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Rasmussen VF, Thrysøe M, Karlsson P, Madsen M, Vestergaard ET, Nyengaard JR, Terkelsen AJ, Kamperis K, Kristensen K. Bladder dysfunction in adolescents with type 1 diabetes. J Pediatr Urol 2024:S1477-5131(24)00199-2. [PMID: 38705761 DOI: 10.1016/j.jpurol.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/26/2024] [Accepted: 04/09/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND It is increasingly significant that adults with diabetes experience lower urinary tract symptoms, however, there has been limited research in younger individuals with type 1 diabetes. OBJECTIVE To investigate bladder function using non-invasive urodynamics as a potential indicator of autonomic neuropathy in adolescents with type 1 diabetes. This involved examining the association between urinary flow disturbances, reported symptoms, and results from other autonomic tests. STUDY DESIGN Cross-sectional study enrolling 49 adolescents with type 1 diabetes and 18 control subjects. All participants underwent uroflowmetry and ultrasound scanning, completed the Composite Autonomic Symptom Score (COMPASS)-31 questionnaire, and were instructed to record their morning urine volume and voiding frequencies and report them back. Cardiovascular reflex tests (CARTs) and the quantitative sudomotor axon reflex test (QSART) were performed. RESULTS The main results are shown in the Summary figure. DISCUSSION In this study, urological abnormalities were not significantly more frequent in adolescents with diabetes, however, urological issues were observed. This is supported by previous findings of Szabo et al. who found that adolescents with type 1 diabetes had reduced flow acceleration and time to maximum flow compared to control subjects. In our study, we observed cases with reduced acceleration and prolonged uroflow curves, possibly indicating detrusor underactivity. People with diabetes had a higher risk of nocturia than healthy controls, which our results supported. Some adolescents reported urination twice per night. Based on these findings, it is considered beneficial to ask about urological symptoms annually to determine if more examinations (frequency-volume charts and uroflowmetry) are necessary and/or if any opportunities for treatment optimization exist. However, uroflowmetry has limitations, as bladder filling and emptying is a complex process involving multiple pathways and neurological centers, making it difficult to standardize and evaluate. Another limitation of this study was that our control group was smaller and consisted of fewer males than females, which could affect the results due to differences in anatomy and physiology in the lower urinary tract system. CONCLUSION In conclusion, adolescents with type 1 diabetes, as well as healthy adolescents, frequently experience urological symptoms. Although urological abnormalities were not significantly more frequent in adolescents with diabetes in this study, the focus on nocturia and risk for bladder dysfunction seems relevant, even in adolescents without any other tests indicating autonomic dysfunction.
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Affiliation(s)
- Vinni Faber Rasmussen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark; Department of Pediatrics and Adolescents, Randers Regional Hospital, Randers, Denmark.
| | - Mathilde Thrysøe
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Páll Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Madsen
- Steno Diabetes Center North Denmark, Aalborg, Denmark; Department of Pediatric and Adolescents Medicine, Aalborg University Hospital, Aalborg, Denmark
| | | | - Jens Randel Nyengaard
- Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Astrid Juhl Terkelsen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Konstantinos Kamperis
- Department of Pediatric and Adolescents Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
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Iinuma K, Nishino Y, Matsuoka K, Ihara T, Makabe S, Tanji R, Harigane Y, Ishida K, Tamaki M, Yokoi S, Hoshino H, Yuhara K, Yamada T, Kubota Y, Miwa K, Kikuchi M, Kojima Y, Mitsui T, Koie T. The prevalence and predictive factors of nocturnal polyuria in Japanese patients with nocturia: a multicentral retrospective cohort study. Sci Rep 2023; 13:18128. [PMID: 37875562 PMCID: PMC10597993 DOI: 10.1038/s41598-023-45311-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/18/2023] [Indexed: 10/26/2023] Open
Abstract
The aims of this study were to determine the prevalence and predictors of nocturnal polyuria (NP) in Japanese patients. This multicentral, observational study enrolled patients with the chief complaint of nocturia at 17 Japanese institutions between January 2018 and December 2022. The frequency of daily voiding and volume of urination were evaluated using bladder diaries. NP was diagnosed in patients with an NP index of > 33%. The primary endpoint was NP prevalence in patients with nocturia. The secondary endpoints were the prevalence of NP according to sex and age and the identification of factors predicting NP. This study analyzed 875 eligible patients. NP was present in 590 (67.4%) patients, with prevalence rates of 66.6% and 70.0% in men and women, respectively. Age ≥ 78 years, body mass index (BMI) < 23.0 kg/m2, and patients with ischemic heart or cerebrovascular disease were significant predictors of NP (P < 0.001, P < 0.001, P = 0.014, P = 0.016, respectively). This is the first large multicenter study to investigate the prevalence of NP in Japanese patients with nocturia. NP has a prevalence of 67.4%. Significant predictors of NP include age, BMI, and cardiovascular disease.
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Affiliation(s)
- Koji Iinuma
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | | | - Kanako Matsuoka
- Department of Urology, Fukushima Medical University, 1 Hikariga-Oka, Fukushima, Fukushima, 960-1295, Japan
| | - Tatsuya Ihara
- Department of Urology, University of Yamanashi Graduate School of Medical Sciences, 1110 Shimokato, Chuo, Yamanashi, 408-3898, Japan
| | - Shunta Makabe
- Department of Urology, Ohara General Hospital, 6-1 Uwamachi, Fukushima, Fukushima, 960-8611, Japan
| | - Ryo Tanji
- Department of Urology, Japanese Red Cross Fukushima Hospital, 7-7 Yashimacho, Fukushima, Fukushima, 960-8530, Japan
| | - Yuki Harigane
- Department of Urology, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Kenichiro Ishida
- Department of Urology, Gifu Prefectural General Medical Center, 4-6-1 Noisiki, Gifu, Gifu, 500-8717, Japan
| | - Masayoshi Tamaki
- Department of Urology, Gifu Municipal Hospital, 7-1 Kashimacho, Gifu, Gifu, 500-8513, Japan
| | - Shigeaki Yokoi
- Department of Urology, Central Japan International Medical Center, 1-1 Kenkonomachi, Minokamo, Gifu, 5058510, Japan
| | - Hiroki Hoshino
- Department of Urology, Ogaki Municipal Hospital, 4-86 Minaminokawacho, Ogaki, Gifu, 503-8502, Japan
| | - Kazuya Yuhara
- Department of Urology, Japanese Red Cross Takayama Hospital, 3-11 Tenmancho, Takayama, Gifu, 506-8550, Japan
| | - Toru Yamada
- Department of Urology, Tokai Central Hospital, 4-6-2 Soharahigashijimacho, Kagamihara, Gifu, 504-8601, Japan
| | - Yasuaki Kubota
- Department of Urology, Toyota Memorial Hospital, 1-1 Heiwamachi, Toyota, Aichi, 471-0821, Japan
| | - Kousei Miwa
- Department of Urology, Japanese Red Cross Gifu Hospital, 3-36 Iwakuracho, Gifu, Gifu, 502-8511, Japan
| | - Mina Kikuchi
- Sugo Clinic, 1-10-16 Sugo, Gifu, Gifu, 502-0914, Japan
| | - Yoshiyuki Kojima
- Department of Urology, Fukushima Medical University, 1 Hikariga-Oka, Fukushima, Fukushima, 960-1295, Japan
| | - Takahiko Mitsui
- Department of Urology, University of Yamanashi Graduate School of Medical Sciences, 1110 Shimokato, Chuo, Yamanashi, 408-3898, Japan
| | - Takuya Koie
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.
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Wu Y, Li P, Shi J, Li J, Zhang Y, Xiao B. Research trends of acupuncture therapy on stress urinary incontinence from 1992 to 2022: A bibliometric analysis. Heliyon 2023; 9:e19732. [PMID: 37810054 PMCID: PMC10559016 DOI: 10.1016/j.heliyon.2023.e19732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
Background Stress urinary incontinence (SUI), the most prevalent type of urinary incontinence disorder, has aroused increasing attention among societies since it has caused much inconvenience in daily life. In addition to conventional conservative treatments like medication and pelvic floor muscle training, acupuncture is now frequently advised. However, a bibliometric analysis of the trend of SUI therapies is still lacking. Objectives This article was carried out using CiteSpace (6.3.1) software to research the use of acupuncture therapy on SUI worldwide over the past 30 years (since the database's inception). Methods All related articles included were retrieved from the Web of Science Core Collection. CiteSpace (6.3.1) software was used to analyze the number of publications, countries and institutions, authors and cited authors, and burst keywords to assess the hotspots and trends over the previous three decades. And Microsoft Office Excel 2019 was also used for sorting data and generating tables. Results The articles were retrieved on August 31, 2022. A total of 108 records with publication dates ranging from 1992 to 2022 were discovered. The annual number of publications generally increased. In the aspect of publication regions, the USA ranked first in centrality, but China had the largest number of publications. The China Academic of Chinese Medical Sciences, Beijing University of Chinese Medicine, and Shanghai University of Traditional Chinese Medicine were the top 3 institutions, according to the institution map. Liu Z (Liu ZS) was the most productive author, and Chen Y ranked first in the centrality. The article published by Liu Z (Liu ZS) in 2017 was the most cited reference. "Bladder neck suspension", "electrical stimulation" and "acupuncture" were popular therapies mentioned among the top ten hot topics. The keywords "therapy", "postprostatectomy incontinence", "muscle", "cell therapy", and "symptom" ranked in the top five on citation burst. The four frontier topics were "efficacy", "symptom", "cell therapy", and "medical technology". Conclusion This study illustrated that the application of acupuncture on SUI had an increasing acceptance worldwide. Recent research has concentrated mainly on acupuncture and electroacupuncture, however, there is still not enough literature on these topics. The valuable information was provided for acupuncture researchers to identify prospects including potential collaborators, cooperation institutions, hot themes, and research frontiers.
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Affiliation(s)
| | | | - Jiani Shi
- Shanghai University of Traditional Chinese Medicine, China
| | - Jiawei Li
- Shanghai University of Traditional Chinese Medicine, China
| | - Yuchen Zhang
- Shanghai University of Traditional Chinese Medicine, China
| | - Bin Xiao
- Shanghai University of Traditional Chinese Medicine, China
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Ali J, Haider SMS, Ali SM, Haider T, Anwar A, Hashmi AA. Overall Clinical Features of Type 2 Diabetes Mellitus With Respect to Gender. Cureus 2023; 15:e35771. [PMID: 37020489 PMCID: PMC10071047 DOI: 10.7759/cureus.35771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2023] [Indexed: 03/07/2023] Open
Abstract
Introduction Since patients with type 2 diabetes are frequently misdiagnosed, provided inappropriate management, or poorly controlled, it is important to comprehend the wide range of clinical signs and symptoms associated with diabetes. Therefore, this study evaluated the overall clinical manifestations of patients with type 2 diabetes patients with respect to gender. Methods This was a multicenter, cross-sectional study that was conducted at various hospitals, using a non-probability sampling technique. The duration of the study was about six months, from January 1, 2022 to June 30, 2022. The study included 590 type 2 diabetes patients, ranging in age from 35 to 70 years. Age, gender, socioeconomic status, health status, co-morbidities, and diabetes symptoms were documented. A chi-square was applied to determine the association between overall symptoms associated with type 2 diabetes and gender. An independent t-test was applied to determine the significance level between means of demographic parameters. Results The study findings showed that out of 590 patients with diabetes, 310 (52.5%) were males and 280 (47.5%) were females. The male and female mean ages were 57.46±14.93 and 50.38±14.85 years, respectively, with a statistically significant gender difference (p<0.001). The prevalence of renal manifestation in type 2 patients with diabetes revealed a significant relationship (p<0.05) for both genders. The prevalence of ocular manifestations revealed a significant relationship with both genders (p<0.05) in terms of distortion and blurred vision. The prevalence of ocular manifestations revealed a significant relationship observed with both genders (p<0.05) in terms of shortness of breath, dyspnea severity, and severity of chest pain. Conclusion This study concluded that women with type 2 diabetes mellitus have a significantly higher frequency of muscular pain, urinary symptoms, neurological symptoms, and dermatological manifestations than men. In contrast, respiratory symptoms were significantly more pronounced in males than in females. The presence of comorbidities such as dyslipidemia significantly increased the probability of developing type 2 diabetes in both genders.
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Fu Z, Wang F, Dang X, Zhou T. The association between diabetes and nocturia: A systematic review and meta-analysis. Front Public Health 2022; 10:924488. [PMID: 36262225 PMCID: PMC9574227 DOI: 10.3389/fpubh.2022.924488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/19/2022] [Indexed: 01/24/2023] Open
Abstract
Background Many studies have explored the association between diabetes and nocturia, but it remains unclear. This article systematically analyses existing evidence of the relationship between diabetes and nocturia, including subgroup analysis based on the number of voids, gender, and continent, in the hope of reaching more reliable clinical conclusions relating to diabetes and nocturia. Methods PubMed, Web of Science, and Cochrane Library were searched for identifying studies relating to diabetes and nocturia prior to July 2021. Literature quality evaluation was performed using the Newcastle Ottawa Scale. A random effect meta-analysis was used for pooled odds ratios (ORs) and confidence intervals (CIs) as a means of evaluating the relationship between diabetes and nocturia. Results In total, 29 of 781 potentially relevant studies were proven to be eligible. The overall pooled OR demonstrated that diabetes increases the risk of nocturia (OR: 1.49; 95% CI: 1.38, 1.61; P < 0.00001). The association was found to be more robust among subjects ≥ 1 void than ≥ 2 void (OR: 1.74; 95% CI: 1.41, 2.14; P < 0.00001 vs. OR: 1.45; 95% CI: 1.33, 1.59; P < 0.00001), in males than females (OR: 1.59; 95% CI: 1.41, 1.79; P < 0.00001 vs. OR: 1.41; 95% CI: 1.20, 1.66; P < 0.0001) and in Asia than Europe or North America (OR: 1.54; 95% CI: 1.36, 1.75; P < 0.00001 vs. OR: 1.43; 95% CI: 1.19, 1.72; P = 0.0001 vs. OR: 1.45; 95% CI: 1.22, 1.73; P < 0.0001). Conclusions Diabetes has an association with a 1.49-fold higher risk of nocturia. This association is more robust for Asian and male subjects or those at a lower nocturia cut-off.
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Affiliation(s)
- Zhiwei Fu
- Department of Pediatric Surgery, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fang Wang
- Department of Nutrition, Dazhou Central Hospital, Dazhou, China
| | - Xing Dang
- Department of Pediatric Surgery, Dazhou Central Hospital, Dazhou, China
| | - Tao Zhou
- Department of Pediatric Surgery, Dazhou Central Hospital, Dazhou, China,*Correspondence: Tao Zhou
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Nocturia independently predicts left ventricular hypertrophy and left atrial enlargement among patients with cardiac symptoms. Sci Rep 2022; 12:14897. [PMID: 36050443 PMCID: PMC9436922 DOI: 10.1038/s41598-022-19190-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022] Open
Abstract
Nocturia can be caused by urological disorders and systemic diseases, including heart diseases. We aimed to investigate the relationship between nocturia and structural abnormalities on echocardiography. Adult patients who underwent echocardiography for cardiac symptoms or heart murmur or had a history of structural heart disease were included. The voiding times during sleep hours were collected prospectively. Univariate and multivariate analyses were performed to evaluate the predictive value of bothersome nocturia (nocturia ≥ 2) on echocardiographic abnormalities. Of 299 patients, 182 (60.9%) reported bothersome nocturia. In patients aged ≥ 65 years, hypertension and left atrial enlargement (LAE) were associated with higher occurrences of bothersome nocturia. On multivariate analysis, bothersome nocturia was a predictive factor of LAE (odds ratio [OR] 2.453, 95% confidence interval [CI] 1.363–4.416, p = 0.003). Moreover, bothersome nocturia could predict both LAE and left ventricular hypertrophy (LVH) (OR 2.285, 95% CI 1.151–4.536, p = 0.018; OR 2.056, 95% CI 1.025–4.124, p = 0.043) in the elderly. Older age, hypertension, and LAE were risk factors for bothersome nocturia. Moreover, bothersome nocturia was predictive of LAE and LVH in the elderly. Patients with bothersome nocturia without other significant lower urinary tract symptoms should be referred to cardiologists.
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Elhadi M, Younis A, Harding C. A systematic approach to the investigation and treatment of nocturia. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415818781289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Level of evidence: 4.
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Krystal AD, Preud’homme XA. Double-Blind, Placebo-Controlled, Crossover Study of Armodafinil Treatment of Daytime Sleepiness Associated With Treated Nocturia. Sleep 2016; 40:2666706. [DOI: 10.1093/sleep/zsw020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2016] [Indexed: 11/14/2022] Open
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Krhut J, Gärtner M, Zvarová K, Desarno M, Zvara P. Validating of a Novel Method for Electronically Recording Overactive Bladder Symptoms in Men. Low Urin Tract Symptoms 2015; 8:177-81. [PMID: 27619783 DOI: 10.1111/luts.12093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 12/10/2014] [Accepted: 01/07/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The goal of this study was to compare a novel wireless phone and web based technology to record and store overactive bladder symptoms (OAB-S) to a traditional pen and paper micturition chart. METHODS Overactive bladder symptoms were recorded over a period of 3 days using both an electronic micturition chart (EMC) and the standard pen and paper micturition chart (MC). Twenty-nine men, with lower urinary tract symptoms (LUTS), were included in the study. Dropout rate, patient's preference, and correlation between the quality of life measures (QoL) and symptoms recorded with EMC versus MC, were assessed and compared. RESULTS Of the total number of 29 patients enrolled into the study, 24 completed the full 3-day trial using MC and 27 using EMC. MC was preferred by 50%, while EMC was preferred by 50% of participants. Using MC, 21% of patients forgot to record at least one episode of urgency, versus 17% using EMC, 17% forgot to record at least one micturition using MC versus 8% using EMC. A statistically significant correlation was found between lower severity of OAB-S and higher QoL, using both recording methods. CONCLUSIONS In this study population, recording symptoms with EMC did not prove to be preferable compared to MC; however, EMC provided the same level of accuracy with the same or better adherence to the study protocol.
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Affiliation(s)
- Jan Krhut
- Department of Urology, University Hospital, Ostrava, Czech Republic
| | - Marcel Gärtner
- Department of Obstetrics and Gynecology, University Hospital, Ostrava, Czech Republic
| | - Katarína Zvarová
- Department of Physiology, Slovak Medical University, Bratislava, Slovak Republic
| | - Michael Desarno
- Biostatistics Unit, University of Vermont, Burlington, Vermont, USA
| | - Peter Zvara
- Department of Surgery, University of Vermont, Burlington, Vermont, USA. .,Department of Surgical Studies, Ostrava University, Ostrava, Czech Republic.
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White RS, Zemen BG, Khan Z, Montgomery JR, Herrera GM, Meredith AL. Evaluation of mouse urinary bladder smooth muscle for diurnal differences in contractile properties. Front Pharmacol 2015; 5:293. [PMID: 25620932 PMCID: PMC4288323 DOI: 10.3389/fphar.2014.00293] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 12/17/2014] [Indexed: 11/17/2022] Open
Abstract
Most physiological systems show daily variations in functional output, entrained to the day–night cycle. Humans exhibit a daily rhythm in urinary voiding (micturition), and disruption of this rhythm (nocturia) has significant clinical impact. However, the underlying mechanisms are not well-understood. Recently, a circadian rhythm in micturition was demonstrated in rodents, correlated with functional changes in urodynamics, providing the opportunity to address this issue in an animal model. Smooth muscle cells from mouse bladder have been proposed to express a functional and autonomous circadian clock at the molecular level. In this study, we addressed whether a semi-intact preparation of mouse urinary bladder smooth muscle (UBSM) exhibited measurable differences in contractility between day and night. UBSM tissue strips were harvested at four time points over the diurnal cycle, and spontaneous (phasic) and nerve-evoked contractions were assessed using isometric tension recordings. During the active period (ZT12-24) when micturition frequency is higher in rodents, UBSM strips had no significant differences in maximal- (high K+) or nerve-evoked contractions compared to strips harvested from the resting period (ZT0-12). However, a diurnal rhythm in phasic contraction was observed, with higher amplitudes at ZT10. Consistent with the enhanced phasic amplitudes, expression of the BK K+ channel, a key suppressor of UBSM excitability, was lower at ZT8. Higher expression of BK at ZT20 was correlated with an enhanced effect of the BK antagonist paxilline (PAX) on phasic amplitude, but PAX had no significant time-of-day dependent effect on phasic frequency or nerve-evoked contractions. Overall, these results identify a diurnal difference for one contractile parameter of bladder muscle. Taken together, the results suggest that autonomous clocks in UBSM make only a limited contribution to the integrated control of diurnal micturition patterns.
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Affiliation(s)
- Rachel S White
- Department of Physiology, University of Maryland School of Medicine Baltimore, MD, USA
| | - Betsir G Zemen
- Department of Physiology, University of Maryland School of Medicine Baltimore, MD, USA
| | - Zulqarnain Khan
- Department of Physiology, University of Maryland School of Medicine Baltimore, MD, USA
| | - Jenna R Montgomery
- Department of Physiology, University of Maryland School of Medicine Baltimore, MD, USA
| | - Gerald M Herrera
- Catamount Research & Development Company and Med Associates Inc., St. Albans VT, USA
| | - Andrea L Meredith
- Department of Physiology, University of Maryland School of Medicine Baltimore, MD, USA
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The impact of adding low-dose oral desmopressin therapy to tamsulosin therapy for treatment of nocturia owing to benign prostatic hyperplasia. World J Urol 2014; 33:649-57. [PMID: 25138579 DOI: 10.1007/s00345-014-1378-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of adding a low-dose oral desmopressin to tamsulosin therapy for treatment of nocturia in patients with benign prostatic hyperplasia (BPH). METHODS Eligible patients with BPH and nocturia ≥2/night were randomly allocated to two treatment groups; the first of which received 3-month treatment scheme of daily oral dose of tamsulosin OCAS 0.4 mg and desmopressin MELT 60 mcg (D/T group), while the second one received tamsulosin OCAS 0.4 mg only (T group). Patients were followed on monthly basis and changes in the parameters from baseline to 3 months after treatment were assessed on I-PSS/QoL questionnaire, 7-day voiding diary, urinalysis, serum sodium, abdominal ultrasonography and uroflowmetry. RESULTS A total of 248 patients were included within the study; 123 patients in the combined D/T group and 125 patients in T group. The frequencies of night voids decreased by 64.3% in D/T group compared to 44.6% in T group. The first sleep period, significantly increased from 82.1 to 160.0 min and from 83.2 to 123.8 min in D/T and T group, respectively; and significant differences between both groups were observed at the end of study (p < 0.001). I-PSS, QoL score, post-void residual urine volume and Q max were significantly improved with no statistical difference between both groups. No serious adverse effects were reported in both groups. CONCLUSION The addition of low-dose oral desmopressin therapy to an α-blocker tamsulosin provides effective treatment for nocturia in patients with LUTS/BPH.
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Elterman DS, Chughtai B, Kaplan SA, Barkin J. Tolterodine for the treatment of urge urinary incontinence. Expert Opin Pharmacother 2013; 14:1987-91. [PMID: 23885788 DOI: 10.1517/14656566.2013.823158] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Overactive bladder (OAB) and its resultant urge urinary incontinence (UUI) are significant problems that medically, psychologically and financially affect people. The constellation of symptoms comprising OAB affects ∼ 16% of the adult population and its prevalence increases with aging. The typical class of medications used to treat OAB is antimuscarinics. AREAS COVERED OAB medications, with a focus on tolterodine for the treatment of UUI are reviewed. A thorough review of English language literature using EMBASE/Medline and PubMed has been performed. EXPERT OPINION Tolterodine provides a reasonable starting point when treating patients with OAB and UUI. Efficacy and tolerability are generally comparable between tolterodine and other newer antimuscarinics. Tolterodine is a good option as part of the algorithm in the treatment of OAB and UUI.
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Affiliation(s)
- Dean S Elterman
- Weill Cornell Medical College of Cornell University, James Buchanan Brady Department of Urology , 425 East 61st Street, 12th floor, New York, NY 10065 , USA
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Affiliation(s)
- Raymond C Rosen
- Chief Scientist, New England Research Institutes, Watertown, MA, USA.
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14
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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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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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Preud'homme XA, Amundsen CL, Webster GD, Krystal AD. Comparison of diary-derived bladder and sleep measurements across OAB individuals, primary insomniacs, and healthy controls. Int Urogynecol J 2012; 24:501-8. [PMID: 22855113 DOI: 10.1007/s00192-012-1890-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 07/02/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Can diary-derived bladder and sleep measurements differentiate individuals with overactive bladder syndrome (OAB) from individuals with primary insomnia and healthy controls? METHODS Bladder- and sleep-diary data were compared in nine OAB, ten insomnia, and five control individuals. One-way analysis of variance (ANOVA) was used for normally and Kruskal-Wallis test for nonnormally distributed variables, followed, when significant effects were found, by pairwise comparisons. RESULTS OAB individuals woke up as frequently as insomniacs, but their awakenings were respectively shorter in duration (18.6 vs. 38.1 min.) and were predominantly initiated by nocturic events (89.2 vs. 23.9 % respectively). Regardless, their reported quality of sleep was as impaired as for the insomniacs. Furthermore, smaller mean volume voided awakenings were evident not only in those with OAB but also in insomniacs compared to controls. CONCLUSIONS Bladder- and sleep-diary data provide means to differentiate those with OAB from those with insomnia and healthy controls. Awakenings in OAB individuals were shorter than those with insomnia and much more likely due to the need to void. Thus, a reduction in the number of nocturic voids could be the most appropriate sleep-related outcome for nocturia therapy in individuals with OAB. In addition, limited nocturnal bladder capacity, though expected in OAB, was unexpectedly found in insomnia, possibly reflecting the role of consciousness (wakefulness at night) in modulating bladder sensation.
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Affiliation(s)
- Xavier A Preud'homme
- Insomnia and Sleep Research Program, Department of Psychiatry, Duke University Medical Center, Durham, NC, USA.
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Weiss JP, van Kerrebroeck PEV, Klein BM, Nørgaard JP. Excessive nocturnal urine production is a major contributing factor to the etiology of nocturia. J Urol 2011; 186:1358-63. [PMID: 21855948 DOI: 10.1016/j.juro.2011.05.083] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE Nocturnal polyuria is a common but often overlooked cause of nocturia. We investigated the proportion of adults with 2 or greater voids nightly who had nocturnal polyuria in 2 cohorts from the United States and Europe. MATERIALS AND METHODS Data on nocturnal polyuria were obtained from 3 or 7-day frequency-volume charts completed by patients as part of screening for inclusion in subsequent trials of nocturia therapy. Patients recorded the time and volume of each void. Nocturnal polyuria was defined as nocturnal urine volume greater than 33% of 24-hour volume, including the first morning void. RESULTS In the first cohort 1,003 patients were screened, of whom 846 provided evaluable diary data, including 641 (76%) with nocturnal polyuria. Of the total screened population of 1,003 patients 641 (64%) had confirmed nocturnal polyuria. The prevalence of nocturnal polyuria increased with age but was high in all age groups. In the second cohort 1,412 patients were screened, of whom 917 provided evaluable diary data, including 806 (88%) with nocturnal polyuria. Of the total screened population of 1,412 patients 806 (57%) had confirmed nocturnal polyuria. The prevalence of nocturnal polyuria increased with age but was high in all age groups. Of 158 patients receiving benign prostatic hyperplasia and/or overactive bladder medication 141 (89%) had nocturnal polyuria. In each cohort the nocturnal polyuria prevalence was high in all ethnic groups (63% or greater). CONCLUSIONS In this large study nocturnal polyuria was present in most patients with nocturia regardless of gender, age, ethnicity, country and concomitant benign prostatic hyperplasia/overactive bladder therapy.
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Affiliation(s)
- Jeffrey P Weiss
- Department of Urology, State University of New York Downstate Medical School, Brooklyn, New York, USA.
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Warren JW, Horne L, Diggs C, Greenberg P, Langenberg PW. Nocturia in interstitial cystitis/painful bladder syndrome. Urology 2011; 77:1308-12. [PMID: 21624590 DOI: 10.1016/j.urology.2011.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 02/09/2011] [Accepted: 02/09/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To explore the roles of pain and urgency in the nocturia of patients with interstitial cystitis/painful bladder syndrome (IC/PBS). METHODS In a longitudinal study of incident IC/PBS cases, we assessed the associations of the presence and severity of nocturia with the presence and severity of pain and urgency, using multivariate analyses when necessary. Additionally, we simply asked patients with IC/PBS what awakens them at night. RESULTS The multivariate analyses revealed associations of urgency with the presence and severity of nocturia and of bladder pain with the severity of nocturia. Direct queries of patients with IC/PBS about urgency and the reasons for awakening demonstrated that bladder pain might have played a twofold role: directly in awakening a large minority of patients and possibly indirectly in the majority by generating the sensation of urgency. CONCLUSIONS These findings are consistent with urinary urgency and bladder pain each being in the causal pathway leading to nocturia in patients with IC/PBS.
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Affiliation(s)
- John W Warren
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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Krystal AD, Preud'homme XA, Amundsen CL, Webster GD. Detrusor overactivity persisting at night and preceding nocturia in patients with overactive bladder syndrome: a nocturnal cystometrogram and polysomnogram study. J Urol 2010; 184:623-8. [PMID: 20639027 DOI: 10.1016/j.juro.2010.03.148] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Indexed: 11/25/2022]
Abstract
PURPOSE Nocturia, a common symptom of overactive bladder syndrome, is associated with substantial adverse consequences and yet its pathophysiology has hardly been studied and the capacity to treat it remains limited. We established methods to study the physiology of overactive bladder associated nocturia and better understand this phenomenon. MATERIALS AND METHODS We recorded simultaneous, time aligned, nocturnal cystometrogram and polysomnogram data during a single night at a sleep laboratory in 9 patients with overactive bladder and detrusor overactivity on daytime cystometrogram, in 10 patients with insomnia and in 5 healthy controls. RESULTS We safely recorded simultaneous polysomnography/nocturnal cystometrography data accurately during the sleep period. Nocturnal detrusor overactivity occurred significantly less often in patients with insomnia and controls than in patients with detrusor overactivity plus overactive bladder (p = 0.02) and only in the 10 minutes before nocturia events in the latter (0%, 0% and 67%, respectively, p = 0.002). Patients with detrusor overactivity plus overactive bladder were awake for a shorter period before nocturia events (p <0.001) and had a greater percent of nocturia associated awakenings. Patients with insomnia had more awakenings unrelated to nocturia. Nocturnal polyuria, another cause of nocturia, was not significantly associated with nocturnal detrusor overactivity. CONCLUSIONS Sleep and bladder pressure physiology may be safely monitored during the sleep period accurately. Nocturnal detrusor overactivity occurs in association with nocturia in most patients with detrusor overactivity plus overactive bladder, does not generally occur during sleep and is not due to sleep disturbance or nocturnal polyuria. This study may provide a foundation for research on overactive bladder related nocturia pathophysiology and treatment.
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Affiliation(s)
- Andrew D Krystal
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Van Kerrebroeck PE, Dmochowski R, FitzGerald MP, Hashim H, Norgaard JP, Robinson D, Weiss JP. Nocturia research: Current status and future perspectives. Neurourol Urodyn 2010; 29:623-8. [DOI: 10.1002/nau.20913] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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