameters were determined. RESULTS Overall 55% of the participants had nocturnal polyuria. Multivariable regression analysis revealed that age, body mass index, use of angiotensin converting enzyme inhibitor/angiotensin receptor blocker, time spent in bed and duration of first uninterrupted sleep were independent correlates of nocturnal polyuria. Participants with a larger nocturnal excretion reported a shorter duration of uninterrupted sleep before first awakening to void and worse sleep quality despite spending similar time in bed. CONCLUSIONS Body mass index, use of angiotensin converting enzyme inhibitor/angiotensin receptor blockers, time in bed and duration of uninterrupted sleep before first awakening to void are independently associated with nocturnal polyuria in older women with urge urinary incontinence, and are potentially modifiable. These findings also confirm the association between sleep and nocturnal polyuria. Further studies should explore whether interventions to reduce nocturnal polyuria and/or increase the duration of uninterrupted sleep before first awakening to void would help to improve sleep quality in this population and thereby reduce or eliminate the need for sedative hypnotics.
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Affiliation(s)
- Shachi Tyagi
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Subashan Perera
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Becky D Clarkson
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stasa D Tadic
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Neil M Resnick
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Denys MA, Cherian J, Rahnama'i MS, O'Connell KA, Singer J, Wein AJ, Dhondt K, Everaert K, Weiss JP. ICI-RS 2015-Is a better understanding of sleep the key in managing nocturia? Neurourol Urodyn 2016; 37:2048-2052. [DOI: 10.1002/nau.23032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 04/18/2016] [Indexed: 11/05/2022]
Affiliation(s)
| | - Jerald Cherian
- Department of Urology; SUNY Downstate College of Medicine; New York
| | - Mohammad S. Rahnama'i
- Department of Urology; Maastricht University Medical Centre, Maastricht; The Netherlands
| | - Kathleen A. O'Connell
- Department of Health and Behavior Studies; Teachers College; Columbia University; New York
| | - Jonathan Singer
- Department of Health and Behavior Studies; Teachers College; Columbia University; New York
| | - Alan J. Wein
- Department of Urology; Perelman School of Medicine-University of Pennsylvania; Philadelphia
| | - Karlien Dhondt
- Department of Child Neurology and Metabolism; Pediatric Sleep Center; Ghent University Hospital; Ghent Belgium
| | - Karel Everaert
- Department of Urology; Ghent University Hospital; Ghent Belgium
| | - Jeffrey P. Weiss
- Department of Urology; SUNY Downstate College of Medicine; New York
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Vicente E, Barrio M, Gual J, Fadil Y, Capdevila M, Muñoz J, Garcia D, Hannaoui N, Prats J. Spanish (Spain) validation of a specific symptomatic questionnaire for male patients with nocturia. Neurourol Urodyn 2016; 35:847-50. [DOI: 10.1002/nau.22814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 05/29/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Eduardo Vicente
- Urology Department; Parc Taulí Universitary Hospital; Sabadell Barcelona Spain
| | - Míriam Barrio
- Urology Department; Parc Taulí Universitary Hospital; Sabadell Barcelona Spain
| | - Josep Gual
- Urology Department; Parc Taulí Universitary Hospital; Sabadell Barcelona Spain
| | - Younes Fadil
- Urology Department; Parc Taulí Universitary Hospital; Sabadell Barcelona Spain
| | - Marta Capdevila
- Urology Department; Parc Taulí Universitary Hospital; Sabadell Barcelona Spain
| | - Jesús Muñoz
- Urology Department; Parc Taulí Universitary Hospital; Sabadell Barcelona Spain
| | - Darío Garcia
- Urology Department; Parc Taulí Universitary Hospital; Sabadell Barcelona Spain
| | - Naim Hannaoui
- Urology Department; Parc Taulí Universitary Hospital; Sabadell Barcelona Spain
| | - Joan Prats
- Urology Department; Parc Taulí Universitary Hospital; Sabadell Barcelona Spain
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Kim JW, Moon YT, Kim KD. Nocturia: The circadian voiding disorder. Investig Clin Urol 2016; 57:165-73. [PMID: 27195315 PMCID: PMC4869573 DOI: 10.4111/icu.2016.57.3.165] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 04/22/2016] [Indexed: 11/23/2022] Open
Abstract
Nocturia is a prevalent condition of waking to void during the night. The concept of nocturia has evolved from being a symptomatic aspect of disease associated with the prostate or bladder to a form of lower urinary tract disorder. However, recent advances in circadian biology and sleep science suggest that it might be important to consider nocturia as a form of circadian dysfunction. In the current review, nocturia is reexamined with an introduction to sleep disorders and recent findings in circadian biology in an attempt to highlight the importance of rediscovering nocturia as a problem of chronobiology.
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Affiliation(s)
- Jin Wook Kim
- Department of Urology, Chung-Ang University, Seoul, Korea
| | - Young Tae Moon
- Department of Urology, Chung-Ang University, Seoul, Korea
| | - Kyung Do Kim
- Department of Urology, Chung-Ang University, Seoul, Korea
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Miotla P, Cartwright R, Futyma K, Bogusiewicz M, Skorupska K, Winkler I, Rechberger T. Can botox improve night-time overactive bladder symptoms in women? Neurourol Urodyn 2016; 36:648-652. [PMID: 26915654 DOI: 10.1002/nau.22983] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/06/2016] [Indexed: 01/22/2023]
Abstract
AIMS Despite the efficacy of intravesical onabotulinumtoxinA (Botox) therapy for urgency, urgency incontinence, and daytime frequency, its value in treatment of nocturia remains unclear. The aim of the prospective observational study was to assess the effect of onabotulinumtoxinA on night-time symptoms in women with overactive bladder (OAB), including nocturia, night-time urgency incontinence, and nocturnal voided volume as end-points. METHODS Women with idiopathic OAB (with at least one episode of urgency urinary incontinence (UUI) per day, ≥8 micturitions per 24 hr, and ≥2 nocturia episodes per night) were enrolled. Patients with nocturnal polyuria were excluded. Botox (100 U) was administered in 20 intra-detrusor injections. Post-void residual volumes (PVR) were checked at 2, 4, and 12 weeks. Participants completed a 3-day bladder diary and the King's Health Questionnaire (KHQ) before and 12 weeks after treatment, and reported the efficacy of the treatment on visual analog scale (VAS) at the final follow-up visit. RESULTS Seventy-six women completed the study. Botox injections were effective in the reduction of nocturia episodes (mean -0.98; P < 0.001) and night-time UUI episodes (-0.37; P < 0.001) compared to the baseline. The increase of mean voided volume of the night-time micturitions was 92.6 ml (P < 0.001). Patients reported a mean 58 points of improvement on the VAS. Urinary retention, which required self-catheterization, was observed in three patients. CONCLUSIONS Intravesical Botox injection provides significant benefit for night-time symptoms in OAB patients. Our results are applicable for women without nocturnal polyuria, and should prove useful when counseling patients about the risks and benefits of Botox. Neurourol. Urodynam. 36:648-652, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Pawel Miotla
- Department of Gynaecology, Medical University of Lublin, Lublin, Poland
| | - Rufus Cartwright
- Department of Epidemiology and Biostatistics, Department of Urogynaecology, Imperial College London, London, United Kingdom
| | - Konrad Futyma
- Department of Gynaecology, Medical University of Lublin, Lublin, Poland
| | | | | | - Izabela Winkler
- Department of Gynaecology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Rechberger
- Department of Gynaecology, Medical University of Lublin, Lublin, Poland
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Yeo JK, Choi H, Bae JH, Kim JH, Yang SO, Oh CY, Cho YS, Kim KW, Kim HJ. Korean clinical practice guideline for benign prostatic hyperplasia. Investig Clin Urol 2016; 57:30-44. [PMID: 26966724 PMCID: PMC4778754 DOI: 10.4111/icu.2016.57.1.30] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 12/24/2015] [Indexed: 11/18/2022] Open
Abstract
In 2014, the Korean Urological Association organized the Benign Prostatic Hyperplasia Guideline Developing Committee composed of experts in the field of benign prostatic hyperplasia (BPH) with the participation of the Korean Academy of Family Medicine and the Korean Continence Society to develop a Korean clinical practice guideline for BPH. The purpose of this clinical practice guideline is to provide current and comprehensive recommendations for the evaluation and treatment of BPH. The committee developed the guideline mainly by adapting existing guidelines and partially by using the de novo method. A comprehensive literature review was carried out primarily from 2009 to 2013 by using medical search engines including data from Korea. Based on the published evidence, recommendations were synthesized, and the level of evidence of the recommendations was determined by using methods adapted from the 2011 Oxford Centre for Evidence-Based Medicine. Meta-analysis was done for one key question and four recommendations. A draft guideline was reviewed by expert peer reviewers and discussed at an expert consensus meeting until final agreement was achieved. This evidence-based guideline for BPH provides recommendations to primary practitioners and urologists for the diagnosis and treatment of BPH in men older than 40 years.
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Affiliation(s)
- Jeong Kyun Yeo
- Department of Urology, Inje University College of Medicine, Busan, Korea
| | - Hun Choi
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Jae Hyun Bae
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Seong Ok Yang
- Department of Urology, VHS Medical Center, Seoul, Korea
| | - Chul Young Oh
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Young Sam Cho
- Department of Urology, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Kyoung Woo Kim
- Department of Family Medicine, Inje University College of Medicine, Busan, Korea
| | - Hyung Ji Kim
- Department of Urology, Dankook University College of Medicine, Cheonan, Korea
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Borkowski T, Golabek T, Chlosta PL, Borkowski A. Evaluation and management of male lower urinary tract symptoms: treatment patterns and guidelines in a correlation study among Polish urology consultants. Arch Med Sci 2015; 11:1340-51. [PMID: 26788100 PMCID: PMC4697063 DOI: 10.5114/aoms.2015.56358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 01/28/2014] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION In March 2013, the European Association of Urology (EAU) released a new edition of the guidelines on management of male lower urinary tract symptoms (LUTS), including benign prostatic obstruction. The objective of this study was to evaluate how well the EAU guidelines have been implemented in day-to-day practice by Polish urologists. MATERIAL AND METHODS A structured questionnaire, which explored how urologists diagnose and manage male lower urinary tract symptoms, was emailed to all certified, actively practicing urologists from a list provided by the Polish Urological Association. RESULTS The questionnaire return rate was 33.7% (135/400). Overall, the median (quartile 1; quartile 3) frequency of correct answers was 65.0% (58.0%; 69.0%). Analysis of the association of availability and acceptance of the EAU guidelines with question answers showed no pattern. A multivariate regression model showed a positive correlation with regards to correct answers given in the survey and doctors' participation in international congresses (p = 0.018, r = 0.181). Basket analysis showed the strongest association for those who failed to correctly answer the questions regarding diagnosis of LUTS and overactive bladder (OAB) (support = 27.41%, confidence = 86.05%). CONCLUSIONS Although there is a significant degree of adherence to the 2013 EAU guidelines, some discrepancies between urologists' practice and the recommendations regarding diagnosis and treatment of male LUTS do exist. The data obtained provide valuable benchmarks and also identify possible interventions that may improve the standard of care in this population of patients.
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Affiliation(s)
- Tomasz Borkowski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Golabek
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr L. Chlosta
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Borkowski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
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Abstract
Nocturia, or awakening one or more times to void at night, becomes clinically significant with two or more voids a night. In the past, nocturia has typically been viewed as a symptom of benign prostatic hyperplasia and/or overactive bladder syndrome. However, newer evidence supports that this is no longer just a symptom but a medical condition that warrants further workup and treatment given its effect on quality of life. The negative effects of nocturia include sleep fragmentation, decreased productivity at work, and increased risk of falls and fractures. A workup to find the underlying cause of nocturia will help guide treatment, which may include pharmacologic agents.
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Fischer KM, Xu M, Weiss JP. Nocturnal Polyuria: What We Need to Know in 2015. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0312-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Zebede S, Lovatsis D, Alarab M, Drutz H. Prevalence of obstructive sleep apnea detected by the Berlin Questionnaire in patients with nocturia attending a urogynecology unit. Int Urogynecol J 2015; 26:881-5. [DOI: 10.1007/s00192-014-2618-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 12/19/2014] [Indexed: 12/20/2022]
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Abstract
Nocturia is a common but overlooked lower urinary tract symptom that substantially reduces patient health and quality of life. Though traditionally viewed as occurring predominantly in males, nocturia has been found to be equally as prevalent in females. The recent emphasis on the importance of nocturia has resulted in a surge of research studies, providing a foundation for current and future management decisions. In this review, we describe the current recommendations for the female patient in light of the most recently published studies, including a unique interest in predicting treatment response.
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Affiliation(s)
- Andrew Chang
- Medical Scientist Training Program, Stony Brook University School of Medicine, Stony Brook, NY, 11794, USA,
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71
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Hofmeester I, Kollen BJ, Steffens MG, Bosch JLHR, Drake MJ, Weiss JP, Blanker MH. Impact of the International Continence Society (ICS) report on the standardisation of terminology in nocturia on the quality of reports on nocturia and nocturnal polyuria: a systematic review. BJU Int 2015; 115:520-36. [PMID: 24684483 DOI: 10.1111/bju.12753] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To systematically review and evaluate the impact of the International Continence Society (ICS)-2002 report on standardisation of terminology in nocturia, on publications reporting on nocturia and nocturnal polyuria (NP). In 2002, the ICS defined NP as a Nocturnal Polyuria Index (nocturnal urine volume/total 24-h urine volume) of >0.2-0.33, depending on age. MATERIALS AND METHODS In April 2013 the PubMed and Embase databases were searched for studies (in English, German, French or Dutch) based on original data and adult participants, investigating the relationship between nocturia and NP. A methodological quality assessment was performed, including scores on external validity, internal validity and informativeness. Quality scores of items were compared between studies published before and after the ICS-2002 report. RESULTS The search yielded 78 publications based on 66 studies. Quality scores of studies were generally high for internal validity (median 5, interquartile range [IQR] 4-6) but low for external validity. After publication of the ICS-2002 report, external validity showed a significant change from 1 (IQR 1-2) to 2 (IQR 1-2.5; P = 0.019). Nocturia remained undefined in 12 studies. In all, 19 different definitions were used for NP, most often being the ICS (or similar) definition: this covered 52% (n = 11) of studies before and 66% (n = 27) after the ICS-2002 report. Clear definitions of both nocturia and NP were identified in 67% and 76% before, and in 88% and 88% of the studies after the ICS-2002 report, respectively. CONCLUSION The ICS-2002 report on standardisation of terminology in nocturia appears to have had a beneficial impact on reporting definitions of nocturia and NP, enabling better interpretation of results and comparisons between research projects. Because the external validity of most of the 66 studies is considered a problem, the results of these studies may not be validly extrapolated to other populations. The ICS definition of NP is used most often. However, its discriminative value seems limited due to the estimated difference of 0.6 nocturnal voids between individuals with and without NP. Refinement of current definitions based on robust research is required. Based on pathophysiological reasoning, we argue that it may be more appropriate to define NP based on nocturnal urine production or nocturnal voided volumes, rather than on a diurnal urine production pattern.
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Affiliation(s)
- Ilse Hofmeester
- Department of Urology, Isala Clinics, Zwolle, The Netherlands
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72
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Van Kerrebroeck P, Andersson KE. Terminology, epidemiology, etiology, and pathophysiology of nocturia. Neurourol Urodyn 2015; 33 Suppl 1:S2-5. [PMID: 24729150 DOI: 10.1002/nau.22595] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/20/2014] [Indexed: 01/13/2023]
Abstract
Nocturia, awaking from sleep to void, has a negative impact on health and well-being. Nocturia affects men and women and is more prevalent among the elderly. More than two nocturnal voids is considered to be a clinically meaningful threshold associated with significant negative outcomes for health and well-being, and the timing of awakening has a significant bearing on the negative consequences of nocturia. Several serious underlying pathophysiologic conditions may be associated with nocturia. A thorough history and assessment of number and times of voids, void volume, and fluid intake is essential for determining the etiology of a patient's nocturia. With data obtained from the frequency-volume chart (FVC), which is used to collect quantitative voiding data, a patient's nocturia may be classified as global polyuria, nocturnal polyuria, reduced bladder capacity, or a combination of these categories. Global polyuria is defined as 24-hr urinary output that exceeds 40 ml/kg body weight and results in increased 24-hr urinary frequency. Nocturnal polyuria is defined as more than 20% of daily urine output at night in young patients and more than 33% in elderly patients. Reduced bladder capacity may be a result of idiopathic or neurogenic detrusor overactivity, bladder outlet obstruction, or reduced nocturnal bladder capacity. The pathophysiology underlying the findings of the FVC falls into five main categories: global polyuria, nocturnal polyuria, reduced bladder capacity, sleep disorders, and circadian clock disorders. This review discusses the epidemiology, etiology, and pathophysiology of nocturia.
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Affiliation(s)
- Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
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73
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Weiss JP, Juul KV, Wein AJ. Management of nocturia: the role of antidiuretic pharmacotherapy. Neurourol Urodyn 2015; 33 Suppl 1:S19-24. [PMID: 24729149 DOI: 10.1002/nau.22592] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/20/2014] [Indexed: 11/11/2022]
Abstract
Strategies to manage nocturia include lifestyle modifications and treatment with alpha-blockers, antimuscarinic therapies, and antidiuretics. The concept of achieving success should not be limited to reduction of nighttime voids; it should ideally include proof of improvement of conditions generally associated with nocturia, such as falls, quality of life, and overall health. Few studies have looked specifically at parameters other than nocturnal voids, such as sleep latency, first undisturbed sleep period (FUSP), and total sleep time, including their clinical relevance to patient well-being. Lifestyle modifications, such as voiding before bedtime, limiting caffeine and alcohol, and adjusting medication timing, may be initially effective in mild cases of nocturia. Statistically significant reductions in voiding have been reported with antimuscarinic agents and alpha-blockers as initial therapy, but these reductions generally are not clinically relevant. The antidiuretic therapy desmopressin acetate, a selective vasopressin receptor 2 agonist, is effective in adults with nocturia associated with nocturnal polyuria; however, hyponatremia can occur. The newest formulation-desmopressin orally disintegrating sublingual tablet (ODST)--has greater bioavailability; thus, lower doses can be used, potentially reducing hyponatremia risk. A phase 3 study demonstrated statistically significant reductions in nocturnal voids for desmopressin ODST 50 and 100 µg versus placebo (-1.18 and -1.43 vs. -0.86; P = 0.02 and P < 0.0001, respectively) in patients with nocturia. Treatment was well-tolerated, and low-dose desmopressin ODST was associated with statistically significant increases in duration of FUSP. Development of a validated composite endpoint may help clinicians identify and compare strategies for treating nocturia.
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Affiliation(s)
- Jeffrey P Weiss
- Department of Urology, SUNY Downstate Medical School, Brooklyn, New York
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74
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Akashi S, Tomita K. The impact of a history of childhood nocturnal enuresis on adult nocturia and urgency. Acta Paediatr 2014; 103:e410-5. [PMID: 24834790 DOI: 10.1111/apa.12694] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 05/14/2014] [Indexed: 11/28/2022]
Abstract
AIM This study examined the association between a childhood history of nocturnal enuresis and nocturia and urgency as an adult. METHODS A questionnaire was completed by 3649 parents and grandparents of children with nocturnal enuresis. The age range of the respondents was 30-89, and 54% were female. The questionnaire included the respondent's age, underlying disease, the age at which nocturnal enuresis was resolved and any current nocturia and urgency. RESULTS The responses enabled us to analyse the risk factors for nocturia and urgency for the total sample, the history of nocturnal eneurisis for 2555 adults aged from 30 to 79 years and the age when nocturnal enuresis resolved for 1300 adults aged from 30 to 49 years. Respondents were significantly more likely to have nocturia and urgency as adults if they had a history of nocturnal enuresis and were aged ≥12 years when their nocturnal enuresis resolved. CONCLUSIONS A childhood history of nocturnal enuresis, particularly nocturnal enuresis that resolved at ≥12 years old, was associated with an increased frequency of adult nocturia and urgency. The impact of previous nocturnal enuresis on adult nocturia and urgency presents a risk that is comparable to ageing and prostatic disease.
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Affiliation(s)
| | - Kazue Tomita
- Department of Pediatrics; Katushika Medical Center; Jikei University School of Medicine; Tokyo Japan
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75
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Giannitsas K, Athanasopoulos A. Desmopressin for the treatment of female storage lower urinary tract symptoms. World J Obstet Gynecol 2014; 3:7-13. [DOI: 10.5317/wjog.v3.i1.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 11/14/2013] [Accepted: 12/11/2013] [Indexed: 02/05/2023] Open
Abstract
Female storage lower urinary tract symptoms are prevalent and bothersome. They are usually attributed to an overactive bladder and treated with antimuscarinics. Nevertheless, failure of conventional treatment to alleviate nocturia in particular and epidemiological data suggesting that nocturnal polyuria is the only or a contributing factor to nocturia, has attracted interest in decreasing nighttime urine production as a method of managing nocturia. A reduction in urine production could also, at least temporarily, delay daytime storage symptoms by delaying bladder filling. Therefore, desmopressin, the synthetic analogue or naturally occurring antidiuretic hormone, could have a role in the management of female frequency, urgency and urgency incontinence. This work aims to review data on the use of desmopressin in females with storage symptoms. Available evidence indicates that desmopressin is efficacious in reducing nighttime urine production and episodes of nocturia, resulting in fewer sleep interruptions. This translates into improved quality of life. Desmopressin is also effective in postponing micturition, urgency and incontinence for several hours after being taken on demand. The tolerability profile of desmopressin is good and significantly improved compared to historical figures due to the introduction of new oral formulations, tailoring the dose according to gender and age and adhering to instructions for fluid restriction before administration. The incidence of hyponatremia, desmopressin’s most important side-effect, is less than 3% in recent trials. The efficacy of desmopressin, combined with its improved safety profile, makes it an interesting method for treating female storage lower urinary tract symptoms.
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76
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Peyronnet B, Pradère B, Bruyère F. Prise en charge de la nycturie : une entité nosologique au sein des troubles mictionnels de l’homme. Prog Urol 2014; 24:80-6. [DOI: 10.1016/j.purol.2013.08.310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 06/24/2013] [Accepted: 08/01/2013] [Indexed: 11/24/2022]
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Friedman FM, Weiss JP. Desmopressin in the treatment of nocturia: clinical evidence and experience. Ther Adv Urol 2013; 5:310-7. [PMID: 24294289 DOI: 10.1177/1756287213502116] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nocturia is a common and bothersome condition experienced by both men and women. Studies have suggested that nocturia contributes a level of morbidity to those who suffer from the condition, both young and old. Desmopressin has historically been utilized to treat conditions such as central diabetes insipidus, certain bleeding disorders and primary nocturnal enuresis. Recently, interest has increased as to the use of desmopressin (a vasopressin analog) in the treatment of adult nocturia, for whom nocturnal polyuria is prevalent. While desmopressin has been traditionally administered in tablet and bioequivalent high dose melt formulations, newer low-dose orally disintegrating sublingual desmopressin has been recently studied to determine safe and efficacious dosing strategies. In this review, nocturia and its associated morbidities are discussed, followed by a contemporary literature review regarding the safety and efficacy of desmopressin for its treatment.
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Affiliation(s)
- Fara M Friedman
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, NY, USA
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78
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Kim JW, Oh MM, Yoon CY, Bae JH, Kim JJ, Moon DG. Nocturnal polyuria and decreased serum testosterone: is there an association in men with lower urinary tract symptoms? Int J Urol 2013; 21:518-23. [PMID: 24286364 DOI: 10.1111/iju.12345] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 10/14/2013] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To investigate the putative association between nocturia and decreased serum testosterone in men with lower urinary tract symptoms. METHODS Frequency volume charts and serum testosterone levels of patients visiting the outpatient clinic for lower urinary tract symptoms were collected and analyzed. Age, prostate volume, body mass index and the presence of comorbidities were accounted for. Frequency volume charts were analyzed for pathophysiological components of nocturnal polyuria, global polyuria, decreased nocturnal bladder capacity and increased frequency to identify associated risks. Frequency volume charts were also used to chart 8-h changes of volume, frequency and capacity to identify time diurnal interactions with risk factors based on serum testosterone levels. RESULTS A total of 2180 patients were enrolled in the study. Multivariate analysis showed testosterone decreased 0.142 ng/mL for every increase in nocturia, independent of other factors. Logistic regression analysis showed a significant difference between pathophysiological components. Decreased testosterone was shown to carry a significant independent risk for overall nocturia (odds ratio 1.60, 95% confidence interval 1.013-2.527, P = 0.044), and particularly nocturnal polyuria (odds ratio 1.934, 95% confidence interval 1.001-3.737, P = 0.027). Repeated measurement models showed patients with serum testosterone below 2.50 ng/mL to have a paradoxical increase in nocturnal urine volume at night. CONCLUSIONS Nocturia, especially nocturnal polyuria, is associated with decreased serum testosterone. Patients with low serum testosterone show increased nocturnal urine output.
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Affiliation(s)
- Jin Wook Kim
- Department of Urology, Korea University Medical Center Guro Hospital, Seoul, Korea
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79
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Wein AJ. Re: A Contemporary Assessment of Nocturia: Definition, Epidemiology, Pathophysiology, and Management—A Systematic Review and Meta-Analysis. J Urol 2013; 190:973. [DOI: 10.1016/j.juro.2013.05.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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80
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Affiliation(s)
- Raymond C Rosen
- Chief Scientist, New England Research Institutes, Watertown, MA, USA.
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81
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Feldstein CA. Nocturia in arterial hypertension: a prevalent, underreported, and sometimes underestimated association. ACTA ACUST UNITED AC 2013; 7:75-84. [PMID: 23321406 DOI: 10.1016/j.jash.2012.12.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 11/26/2012] [Accepted: 12/03/2012] [Indexed: 12/28/2022]
Abstract
Nocturia is a risk factor for morbidity and mortality but is frequently overlooked and underreported by patients and unrecognized by physicians. Epidemiologic studies reported that nocturnal voiding is associated not only with aging and benign prostatic hyperplasia, but also with many other clinical conditions. The majority of epidemiologic studies reported a significant relationship between nocturia and hypertension. However, the cause-and-effect relationship between them has not been established. Some physiopathological changes in hypertension are conducive to result in nocturia. These include the effects of hypertension on glomerular filtration and tubular transport, resetting of the kidney pressure-natriuresis relationship, atrial stretch and release of atrial natriuretic peptide when congestive heart failure complicates hypertension, and peripheral edema. Another link between hypertension and nocturia is obstructive sleep apnea. Furthermore, some evidence supports the relationship between nondipping behavior of blood pressure and an increased prevalence of nocturia. The use of some classes of antihypertensive agents may result in nocturia. The present review aims to provide a comprehensive evaluation of the epidemiologic evidence and physiopathological links that correlate hypertension and nocturia. Emphasis is placed on the need to take a pro-active attitude to detect and treat this hazardous condition.
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82
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83
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van Doorn B, Blanker MH, Kok ET, Westers P, Bosch JR. Prevalence, Incidence, and Resolution of Nocturnal Polyuria in a Longitudinal Community-based Study in Older Men: The Krimpen Study. Eur Urol 2013; 63:542-7. [DOI: 10.1016/j.eururo.2012.10.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 10/05/2012] [Indexed: 11/27/2022]
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84
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Weiss JP, Herschorn S, Albei CD, van der Meulen EA. Efficacy and safety of low dose desmopressin orally disintegrating tablet in men with nocturia: results of a multicenter, randomized, double-blind, placebo controlled, parallel group study. J Urol 2013; 190:965-72. [PMID: 23454402 DOI: 10.1016/j.juro.2012.12.112] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 12/19/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE We investigated the efficacy and safety of 50 and 75 μg desmopressin orally disintegrating tablets in men with nocturia (2 or more nocturnal voids). MATERIALS AND METHODS In this 3-month, randomized, double-blind, parallel study 50 and 75 μg desmopressin were compared with placebo. The co-primary efficacy end points were changes from baseline in mean number of nocturnal voids and proportions of patients achieving at least a 33% reduction from baseline in nocturnal voids (33% responders) during a 3-month treatment period. RESULTS The full analysis set comprised 385 men (age range 20 to 87 years). The 50 and 75 μg doses significantly reduced the number of nocturnal voids (-0.37, p <0.0001 and -0.41, p = 0.0003, respectively) and increased the odds of a 33% or greater response (OR 1.98, p = 0.0009 and OR 2.04, p = 0.0004, respectively) compared with placebo during 3 months. Desmopressin 50 and 75 μg increased the time to first void from baseline by approximately 40 minutes compared to placebo (p = 0.006 and p = 0.003, respectively). The response to desmopressin was seen by 1 week of treatment and was sustained. Significant increases in health related quality of life and sleep quality were observed compared to placebo. Desmopressin was well tolerated as only 2 subjects (age 74 and 79 years) on 50 μg had a serum sodium level of less than 130 mmol/L (vs 9 subjects on 75 μg). CONCLUSIONS Desmopressin (orally disintegrating tablet) is an effective and well tolerated treatment for men with nocturia. Treatment with 50 μg desmopressin, the minimum effective dose, provided sustained improvement of nocturia throughout the study and meaningful benefits to patients with an improved safety profile.
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Affiliation(s)
- Jeffrey P Weiss
- Department of Urology, SUNY Downstate College of Medicine, Brooklyn, New York 11203, USA.
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85
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Sand PK, Dmochowski RR, Reddy J, van der Meulen EA. Efficacy and safety of low dose desmopressin orally disintegrating tablet in women with nocturia: results of a multicenter, randomized, double-blind, placebo controlled, parallel group study. J Urol 2013; 190:958-64. [PMID: 23454404 DOI: 10.1016/j.juro.2013.02.037] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 02/13/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Previous studies suggest a lower dose of desmopressin orally disintegrating tablet may be effective in females compared to males with nocturia. We confirm the efficacy and safety of 25 μg desmopressin orally disintegrating tablet compared to placebo in female patients. MATERIALS AND METHODS In this 3-month, randomized, double-blind, parallel group study 25 μg desmopressin once daily was compared to placebo in women with nocturia (2 or more nocturnal voids). The co-primary efficacy end points were change from baseline in mean number of nocturnal voids and proportion of patients achieving at least a 33% reduction from baseline in the mean number of nocturnal voids (33% responders). RESULTS The full analysis set comprised 261 patients (age range 19 to 87 years). Desmopressin significantly reduced the mean number of nocturnal voids and increased the odds of a 33% or greater response compared to placebo during 3 months, assessed by longitudinal analysis (-0.22, p = 0.028 and OR 1.85, p = 0.006, respectively). Desmopressin increased the mean time to first nocturnal void by 49 minutes compared to placebo at 3 months (p = 0.003). The response to desmopressin was seen by week 1 of treatment and was sustained throughout the trial. Significant increases in health related quality of life and sleep quality were observed compared to placebo. Desmopressin was well tolerated. Serum sodium levels remained greater than 125 mmol/L throughout the trial and 3 transient decreases to less than 130 mmol/L were recorded. CONCLUSIONS At a dose of 25 μg, desmopressin orally disintegrating tablet is an effective and well tolerated treatment for women with nocturia. Treatment provides rapid and sustained improvement in nocturia and quality of life.
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Affiliation(s)
- Peter K Sand
- NorthShore University HealthSystem, Evanston, Illinois 60201, USA.
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86
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Jeong JY, Kim SJ, Cho HJ, Hong SH, Lee JY, Hwang TK, Kim SW. Influence of type of nocturia and lower urinary tract symptoms on therapeutic outcome in women treated with desmopressin. Korean J Urol 2013; 54:95-9. [PMID: 23549374 PMCID: PMC3580312 DOI: 10.4111/kju.2013.54.2.95] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 09/26/2012] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To investigate the type of nocturia and concomitant voiding dysfunction (VD) and the effect of desmopressin treatment on nocturia in women. MATERIALS AND METHODS We reviewed 84 women who experienced more than 2 nocturia episodes as recorded on a pretreatment frequency volume chart and who were treated with desmopressin. All patients underwent history taking, physical examination, urinalysis, International Prostate Symptom Score assessment, completion of a urinary sensation scale, and completion of a 3 day frequency volume chart. Nocturia was divided into nocturnal polyuria (NP), reduced nocturnal bladder capacity (RNBC), and mixed type. After treatment with desmopressin, a reduction in nocturia of over 50% compared with baseline was regarded as effective. RESULTS Among 84 women, the most common concomitant VD was overactive bladder (OAB, 60.7%). NP was observed in 70.2% (59/84) of the women, RNBC in 7.1% (6/84), and mixed type in 22.6% (19/84). After medication with desmopressin, 73 women (86.9%) showed a significantly reduced number of nocturia episodes (1.4±1.5) compared with baseline (3.7±1.3, p<0.05). Eleven women (13.1%) did not show improvement. Of the 73 women who showed improvement, 41 women showed a reduction of more than 50% over baseline, and these women had a lower baseline urgency grade. CONCLUSIONS In the majority of women, nocturia coexisted with other VD such as OAB. Treatment with desmopressin effectively reduced the nocturia. However, other lower urinary tract symptoms (LUTS) such as urgency may reduce the effect of desmopressin. Therefore, consideration of concomitant LUTS seems to be necessary to increase the treatment effect of desmopressin on nocturia in women.
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Affiliation(s)
- Jae Young Jeong
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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87
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Cornu JN, Abrams P, Chapple CR, Dmochowski RR, Lemack GE, Michel MC, Tubaro A, Madersbacher S. A Contemporary Assessment of Nocturia: Definition, Epidemiology, Pathophysiology, and Management—a Systematic Review and Meta-analysis. Eur Urol 2012; 62:877-90. [DOI: 10.1016/j.eururo.2012.07.004] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 07/06/2012] [Indexed: 01/19/2023]
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88
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van Haarst EP, Bosch JLHR. A cutoff value based on analysis of a reference population decreases overestimation of the prevalence of nocturnal polyuria. J Urol 2012; 188:869-73. [PMID: 22819414 DOI: 10.1016/j.juro.2012.04.112] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE We sought criteria for nocturnal polyuria in asymptomatic, nonurological adults of all ages by reporting reference values of the ratio of daytime and nighttime urine volumes, and finding nocturia predictors. MATERIALS AND METHODS Data from a database of frequency-volume charts from a reference population of 894 nonurological, asymptomatic volunteers of all age groups were analyzed. The nocturnal polyuria index and the nocturia index were calculated and factors influencing these values were determined by multivariate analysis. RESULTS The nocturnal polyuria index had wide variation but a normal distribution with a mean ± SD of 30% ± 12%. The 95th percentile of the values was 53%. Above this cutoff a patient had nocturnal polyuria. This value contrasts with the International Continence Society definition of 33% but agrees with several other reports. On multivariate regression analysis with the nocturnal polyuria index as the dependent variable sleeping time, maximum voided volume and age were the covariates. However, the increase in the nocturnal polyuria index by age was small. Excluding polyuria and nocturia from analysis did not alter the results in a relevant way. The nocturnal voiding frequency depended on sleeping time and maximum voided volume but most of all on the nocturia index. CONCLUSIONS The prevalence of nocturnal polyuria is overestimated. We suggest a new cutoff value for the nocturnal polyuria index, that is nocturnal polyuria exists when the nocturnal polyuria index exceeds 53%. The nocturia index is the best predictor of nocturia.
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Affiliation(s)
- Ernst P van Haarst
- Department of Urology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands.
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