1
|
Verbakel I, Bou Kheir G, de Rijk M, Dhondt K, Bliwise D, Pauwaert K, Monaghan T, Hervé F, Vogelaers D, Mariman A, Everaert K. Is the insomnia phenotype the common denominator in LUTS during transition periods? An expert NOPIA research group review. Neurourol Urodyn 2024; 43:1134-1146. [PMID: 38289321 DOI: 10.1002/nau.25372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/28/2023] [Accepted: 12/11/2023] [Indexed: 02/01/2024]
Abstract
AIMS As people age, sleep stages and characteristics transition over time, but sleep deficits can profoundly impact health and cognitive functioning. Chronic sleep deprivation is linked to impaired attention and productivity, weakened immunity, increased risk of cardiovascular disease, obesity, and mental health disorders. Insomnia, obstructive sleep apnea syndrome, hormonal changes, nocturia, neurological disorders, and life events interfere with sleep patterns and some are linked to lower urinary tract symptoms (LUTS). This NOPIA symposium on Lifelong LUTS aimed to analyze the literature on associations between sleep and LUTS, generate ideas for future research, and explore whether there is support for the concept of lifelong LUTS in relation to changes in sleep throughout the lifespan. METHODS An international panel of experts took part in an online meeting addressing the role of lifelong LUTS in relationship to sleep and the brain organized by the NOPIA research group. The manuscript summarizes existing literature, hypotheses, future research ideas, and clinical recommendations. RESULTS Insomnia, sleep fragmentation, hyperarousal, and sensory processing disorders emerged as potential factors in the relationship between sleep and LUTS. Insomnia is often a persistent factor and may have been the initial symptom; however, it is often unrecognized and/or unaddressed in healthcare settings. By recognizing insomnia as a primary driver of various health issues, including nocturia, transitional care aims to address root causes and underlying problems earlier to initiate appropriate treatment. CONCLUSIONS A multidisciplinary approach with collaboration between healthcare professionals from various disciplines, such as urology, sleep medicine, gynecology, pediatrics, and geriatrics, is needed and should include validated measurements such as the insomnia severity index and sleep and voiding diaries. Ensuring ongoing follow-up and monitoring through transitional care is crucial for individuals with persistent sleep problems and LUTS, allowing issues that arise or fluctuate over the lifespan to be addressed.
Collapse
Affiliation(s)
- Irina Verbakel
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - George Bou Kheir
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Mathijs de Rijk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Karlien Dhondt
- Department of Child and Adolescent Psychiatry, Pediatric Sleep Center, Ghent University Hospital, Ghent, Belgium
| | - Don Bliwise
- Sleep Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kim Pauwaert
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Thomas Monaghan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - François Hervé
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Dirk Vogelaers
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
- Department of General Internal Medicine, AZ Delta, Roeselare, Belgium
| | - An Mariman
- Center for Integrative Medicine, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
2
|
Monaghan TF, Fang A, Ksido LR, Hachicho C, Muneeb M, Rahman SN, Bou Kheir G, Lazar JM, Everaert K, Wein AJ, Weiss JP. Prevalence of Sleep CALM nocturia factors in a male veteran population. Neurourol Urodyn 2024; 43:1127-1133. [PMID: 38511613 DOI: 10.1002/nau.25410] [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: 10/06/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Nocturia is a complex and multifactorial condition, associated with several genitourinary abnormalities as well as a host of conditions beyond the urinary tract, and thus often poses a significant diagnostic challenge in real-world practice. Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications, the so-called "Sleep C.A.L.M." factors, are five common causes of nocturia requiring judicious evaluation according to current consensus guidelines. This study aims to assess the prevalence of the Sleep C.A.L.M. factors in a nocturia clinical population. METHODS Retrospective analysis of frequency-volume charts from men with ≥2 nocturnal voids as well as concurrent demographic, clinical, and medical history data to identify patients with each of the Sleep C.A.L.M. FACTORS Comorbidities and medications were classified as a single group. RESULTS A total of 213 subjects met the criteria for inclusion (median age 68.0 [63.5-75.5] years). The prevalence of 1) sleep disorders, 2) comorbidities and/or medication use, 3) actions (i.e., modifiable behaviors/lifestyle factors), and 4) lower urinary tract dysfunction was 31%, 31%, 19%, and 41%, respectively. Among included participants, 73% were found to have at least 1 Sleep C.A.L.M. factor, and 33% had multiple Sleep C.A.L.M. FACTORS Results were similar upon stratification by age and nocturnal polyuria status. CONCLUSIONS The Sleep C.A.L.M. factors are highly common among nocturia patients in the clinical urology setting. Although many of these factors are strongly associated with advanced age in community-based nocturia study samples, they appear common even among younger men in a nocturia patient population; the differential effect of age and individual Sleep C.A.L.M. factors on nocturia pathophysiology requires further investigation.
Collapse
Affiliation(s)
- Thomas F Monaghan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alexander Fang
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Lennox R Ksido
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Carla Hachicho
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Manahil Muneeb
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Syed N Rahman
- Department of Urology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - George Bou Kheir
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Jason M Lazar
- Division of Cardiovascular Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Alan J Wein
- Desai Sethi Urology Institute, Department of Urology, University of Miami Health System, Miami, Florida, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| |
Collapse
|
3
|
Worthington J, Frost J, Sanderson E, Cochrane M, Wheeler J, Cotterill N, MacNeill SJ, Noble S, Avery M, Clarke S, Fader M, Hashim H, McGeagh L, Macaulay M, Rees J, Robles L, Taylor G, Taylor J, Thompson J, Lane JA, Ridd MJ, Drake MJ. Lower urinary tract symptoms in men: the TRIUMPH cluster RCT. Health Technol Assess 2024; 28:1-162. [PMID: 38512051 PMCID: PMC11017146 DOI: 10.3310/gvbc3182] [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] [Indexed: 03/22/2024] Open
Abstract
Background Conservative therapies are recommended as initial treatment for male lower urinary tract symptoms. However, there is a lack of evidence on effectiveness and uncertainty regarding approaches to delivery. Objective The objective was to determine whether or not a standardised and manualised care intervention delivered in primary care achieves superior symptomatic outcome for lower urinary tract symptoms to usual care. Design This was a two-arm cluster randomised controlled trial. Setting The trial was set in 30 NHS general practice sites in England. Participants Participants were adult men (aged ≥ 18 years) with bothersome lower urinary tract symptoms. Interventions Sites were randomised 1 : 1 to deliver the TReatIng Urinary symptoms in Men in Primary Health care using non-pharmacological and non-surgical interventions trial intervention or usual care to all participants. The TReatIng Urinary symptoms in Men in Primary Health care using non-pharmacological and non-surgical interventions intervention comprised a standardised advice booklet developed for the trial from the British Association of Urological Surgeons' patient information sheets, with patient and expert input. Patients were directed to relevant sections by general practice or research nurses/healthcare assistants following urinary symptom assessment, providing the manualised element. The healthcare professional provided follow-up contacts over 12 weeks to support adherence to the intervention. Main outcome measures The primary outcome was the validated patient-reported International Prostate Symptom Score 12 months post consent. Rather than the minimal clinically important difference of 3.0 points for overall International Prostate Symptom Score, the sample size aimed to detect a difference of 2.0 points, owing to the recognised clinical impact of individual symptoms. Results A total of 1077 men consented to the study: 524 in sites randomised to the intervention arm (n = 17) and 553 in sites randomised to the control arm (n = 13). A difference in mean International Prostate Symptom Score at 12 months was found (adjusted mean difference of -1.81 points, 95% confidence interval -2.66 to -0.95 points), with a lower score in the intervention arm, indicating less severe symptoms. Secondary outcomes of patient-reported urinary symptoms, quality of life specific to lower urinary tract symptoms and perception of lower urinary tract symptoms all showed evidence of a difference between the arms favouring the intervention. No difference was seen between the arms in the proportion of urology referrals or adverse events. In qualitative interviews, participants welcomed the intervention, describing positive effects on their symptoms, as well as on their understanding of conservative care and their attitude towards the experience of lower urinary tract symptoms. The interviews highlighted that structured, in-depth self-management is insufficiently embedded within general practitioner consultations. From an NHS perspective, mean costs and quality-adjusted life-years were similar between trial arms. The intervention arm had slightly lower mean costs (adjusted mean difference of -£29.99, 95% confidence interval -£109.84 to £22.63) than the usual-care arm, and a small gain in quality-adjusted life-years (adjusted mean difference of 0.001, 95% confidence interval -0.011 to 0.014). Conclusions The intervention showed a small, sustained benefit for men's lower urinary tract symptoms and quality of life across a range of outcome measures in a UK primary care setting. Qualitative data showed that men highly valued the intervention. Intervention costs were marginally lower than usual-care costs. Limitations of the study included that trial participants were unmasked, with limited diversity in ethnicity and deprivation level. Additional research is needed to assess the applicability of the intervention for a more ethnically diverse population.. Trial registration This trial is registered as ISRCTN11669964. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/90/03) and is published in full in Health Technology Assessment; Vol. 28, No. 13. See the NIHR Funding and Awards website for further award information.
Collapse
Affiliation(s)
- Jo Worthington
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jessica Frost
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily Sanderson
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Madeleine Cochrane
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jessica Wheeler
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nikki Cotterill
- School of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Bristol, UK
| | - Stephanie J MacNeill
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian Noble
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Miriam Avery
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Samantha Clarke
- Clinical Research Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Mandy Fader
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Hashim Hashim
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Lucy McGeagh
- National Institute for Health and Care Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Margaret Macaulay
- School of Health Sciences, University of Southampton, Southampton, UK
| | | | - Luke Robles
- National Institute for Health and Care Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | | | - Jodi Taylor
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanne Thompson
- Clinical Research Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - J Athene Lane
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew J Ridd
- Centre of Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
4
|
Hajebrahimi S, Darvishi A, HajEbrahimi R, Asadi N, Jafari Shendi Z, Asiaban N, Naseri A, Sadeghi-Ghyassi F, Mostafaei H, Salehi-Pourmehr H. Efficacy and safety of desmopressin in nocturia and nocturnal polyuria control of neurological patients: A systematic review and meta-analysis. Neurourol Urodyn 2024; 43:167-182. [PMID: 37746880 DOI: 10.1002/nau.25291] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE Evidence on the efficacy of desmopressin in nocturia in patients with neurological diseases is still very limited except for multiple sclerosis (MS). Our aim was to evaluate the efficacy and safety of desmopressin treatment on nocturia in patients with underlying neurological diseases. METHODS Studies were identified by electronic search of PubMed, Embase, Cochrane, CINAHL, and Google Scholar databases. Studies were considered if they provided information on the effectiveness and safety of desmopressin (1-desamino-8-d-arginine vasopressin, or DDAVP) in the treatment of nocturia and their participants had acquired neurological pathology. Two researchers independently extracted the articles using specified datasets, such as quality-of-study indicators. Statistical meta-analysis was carried out using Review Manager (RevMan) 5.4 statistical software (Cochrane Collaboration). RESULTS Of a total of 1042 articles in the initial search, 14 studies were included. Most of the published papers were related to MS (n = 7), two were on spinal cord injury, and other conditions were neural tube defect, myelodysplasia, Parkinson's disease, stroke, and multiple system atrophy. Overall, a total of 200 patients (mostly females) were enrolled. Thirteen studies evaluated the intranasal formulation of desmopressin and one study evaluated oral desmopressin. A significant decrease in nocturia episodes was reported in seven studies evaluating this topic. An increase in the maximum hours of uninterrupted sleep was reported in the three studies in which this outcome was assessed. A significant reduction in the volume of nocturnal incontinence was found in one study. Three studies were eligible to include in the meta-analysis. The results showed that desmopressin compared to placebo, significantly reduced nighttime urination (mean difference: -0.75, 95% CI: -1.10 to -0.41; p < 0.00001). The rate of adverse events ranged from 0% to 68.42%. The critical appraisal results for all trials showed that most of the studies had low or moderate quality. CONCLUSIONS Our results emphasized desmopressin's safety and efficacy in reducing nocturia episodes, with transient adverse effects on neurological patients. However, the data were achieved from low or medium-quality trials, and further well-designed randomized controlled trials are needed.
Collapse
Affiliation(s)
- Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Afra Darvishi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reyhaneh HajEbrahimi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nazli Asadi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Jafari Shendi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Negar Asiaban
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Sadeghi-Ghyassi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
5
|
Tyagi S, Resnick NM, Clarkson BD, Zhang G, Krafty RT, Perera S, Subramanya AR, Buysse DJ. Impact of sleep on chronobiology of micturition among healthy older adults. Am J Physiol Renal Physiol 2023; 325:F407-F417. [PMID: 37560770 PMCID: PMC10639023 DOI: 10.1152/ajprenal.00025.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/14/2023] [Accepted: 08/07/2023] [Indexed: 08/11/2023] Open
Abstract
Nocturia (waking to void) is prevalent among older adults. Disruption of the well-described circadian rhythm in urine production with higher nighttime urine output is its most common cause. In young adults, their circadian rhythm is modulated by the 24-h secretory pattern of hormones that regulate salt and water excretion, including antidiuretic hormone (ADH), renin, angiotensin, aldosterone, and atrial natriuretic peptide (ANP). The pattern of hormone secretion is less clear in older adults. We investigated the effect of sleep on the 24-h secretion of these hormones in healthy older adults. Thirteen participants aged ≥65 yr old underwent two 24-h protocols at a clinical research center 6 wk apart. The first used a habitual wake-sleep protocol, and the second used a constant routine protocol that removed the influence of sleep, posture, and diet. To assess hormonal rhythms, plasma was collected at 8:00 am, 12:00 pm, 4:00 pm, and every 30 min from 7:00 pm to 7:00 am. A mixed-effects regression model was used to compare subject-specific and mean trajectories of hormone secretion under the two conditions. ADH, aldosterone, and ANP showed a diurnal rhythm that peaked during sleep in the wake-sleep protocol. These nighttime elevations were significantly attenuated within subjects during the constant routine. We conclude that sleep has a masking effect on circadian rhythm amplitude of ADH, aldosterone, and ANP: the amplitude of each is increased in the presence of sleep and reduced in the absence of sleep. Disrupted sleep could potentially alter nighttime urine output in healthy older adults via this mechanism.NEW & NOTEWORTHY Nocturia (waking to void) is the most common cause of sleep interruption among older adults, and increased nighttime urine production is its primary etiology. We showed that in healthy older adults sleep affects the 24-h secretory rhythm of hormones that regulate salt-water balance, which potentially alters nighttime urine output. Further studies are needed to elucidate the impact of chronic insomnia on the secretory rhythms of these hormones.
Collapse
Affiliation(s)
- Shachi Tyagi
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Neil M Resnick
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Becky D Clarkson
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Gehui Zhang
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Robert T Krafty
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - Subashan Perera
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Arohan R Subramanya
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| |
Collapse
|
6
|
Yoshiyama A, Tsujimura A, Hiramatsu I, Morino J, Anno Y, Kurosawa M, Kure A, Uesaka Y, Nozaki T, Shirai M, Kiuchi H, Horie S. Circadian Rhythm of Voided Volume, Maximum Flow Rate, and Voiding Time Evaluated by Toilet Uroflowmetry in Hospitalized Women With Nocturia. Urology 2023; 179:50-57. [PMID: 37353090 DOI: 10.1016/j.urology.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To clarify the circadian rhythm of urination in hospitalized women with nocturia measured by toilet uroflowmetry and its age-related change. METHODS We evaluated 2602 urinations of 58 female patients (age, 68.4 ± 15.2 years) who were hospitalized in our institution for urological disease. We assessed voided volume (VV) as averages of every hour by generalized linear mixed models with an identity link function to adjust for personal bias and age. Maximum flow rate and voiding time were analyzed by the same method after adjustment for age, personal bias, and VV. We also compared these circadian rhythms between women <70 and ≥70 years. RESULTS VVs in the nighttime were significantly higher than that from 06:00-07:00 (205.6 ± 11.7 ml). Maximum flow rates in the afternoon were significantly higher than that from 06:00-07:00 (18.8 ± 0.93 ml/sec). Voiding time showed no statistically significant difference between the values at any time of day and that from 06:00-07:00. We also showed that the circadian rhythm of VV becomes less clear in the elderly women (P interaction = .0057). However, no significant difference was found in the maximum flow rate and voiding time regarding the pattern of the circadian rhythm between women <70 and ≥70 years old. CONCLUSION The present study clearly showed a circadian rhythm of VV and maximum flow rate in hospitalized women with nocturia. In addition, the pattern of the circadian rhythm of VV was attenuated in women ≥70 years old.
Collapse
Affiliation(s)
- Azusa Yoshiyama
- Department of Urology, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan; Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Akira Tsujimura
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
| | - Ippei Hiramatsu
- Department of Urology, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan; Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Junki Morino
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Yuta Anno
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Makoto Kurosawa
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Akimasa Kure
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Yuka Uesaka
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Taiji Nozaki
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Masato Shirai
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Hiroshi Kiuchi
- Osaka University Graduate School of Medicine Department of Urology, Suita, Osaka, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
7
|
Gravas S, Gacci M, Gratzke C, Herrmann TRW, Karavitakis M, Kyriazis I, Malde S, Mamoulakis C, Rieken M, Sakalis VI, Schouten N, Speakman MJ, Tikkinen KAO, Cornu JN. Summary Paper on the 2023 European Association of Urology Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms. Eur Urol 2023; 84:207-222. [PMID: 37202311 DOI: 10.1016/j.eururo.2023.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/06/2023] [Indexed: 05/20/2023]
Abstract
CONTEXT Lower urinary tract symptoms (LUTS) are common, often bothersome, and have multifactorial aetiology. OBJECTIVE To present a summary of the 2023 version of the European Association of Urology guidelines on the management of male LUTS. EVIDENCE ACQUISITION A structured literature search from 1966 to 2021 selected the articles with the highest certainty evidence. The Delphi technique consensus approach was used to develop the recommendations. EVIDENCE SYNTHESIS The assessment of men with LUTS should be practical. A careful medical history and physical examination are essential. Validated symptom scores, urine test, uroflowmetry, and postvoid urine residual, as well as frequency-volume charts for patients with nocturia or predominately storage symptoms should be used. Prostate-specific antigen should be ordered if a diagnosis of prostate cancer changes the treatment plan. Urodynamics should be performed for selected patients. Men with mild symptoms are candidates for watchful waiting. Behavioural modification should be offered to men with LUTS prior to, or concurrent with, treatment. The choice of medical treatment depends on the assessment findings, predominant type of symptoms, ability of the treatment to change the findings, and the expectations to be met in terms of the speed of onset, efficacy, side effects, and disease progression. Surgery is reserved for men with absolute indications, and for patients who fail or prefer not to receive medical therapy. Surgical management has been divided into five sections: resection, enucleation, vaporisation, and alternative ablative and nonablative techniques. The choice of surgical technique depends on patient's characteristics, expectations, and preferences; surgeon's expertise; and availability of modalities. CONCLUSIONS The guidelines provide an evidence-based approach for the management of male LUTS. PATIENT SUMMARY A clinical assessment should identify the cause(s) of symptoms and define the clinical profile and patient's expectations. The treatment should aim to ameliorate symptoms and reduce the risk of complications.
Collapse
Affiliation(s)
- Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Christian Gratzke
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | | | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Iason Kyriazis
- Department of Urology, General University Hospital of Patras, Patras, Greece
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | | | - Vasileios I Sakalis
- Department of Urology, Hippokrateion General Hospital, Thessaloniki, Greece.
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Mark J Speakman
- Department of Urology, Taunton & Somerset Hospital, Taunton, UK
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | - Jean-Nicolas Cornu
- Department of Urology, CHU Hôpitaux de Rouen - Hôpital Charles Nicolle, Rouen, France
| |
Collapse
|
8
|
Mohamed-Ahmed R, Taithongchai A, da Silva AS, Robinson D, Cardozo L. Treating and Managing Urinary Incontinence: Evolving and Potential Multicomponent Medical and Lifestyle Interventions. Res Rep Urol 2023; 15:193-203. [PMID: 37351339 PMCID: PMC10284157 DOI: 10.2147/rru.s387205] [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: 03/16/2023] [Accepted: 06/10/2023] [Indexed: 06/24/2023] Open
Abstract
Incontinence is defined by either ICS 2002 or IUGA/ICS 2010 as the involuntary loss of urine and includes urgency urinary incontinence (UUI), stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). It has a high worldwide prevalence with an associated impact on quality of life. Despite existing management options for the management of urinary incontinence, patients continue to be troubled by symptoms or side effects of existing treatment. There is therefore a requirement for ongoing research into treatment options for the management of UUI and SUI, that are more effective and tolerable to patients. Advances in treatment of UUI include a more selective beta 3 agonist, Vibegron, which has less impact on cardiac function than Mirabegron. Hormonal treatment, including Ospemifene and Prasterone, may improve GSM and in turn symptoms of UUI. There are advances in the types of neuromodulators available, including those that are rechargeable at home and are MRI safe. Laser has shown promising initial results. There is developing interest in the microbiome, and how this may impact future treatment modalities. Advances in treatment of SUI include the use of mobile health applications to support delivery of pelvic floor muscle training. Litoxetine, a selective serotonin reuptake inhibitor, has shown promising results at phase III trials. Functional magnetic stimulation is being developed to improve contractility of pelvic floor muscles. We also discuss interventions that improve tissue elasticity and regeneration, such as platelet rich plasma, autologous stem cell transplantation, laser therapy and radiofrequency treatment, which show short term benefits.
Collapse
Affiliation(s)
| | | | | | - Dudley Robinson
- Department of Urogynaecology, King’s College Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King’s College Hospital, London, UK
| |
Collapse
|
9
|
Hafner M, Yerushalmi E, Andersson FL, Burtea T. Partially different? The importance of general equilibrium in health economic evaluations: An application to nocturia. HEALTH ECONOMICS 2023; 32:654-674. [PMID: 36424887 PMCID: PMC10100343 DOI: 10.1002/hec.4638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 09/29/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Both the human capital approach and the friction cost approach are frequently used to quantify the productivity costs associated with illness, disability or death in health economic evaluations. In this paper we argue that these approaches have one major, but common shortcoming: they only capture partial equilibrium (PE) effects and therefore underestimate the true potential productivity costs associated with health conditions. They neglect the sizable, indirect, ripple effects in the economy captured by general equilibrium (GE) models. To demonstrate our point, we compare a traditional PE with a GE approach for the application to nocturia, a condition characterized by the need to frequently wake up at night to urinate. Nocturia is associated with substantial impairment of daytime functioning and work productivity. We employ large-scale United Kingdom (UK) employer-employee survey data to estimate the prevalence and productivity loss. These estimates are then used as shared inputs to drive both approaches. We find that the traditional PE approach underestimates the annual productivity cost of clinically relevant nocturia by around 16%. We propose a generalized GE/PE multiplier to approximate the GE effect for other health conditions. Our findings stress the importance of accounting for sizable GE effects when conducting health economic evaluations.
Collapse
Affiliation(s)
| | - Erez Yerushalmi
- Birmingham City Business SchoolBirmingham City UniversityBirminghamUK
| | | | - Teodor Burtea
- Ferring International Center SASaint‐PrexSwitzerland
| |
Collapse
|
10
|
Monaghan TF, Weiss JP, Wein AJ, Rahman SN, Lazar JM, Bliwise DL, Everaert K, Lemack GE, Cornu JN, Drake MJ, Chapple CR, Hashim H, Blaivas JG, Dmochowski RR. Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications ("Sleep C.A.L.M.") in the evaluation and management of nocturia: A simple approach to a complex diagnosis. Neurourol Urodyn 2023; 42:562-572. [PMID: 36655726 DOI: 10.1002/nau.25128] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Nocturia arises from a fundamental mismatch between nocturnal urine production, storage capacity, and sleep architecture, which may be driven by abnormalities of the genitourinary tract, but also by sleep disorders, medical diseases, patient actions/lifestyle factors, or medications. This article introduces a novel system for organizing the complex differential diagnosis for nocturia, as proposed by an international collective of practicing urologists, physician specialists, and sleep experts: "Sleep CALM"-Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications. METHODS Narrative review of current evidence regarding the relevance of each "Sleep CALM" factor to nocturia pathogenesis, evaluation, and management. RESULTS Nocturia and sleep disorders are highly intertwined and often bidirectional, such that nocturnal awakenings for reasons other than a sensation of bladder fullness should not be used as grounds for exclusion from nocturia treatment, but rather leveraged to broaden therapeutic options for nocturia. Nocturia is an important potential harbinger of several serious medical conditions beyond the genitourinary tract. Urologists should have a low threshold for primary care and medical specialty referral for medical optimization, which carries the potential to significantly improve nocturnal voiding frequency in addition to overall health status. Adverse patient actions/lifestyle factors, lower urinary tract dysfunction, and medication use commonly coexist with disordered sleep and comorbid medical conditions, and may be the primary mediators of nocturia severity and treatment response, or further exacerbate nocturia severity and complicate treatment. CONCLUSION "Sleep CALM" provides a memorable and clinically relevant means by which to structure the initial patient history, physical exam, and clinical testing in accordance with current best-practice guidelines for nocturia. Although not intended as an all-encompassing diagnostic tool, the "Sleep CALM" schema may also be useful in guiding individualized ancillary testing, identifying the need for specialty referral and multidisciplinary care, and uncovering first-line treatment targets.
Collapse
Affiliation(s)
- Thomas F Monaghan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Alan J Wein
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Syed N Rahman
- Department of Urology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jason M Lazar
- Department of Medicine, Division of Cardiovascular Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Karel Everaert
- Department of Human Structure and Repair, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
| | - Gary E Lemack
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jean-Nicolas Cornu
- Department of Urology, Charles Nicolle University Hospital, Rouen, France
| | - Marcus J Drake
- Department of Urology, Imperial College London, Imperial College Healthcare NHS Trust, London, UK
| | - Christopher R Chapple
- Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Hashim Hashim
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Jerry G Blaivas
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roger R Dmochowski
- Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
11
|
Bryophyllum pinnatum and Improvement of Nocturia and Sleep Quality in Women: A Multicentre, Nonrandomised Prospective Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2023; 2023:2115335. [PMID: 36798727 PMCID: PMC9928503 DOI: 10.1155/2023/2115335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/07/2022] [Accepted: 11/24/2022] [Indexed: 02/10/2023]
Abstract
Nocturia is a pathologic condition that significantly affects the quality of sleep. The aetiology of nocturia is multifactorial, and the evidence available on its management remains limited. Besides behavioural measures, validated pharmaceutical treatment options exist but are, however, associated with marked side effects. Prospective clinical studies with tablets prepared from the leaf press juice of the plant Bryophyllum pinnatum revealed a tendency towards reduction of micturition in patients with overactive bladder (OAB) and several improvements in sleep quality. These observations are in part supported by in vitro and in vivo data. In the present study, we investigated the effectiveness of Bryophyllum 50% chewable tablets in the treatment of nocturia and associated sleep disorders. Altogether, 49 women with idiopathic OAB and nocturia of ≥2 voids/night were treated with Bryophyllum 50% tablets for 3 weeks (350 mg chewable tablets, dosage 0-0-2-2 oral tablets; WELEDA AG, Arlesheim, Switzerland). Nocturia, voiding volumes at night (ml), quality of life, sleep quality, and daily sleepiness were assessed before and after treatment with a 3-day micturition diary, the International Consultation on Incontinence evaluating overactive bladder and related impact on quality of life (QoL) [ICIQ-OAB], the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale (ESS), respectively. The age of the study population was 68.5 ± 11.6 y. After treatment, nocturia diminished from 3.2 ± 1.4 to 2.3 ± 1.3 (P < 0.001) and the PSQI score decreased from 7.7 ± 3.7 to 6.6 ± 3.4 (P=0.004). Urgency, the ICIQ score, and the ESS lowered significantly, and the micturition volume showed a tendency to increase. No serious adverse drug reactions were reported, and compliance was good. The results show a beneficial effect on the nocturnal voids and sleep quality of women with OAB. Bryophyllum 50% tablets can be regarded as a well-tolerated alternative in the treatment of nocturia and broaden the repertoire of standard management.
Collapse
|
12
|
Leerasiri P, Pariyaeksut P, Hengrasmee P, Asumpinwong C. Effectiveness of melatonin for the treatment of nocturia: a randomized controlled trial. Int Urogynecol J 2023; 34:485-492. [PMID: 35596803 DOI: 10.1007/s00192-022-05232-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/02/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Nocturia affects health and quality of life (QoL). Current medical treatments can cause severe adverse effects, especially when treating elderly patients. Endogenous melatonin has a physiologic role in urinary bladder function, and the exogenous one may be beneficial for this condition. This article aims to evaluate the effectiveness and safety of melatonin for ameliorating nocturia in older women. METHODS This randomized, double-blind, placebo-controlled trial was conducted at a university hospital in Thailand. Sixty women with nocturia, aged > 55 years, were prospectively recruited and were later randomly allocated to treatment (melatonin 2 mg/day, n = 30) and control (placebo, n = 30) arms for 2 weeks. Outcome measures included nocturia episodes, nocturia-related parameters, Nocturia Quality of Life Questionnaire (N-QoL) scores, and adverse events. RESULTS The treatment and control groups were comparable in mean age (65.9 + 7.5 vs. 68.5 + 6.3 years). Both groups had comparable causes of nocturia with a baseline median voiding frequency of 2.3 (1.3, 6.3) and 2.3 (1.7, 5.3) episodes/night, respectively. The treatment group had significantly better outcomes than the placebo group in terms of median reduction in nocturia [-1.0 (-3.0, 0.0) vs. 0.0 (-2.3, 1.3) episodes/night; p < 0.001], increased median duration of the first uninterrupted sleep [1.0 (-0.3, 4.5) vs. 0.0 (-3.0, 2.3) h; p < 0.001], and improvement in N-QoL scoring, especially in the sleep/energy subscale (p = 0.019) and the total score (p = 0.016). Adverse events were comparable between groups. CONCLUSIONS Melatonin can be considered a safe and effective treatment for nocturia in elderly women.
Collapse
Affiliation(s)
- Pichai Leerasiri
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Pattaya Hengrasmee
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | |
Collapse
|
13
|
Chen SH, Chin WC, Huang YS, Chuech LS, Lin CM, Lee CP, Lin HL, Tang I, Yeh TC. The effect of electromagnetic field on sleep of patients with nocturia. Medicine (Baltimore) 2022; 101:e29129. [PMID: 35960119 PMCID: PMC9371528 DOI: 10.1097/md.0000000000029129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Accumulated studies revealed that electromagnetic field can affect human brain and sleep. We explored the effectiveness of electromagnetic field [Schumann resonance (SR)] on nocturia symptoms, quality of life, and sleep in patients with nocturia. METHODS This is a randomized, open-label, and active-controlled study, in which 35 participants were randomized into 2 groups. Group A received oxybutynin and the SR device for 12 weeks, while the active-control group received only the medication. We followed these patients every 4 weeks with a number of questionnaires, including the Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale (ESS) for sleep, the American Urological Association Symptom Score (AUASS) for nocturia symptoms, and the Nocturia-Quality-of-Life-questionnaire (N-QOL) for quality of life. Descriptive statistics, pair t-tests, Chi-squared tests, and repeated measures were applied for data analysis. RESULTS No significant difference was found in the demographic data between the 2 groups. The AUASS, N-QOL, PSQI, and ESS total scores were significantly improved in the SR-sleep-device group (P < .001, P = .005, P < .001, P = .001) after treatment, but no significant change was found in the active-control group. Several variables of AUASS in the SR-sleep-device group were significantly improved, especially streaming and sleeping (both P = .001), and subjective sleep quality and sleep efficiency also demonstrated significant improvement (both P < .001). CONCLUSIONS Our study revealed that electromagnetic field (SR) as an add-on can improve not only sleep and quality of life but also nocturia symptoms in patients with nocturia. These findings suggest that SR can be effective for sleep disturbance secondary to physical disease, which can be a new application of the electromagnetic field.
Collapse
Affiliation(s)
- Shin-Hong Chen
- Division of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Wei-Chih Chin
- Division of Pediatric Psychiatry and Sleep Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Shu Huang
- Division of Pediatric Psychiatry and Sleep Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Yu-Shu Huang, MD, PhD, Department of Psychiatry and Sleep Center, Chang Gung Memorial Hospital, 5 Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan (e-mail: )
| | | | - Chang-Min Lin
- Division of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Chin-Pang Lee
- Division of Pediatric Psychiatry and Sleep Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huang-Li Lin
- Division of Pediatric Psychiatry and Sleep Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - I Tang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Chun Yeh
- Division of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| |
Collapse
|
14
|
Ahmad T, Khan M, Al-Omari B. Mapping the global literature output on nocturia: A bibliometric and visualized analysis. Medicine (Baltimore) 2022; 101:e29455. [PMID: 35945764 PMCID: PMC9351897 DOI: 10.1097/md.0000000000029455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE This study aims to facilitate researchers' and clinicians' understanding of research frontiers and trends in nocturia. It explores the scientific research outcomes and key bibliometric indices and plots global research on nocturia. METHODS A bibliometric retrospective study was designed, and an online search was conducted in the Web of Science Core Collection database using the potential search keywords related to nocturia in the title field with some specific filtration. HistCite™ and VOSviewer software for windows were used to analyze the data obtained for authors, journals, countries, institutions, keywords, and visualization mapping. RESULTS The initial search retrieved 1479 hits. A total of 1445 publications were included in the final analysis. Of these, 43.53% were published as articles. The most studied area in nocturia is urology nephrology. The most productive year was 2019 (n = 121, citations = 335), and the most prolific author, both in terms of publications (n = 97) and citations (1658) was Weiss JP. The most cited journal in nocturia research was the Journal of Urology (n = 293, citations = 3050). The most widely used keyword in nocturia publications was nocturia (n = 1249). Visualization mapping shows that the USA was the most influential and highly cited country in nocturia research. CONCLUSION This study showed that there has been an increasing research trend in nocturia over the past few years. The current findings provide important empirical evidence for researchers, clinicians, and physicians to understand research frontiers and trends, achievements, collaborative networks, and hotspot research topics in the research field of nocturia.
Collapse
Affiliation(s)
- Tauseef Ahmad
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210096, China
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
| | - Muhammad Khan
- Department of Biotechnology and Genetic Engineering, Hazara University, Mansehra, 21120, Khyber Pakhtunkhwa, Islamic Republic of Pakistan
| | - Basem Al-Omari
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- KU Research and Data Intelligence Support Center (RDISC) AW 8474000331, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- *Correspondence: Basem Al-Omari, Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates (e-mail: )
| |
Collapse
|
15
|
Nguyen LN, Randhawa H, Nadeau G, Cox A, Hickling D, Campeau L, Li J, Welk B, Carlson K. Canadian Urological Association best practice report: Diagnosis and management of nocturia. Can Urol Assoc J 2022; 16:E336-E349. [PMID: 35819914 PMCID: PMC9328849 DOI: 10.5489/cuaj.7970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Affiliation(s)
- Laura N. Nguyen
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Harkanwal Randhawa
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Geneviève Nadeau
- Division of Urology, CIUSSS-Capitale Nationale Université Laval, Quebec, QC, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Duane Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Lysanne Campeau
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Juliana Li
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Blayne Welk
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Kevin Carlson
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
16
|
Anapindi KDB, Romanova EV, Checco JW, Sweedler JV. Mass Spectrometry Approaches Empowering Neuropeptide Discovery and Therapeutics. Pharmacol Rev 2022; 74:662-679. [PMID: 35710134 DOI: 10.1124/pharmrev.121.000423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The discovery of insulin in the early 1900s ushered in the era of research related to peptides acting as hormones and neuromodulators, among other regulatory roles. These essential gene products are found in all organisms, from the most primitive to the most evolved, and carry important biologic information that coordinates complex physiology and behavior; their misregulation has been implicated in a variety of diseases. The evolutionary origins of at least 30 neuropeptide signaling systems have been traced to the common ancestor of protostomes and deuterostomes. With the use of relevant animal models and modern technologies, we can gain mechanistic insight into orthologous and paralogous endogenous peptides and translate that knowledge into medically relevant insights and new treatments. Groundbreaking advances in medicine and basic science influence how signaling peptides are defined today. The precise mechanistic pathways for over 100 endogenous peptides in mammals are now known and have laid the foundation for multiple drug development pipelines. Peptide biologics have become valuable drugs due to their unique specificity and biologic activity, lack of toxic metabolites, and minimal undesirable interactions. This review outlines modern technologies that enable neuropeptide discovery and characterization, and highlights lessons from nature made possible by neuropeptide research in relevant animal models that is being adopted by the pharmaceutical industry. We conclude with a brief overview of approaches/strategies for effective development of peptides as drugs. SIGNIFICANCE STATEMENT: Neuropeptides, an important class of cell-cell signaling molecules, are involved in maintaining a range of physiological functions. Since the discovery of insulin's activity, over 100 bioactive peptides and peptide analogs have been used as therapeutics. Because these are complex molecules not easily predicted from a genome and their activity can change with subtle chemical modifications, mass spectrometry (MS) has significantly empowered peptide discovery and characterization. This review highlights contributions of MS-based research towards the development of therapeutic peptides.
Collapse
Affiliation(s)
- Krishna D B Anapindi
- Department of Chemistry and the Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, Illinois (K.D.B.A., E.V.R., J.V.S.) and Department of Chemistry, University of Nebraska-Lincoln, Lincoln, Nebraska (J.W.C.)
| | - Elena V Romanova
- Department of Chemistry and the Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, Illinois (K.D.B.A., E.V.R., J.V.S.) and Department of Chemistry, University of Nebraska-Lincoln, Lincoln, Nebraska (J.W.C.)
| | - James W Checco
- Department of Chemistry and the Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, Illinois (K.D.B.A., E.V.R., J.V.S.) and Department of Chemistry, University of Nebraska-Lincoln, Lincoln, Nebraska (J.W.C.)
| | - Jonathan V Sweedler
- Department of Chemistry and the Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, Illinois (K.D.B.A., E.V.R., J.V.S.) and Department of Chemistry, University of Nebraska-Lincoln, Lincoln, Nebraska (J.W.C.)
| |
Collapse
|
17
|
Müderrisoglu AE, Oelke M, Schneider T, Murgas S, de la Rosette JJMCH, Michel MC. What Are Realistic Expectations to Become Free of Overactive Bladder Symptoms? Experience from Non-interventional Studies with Propiverine. Adv Ther 2022; 39:2489-2501. [PMID: 35325367 PMCID: PMC9123021 DOI: 10.1007/s12325-022-02114-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/03/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Unmet expectations are a major cause of perceived treatment failure and discontinuation of treatment. To enable evidence-based counselling of patients on realistic expectations, we determined the chance of patients with overactive bladder becoming free of a given symptom upon treatment with a muscarinic antagonist in a non-interventional setting. METHODS Two non-interventional studies included 1335 and 745 patients, respectively, who received 30 or 45 mg q.d. propiverine ER for 12 weeks. They were monitored for becoming free of urgency, urinary incontinence, frequency, or nocturia. Analyses were also performed in subgroups defined by basal symptom severity, age, and gender. Categorical data are shown as a percentage of the respective population. Continuous data are expressed as means or as median depending on whether the variability was considered to exhibit a normal distribution. RESULTS The probability of becoming symptom-free was largest for incontinence and frequency (about 50%), but lesser for urgency (about 20%) and nocturia (about 10%). Greater basal severity of a symptom reduced the chance to become free of that symptom upon treatment, but the chance to become free of incontinence and frequency was still considerable. Age and gender had only minor if any effects on the chance of becoming symptom-free. These findings are in line with those of a limited number of randomized controlled trials. CONCLUSION These data provide an evidence base for the counselling of patients with overactive bladder on realistic expectations of treatment outcomes. We propose that realistic expectations can lead to greater long-term adherence.
Collapse
Affiliation(s)
- A Elif Müderrisoglu
- Department of Medical Pharmacology, Istanbul Medipol University, Istanbul, Turkey
| | - Matthias Oelke
- Department of Urology, St. Antonius-Hospital, Gronau, Germany
| | - Tim Schneider
- Clinic for Urology Rhein Ruhr (PUR/R), Mülheim, Germany
| | | | | | - Martin C Michel
- Department of Pharmacology, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
| |
Collapse
|
18
|
Michel MC, Madersbacher S. [Medical treatment of male lower urinary tract symptoms: what's new?]. Aktuelle Urol 2022; 53:240-245. [PMID: 35193150 DOI: 10.1055/a-1749-4556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Decades after the introduction of 5α-reductase inhibitors and α1-adrenoceptor antagonists, new data of practical relevance related to their desired and adverse effects continues to emerge. Some of these novel findings are to be taken seriously but are insufficiently established, for instance associations between drug use and depression or dementia. Multiple combination treatments have been tested. While combination treatment was often statistically superior to monotherapy, the difference was mostly in the range of 1 IPSS point, which raises doubts on the clinical relevance of the findings at the group level. The new evidence enables further personalisation of the treatment of male lower urinary tract dysfunction, but also makes individual risk-benefit considerations more complex.
Collapse
Affiliation(s)
- Martin C. Michel
- Pharmacology, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Stephan Madersbacher
- Urologie, Kaiser Franz Josef Krankenhaus, Sigmund Freud Privatuniversität, Wien, Austria
| |
Collapse
|
19
|
Chung YH, Kim JR, Choi SJ, Joo EY. Prevalence and predictive factors of nocturia in patients with obstructive sleep apnea syndrome: A retrospective cross-sectional study. PLoS One 2022; 17:e0267441. [PMID: 35476719 PMCID: PMC9045637 DOI: 10.1371/journal.pone.0267441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/09/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives Many patients with obstructive sleep apnea syndrome (OSAS) have nocturia. However, the predictive index of nocturia in patients with OSAS is currently not well known. We aimed to investigate the prevalence of nocturia in patients with OSAS and determine the factors that could predict nocturia in these patients. Methods In this retrospective cross-sectional study, we enrolled 1,264 untreated patients with OSAS (Apnea-Hypopnea Index, AHI ≥5/h on polysomnography [PSG]) from January 2017 to January 2020. Participants completed the Beck Depression Inventory-II (BDI-II), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Epworth Sleepiness Scale. Participants were divided by sex and then subdivided into nocturia and non-nocturia groups according to the following question, “Do you go to the bathroom two times or more during your sleep?” Participants’ characteristics and underlying disease were investigated, and all information, including PSG data, was compared between the two groups using the t-test or chi-square test. Results Overall, 35.2% (337/958) of male participants with OSAS and 59.8% (183/306) of female participants with OSAS had nocturia. The nocturia group was older; scored higher on the BDI-II, PSQI, and ISI; and had more underlying disease in both sexes. There was no difference in the AHI between the two groups among both sexes, but the hypoxia-related PSG parameters and sleep quality parameters, such as higher 90% oxygen desaturation index (90% ODI), lesser N3 sleep, and higher wakefulness after sleep onset, were worse among male participants with OSAS in the nocturia group than in the non-nocturia group. In multivariate logistic analysis, 90% ODI was an independent risk factor associated with nocturia in male participants with OSAS. Conclusions Considerable number of patients with OSAS had nocturia and poor sleep quality. Nocturia should be evaluated in male OSAS patients with severe hypoxia observed during sleep.
Collapse
Affiliation(s)
- Yeon Hak Chung
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Rim Kim
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su Jung Choi
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Graduate School of Clinical Nursing Science, Sungkyunkwan University, Seoul, Korea
| | - Eun Yeon Joo
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| |
Collapse
|
20
|
Dietary salt with nitric oxide deficiency induces nocturnal polyuria in mice via hyperactivation of intrarenal angiotensin II-SPAK-NCC pathway. Commun Biol 2022; 5:175. [PMID: 35228649 PMCID: PMC8885931 DOI: 10.1038/s42003-022-03104-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/01/2022] [Indexed: 11/12/2022] Open
Abstract
Nocturnal polyuria is the most frequent cause of nocturia, a common disease associated with a compromised quality of life and increased mortality. Its pathogenesis is complex, and the detailed underlying mechanism remains unknown. Herein, we report that concomitant intake of a high-salt diet and reduced nitric oxide (NO) production achieved through Nω-Nitro-L-arginine methyl ester hydrochloride (L-NAME) administration in mice resulted in nocturnal polyuria recapitulating the clinical features in humans. High salt intake under reduced NO production overactivated the angiotensin II-SPAK (STE20/SPS1-related proline–alanine-rich protein kinase)-NCC (sodium chloride co-transporter) pathway in the kidney, resulting in the insufficient excretion of sodium during the day and its excessive excretion at night. Excessive Na excretion at night in turn leads to nocturnal polyuria due to osmotic diuresis. Our study identified a central role for the intrarenal angiotensin II-SPAK-NCC pathway in the pathophysiology of nocturnal polyuria, highlighting its potential as a promising therapeutic target. This study reports a mouse model of nocturnal polyuria - increased urine production at night that causes compromised quality of life and may impact mortality in older people. The authors identify a molecular pathway in the kidney that could prove to be a promising drug target for nocturnal polyuria.
Collapse
|
21
|
Smith M, Dawson S, Andrews RC, Eriksson SH, Selsick H, Skyrme-Jones A, Udayaraj U, Rees J, Strong E, Henderson EJ, Drake MJ. Evaluation and Treatment in Urology for Nocturia Caused by Nonurological Mechanisms: Guidance from the PLANET Study. Eur Urol Focus 2022; 8:89-97. [PMID: 35101453 DOI: 10.1016/j.euf.2022.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/07/2022] [Indexed: 11/27/2022]
Abstract
Patients with nocturia are commonly referred to urology clinics, including many for whom a nonurological medical condition is responsible for their symptoms. The PLanning Appropriate Nocturia Evaluation and Treatment (PLANET) study was established to develop practical approaches to equip healthcare practitioners to deal with the diverse causes of nocturia, based on systematic reviews and expert consensus. Initial assessment and therapy need to consider the possibility of one or more medical conditions falling into the "SCREeN" areas of Sleep medicine (insomnia, periodic limb movements of sleep, parasomnias, and obstructive sleep apnoea), Cardiovascular (hypertension and congestive heart failure), Renal (chronic kidney disease), Endocrine (diabetes mellitus, thyroid disease, pregnancy/menopause, and diabetes insipidus), and Neurology. Medical and medication causes of xerostomia should also be considered. Some key indicators for these conditions can be identified in urology clinics, working in partnership with the primary care provider. Therapy of the medical condition in some circumstances lessens the severity of nocturia. However, in many cases there is a conflict between the two, in which case the medical condition generally takes priority on safety grounds. It is important to provide patients with a realistic expectation of therapy and awareness of limitations of current therapeutic options for nocturia. PATIENT SUMMARY: Nocturia is the symptom of waking at night to pass urine. Commonly, this problem is referred to urology clinics. However, in some cases, the patient does not have a urological condition but actually a condition from a different speciality of medicine. This article describes how best the urologist and the primary care doctor can work together to assess the situation and make sensible and safe treatment suggestions. Unfortunately, there is sometimes no safe or effective treatment choice for nocturia, and treatment needs to focus instead on supportive management of symptoms.
Collapse
Affiliation(s)
- Matthew Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Robert C Andrews
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Sofia H Eriksson
- Department of Clinical and Experiential Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Hugh Selsick
- Insomnia and Behavioural Sleep Medicine, University College London Hospitals, London, UK
| | - Andrew Skyrme-Jones
- Cardiology Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Udaya Udayaraj
- Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, UK; Oxford Kidney Unit, Churchill Hospital, Oxford, UK
| | | | - Edward Strong
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Older People's Unit, Royal United Hospital NHS Foundation Trust, Bath, UK
| | - Marcus J Drake
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| |
Collapse
|
22
|
Ochoa DC, Hashim H. The Importance of Terminology for Quantifying Nocturia in Practice. Eur Urol Focus 2022; 8:81-85. [PMID: 35094963 DOI: 10.1016/j.euf.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/09/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although nocturia, affecting mainly the elderly population, is a urinary tract symptom, it may also be a part of conditions not related to the urinary tract. In this scenario, nocturia terminology is crucial to avoid confusion and misunderstanding across different specialities. The International Continence Society (ICS) provides the updated nocturia terminology. OBJECTIVE To review, describe, and explain the applicability of nocturia terminology based on the ICS standardisation documents. DESIGN, SETTING, AND PARTICIPANTS The ICS report provides definitions on the terminology for nocturia and nocturnal lower urinary tract function, which were identified and summarised. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Terminology was classified as symptoms and signs, and an explanation of how terms are applied in a bladder diary for use in clinical practice was given. RESULTS AND LIMITATIONS Terminology was classified into symptoms and signs. Nocturia is a symptom where the patient reports waking up to pass urine during their main sleep period, and every episode is followed by sleep or the intention to sleep. Nocturnal polyuria is a symptom when the patient perceives that they have passed large volumes of urine during the main sleep period. Enuresis is the complaint of incontinence that occurs while a patient is asleep and is usually unaware of it. All these terms can be a sign when quantified on the bladder diary. The remaining terminology is identified and quantified on the 3-d bladder diary (24-h voided volume, 24-h polyuria, nocturnal urine volume, night-time frequency, first morning void, night-time main sleep period). CONCLUSIONS The health care provider must understand the critical differences between the different terms. It will facilitate communication among all the professionals involved in the care of these patients. A 3-d bladder diary is a fundamental tool for assessing nocturia. PATIENT SUMMARY This paper has the objective of defining and explaining all the terms currently used for nocturia. For this purpose, we utilised the published standard terminology and summarised it with examples for better understanding and applicability.
Collapse
Affiliation(s)
| | - Hashim Hashim
- Bristol Urological Institute, North Bristol Trust, Bristol, UK
| |
Collapse
|
23
|
Olaniyi P, Cotterill N, Drake MJ, Frost J, Lane JA, Ridd M, Robles L, Taylor G, Worthington J, Wheeler J. Qualitative Assessment of the Conservative Management of Nocturia with Standardised Written Materials for Lower Urinary Tract Symptoms in Men Treated in Primary Care. Eur Urol Focus 2022; 8:75-80. [PMID: 35034867 DOI: 10.1016/j.euf.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many men prefer conservative treatment of lower urinary tract symptoms (LUTS) but education and self-help guidance are limited in primary care. OBJECTIVE To report qualitative interview findings for men reporting nocturia in a primary care setting for LUTS. DESIGN, SETTING, AND PARTICIPANTS TRIUMPH (Treating Urinary Symptoms in Men in Primary Healthcare) is a multicentre cluster randomised trial of standardised manualised care (a booklet delivered by a health care professional) versus usual care for LUTS. The participants (524 in the intervention arm and 553 in the usual care arm) were men presenting for primary care for LUTS at 30 general practice (GP) sites in the UK. INTERVENTION Delivery of a LUTS self-management booklet by health care staff in comparison to usual care for men with LUTS. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The qualitative component included 58 early-stage (0-3 mo after study enrolment) and 33 late-stage (3-9 mo later) interviews with participants to assess their experience of LUTS and conservative treatment in primary care. Purposive sampling was used to select participants for interview. RESULTS AND LIMITATIONS Nocturia is a common driver for seeking health care and is perceived by men as relatively acceptable to discuss. Information and self-help guidance were largely absent from descriptions of GP consultations, other than reducing evening caffeine and fluid intake. The TRIUMPH LUTS intervention booklet offers explanations and self-management guidance. Men with long-term disruptive symptoms, a perception that the booklet content was novel or worthwhile, and a belief that self-management might help, were more receptive to the intervention. In follow-up, improvements in nocturia were related to successful implementation of several aspects of the guidance. Most men were willing to complete a bladder diary, but some found it inconvenient, especially men in employment. The characteristics of the trial population mean that the findings may not apply to all men. CONCLUSIONS Reassuring men that nocturia is part of ageing without offering them information and support risks reinforcing the tendency to discount problematic LUTS. The trial booklet and the training of health care professionals support guidance on nocturia self-management, which is most effective for men receptive to this approach. However, the nature of the trial population means that the findings may not apply to all men. PATIENT SUMMARY Men are more comfortable in discussing waking at night to urinate than talking about other urinary symptoms with their GP. This problem should lead to a detailed discussion of all urinary symptoms rather than being thought of as a sign of ageing. An information booklet and nurse consultation helped many men to improve this symptom.
Collapse
Affiliation(s)
- Patrick Olaniyi
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Nikki Cotterill
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Jessica Frost
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - J Athene Lane
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Ridd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Luke Robles
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gordon Taylor
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jo Worthington
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jessica Wheeler
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
24
|
van Merode NAM, Dawson S, Coulthard E, Henderson EJ, Rice CM, Rees J, Smith M, Strong E, Cotterill N, Huntley AL, Drake MJ. Assessment and Treatment of Nocturia in Neurological Disease in a Primary Care Setting: Systematic Review and Nominal Group Technique Consensus. Eur Urol Focus 2022; 8:33-41. [PMID: 35031351 DOI: 10.1016/j.euf.2021.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Neurological disease can affect the rate of urine production and bladder storage function, increasing nocturia severity, with additional risks if mobility or cognition is impaired. OBJECTIVE To conduct a systematic review (SR) of nocturia in neurological diseases and achieve expert consensus for management in clinics without neurologist input. EVIDENCE ACQUISITION Four databases were searched from January 2000 to April 2020. A total of 6262 titles and abstracts were screened and 43 studies were included for full-text screening. Eleven of these met the inclusion criteria and two studies were identified through other sources. The nominal group technique (NGT) was used to develop consensus in panel comprising experts and public representation. EVIDENCE SYNTHESIS Thirteen studies (seven in Parkinson's disease, five in multiple sclerosis) were included, all undertaken in secondary care. Neurological disease severity was incompletely described, and nocturia severity was generally measured subjectively. NGT consensus supported basic neurological assessment, and the use of bladder diaries where neurological impairment permits. Treatments include pelvic-floor muscle training, review of medications, risk mitigation, improving bowel function, therapy for overactive bladder syndrome (if urgency is reported in association with nocturia episodes), treatment of postvoid residual and desmopressin according to licence. Measures to improve mobility and mitigate risk when using the toilet overnight should be considered. Multifactorial issues such as obstructive sleep apnoea and hypoventilation must be considered. CONCLUSIONS Nocturia in neurological disease is complex and lacks a robust evidence base, with very little research done in the primary care context. Guidance should be pragmatic, with reduction of risk a key requirement, until a multidisciplinary evidence base can be developed. PATIENT SUMMARY People with a neurological disease can suffer severe sleep disturbance because of the need to pass urine several times overnight (called nocturia). We looked at published research and found very little information to help general practitioners in managing this condition. We assembled a group of experts to develop practical approaches for assessing and treating nocturia in neurological disease.
Collapse
Affiliation(s)
| | - Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Elizabeth Coulthard
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Older Person's Unit, Royal United Hospital NHS Foundation Trust Bath, Combe Park, Bath, UK
| | - Claire M Rice
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Matthew Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Edward Strong
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nikki Cotterill
- School of Health and Social Wellbeing, University of the West of England, Bristol, Bristol, UK; Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Alyson L Huntley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK.
| |
Collapse
|
25
|
Papworth E, Dawson S, Henderson EJ, Eriksson SH, Selsick H, Rees J, Gimson A, Strong E, Cotterill N, Huntley AL, Drake MJ. Association of Sleep Disorders with Nocturia: A Systematic Review and Nominal Group Technique Consensus on Primary Care Assessment and Treatment. Eur Urol Focus 2022; 8:42-51. [PMID: 35027331 DOI: 10.1016/j.euf.2021.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 12/26/2022]
Abstract
CONTEXT Sleep disorders affect responsiveness to sensory information and can cause nocturnal polyuria and reduced sleep depth; hence, these are potentially influential in understanding the mechanism of nocturia. OBJECTIVE To report the systematic review (SR) and expert consensus for primary care management of nocturia in sleep disorders. EVIDENCE ACQUISITION Four databases were searched from January to April 2020. A total of 1658 titles and abstracts were screened, and 23 studies potentially applicable were included for full-text screening. The nominal group technique (NGT) was used to derive a consensus on recommendations for management using an expert panel with public involvement. EVIDENCE SYNTHESIS Thirteen studies met the SR inclusion criteria, all of which studied obstructive sleep apnoea (OSA), with ten evaluating the effect of continuous positive airway pressure. The NGT consensus discussed the assessment of OSA with other key sleep disorders, notably insomnia, restless legs syndrome/periodic limb movements of sleep, and parasomnias, including non-rapid eye movement (non-REM) parasomnias and REM sleep behaviour disorder (RBD). The NGT considered that the use of screening questions to reach a clinical diagnosis is a sufficient basis for offering conservative therapy within primary care. Reasons for referral to a sleep clinic are suspected sleep disorder with substantially impaired daytime function despite conservative treatment. Suspected RBD should be referred, and if confirmed, neurology opinion is indicated. Referrals should follow local guidelines. Persisting nocturia is not currently considered an indication for referral to a sleep clinic. CONCLUSIONS Sleep disorders are potentially highly influential in nocturia, but are often overlooked. PATIENT SUMMARY People with sleep disorders can experience nocturia due to easy waking or increased bladder filling. We looked at published research, and information was limited to one form of sleep disturbance-obstructive sleep apnoea. We assembled a group of experts, to develop practical approaches for assessing and treating nocturia in the potentially relevant sleep disorders.
Collapse
Affiliation(s)
- Emma Papworth
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily J Henderson
- Older Person's Unit, Royal United Hospital NHS Foundation Trust Bath, Combe Park, Bath, UK
| | - Sofia H Eriksson
- Department of Clinical and Experiential Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Hugh Selsick
- Insomnia and Behavioural Sleep Medicine, University College London Hospitals, London, UK
| | - Jonathan Rees
- Tyntesfield Medical Group, North Somerset, Bristol, UK
| | - Amy Gimson
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Edward Strong
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nikki Cotterill
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Alyson L Huntley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| |
Collapse
|
26
|
Harris WN, Everaert K. Overactive Bladder as a Key Driver of Nocturia: The Argument Against. Eur Urol Focus 2022; 8:6-7. [PMID: 35027328 DOI: 10.1016/j.euf.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/17/2021] [Accepted: 12/28/2021] [Indexed: 11/26/2022]
Abstract
Studies have shown that therapies for overactive bladder reduce urgency symptoms. However, these studies fail to demonstrate clinically significant increases in bladder capacity or changes in mean voided volumes at night.
Collapse
Affiliation(s)
- William N Harris
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
27
|
Dawson S, Duncan L, Ahmed A, Gimson A, Henderson EJ, Rees J, Strong E, Drake MJ, Cotterill N, Huntley AL, Andrews RC. Assessment and Treatment of Nocturia in Endocrine Disease in a Primary Care Setting: Systematic Review and Nominal Group Technique Consensus. Eur Urol Focus 2022; 8:52-59. [PMID: 34996740 DOI: 10.1016/j.euf.2021.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Salt and water homeostasis is regulated hormonally, so polyuria can result from endocrine disease directly or via secondary effects. These mechanisms are not consistently considered in primary care management of nocturia. OBJECTIVE To conduct a systematic review (SR) of nocturia in endocrine disease and reach expert consensus for primary care management. EVIDENCE ACQUISITION Four databases were searched from January 2000 to April 2020. A total of 4382 titles and abstracts were screened, 36 studies underwent full-text screening, and 14 studies were included in the analysis. Expert and public consensus was achieved using the nominal group technique (NGT). EVIDENCE SYNTHESIS Twelve studies focused on mechanisms of nocturia, while two evaluated treatment options; none of the studies took place in a primary care setting. NGT consensus identified key clinical evaluation themes, including the presence of thirst, a medical background of diabetes mellitus or insipidus, thyroid disease, oestrogen status, medications (fluid loss or xerostomia), and general examination including body mass index. Proposed investigations include a bladder diary, renal and thyroid function, calcium, and glycated haemoglobin. Morning urine osmolarity should be examined in the context of polyuria of >2.5 l/24 h persisting despite fluid advice, with urine concentration >600 mOsm/l after fluid restriction excluding diabetes insipidus. Treatment should involve education, including adjustment of lifestyle and medication where possible. Any underlying endocrine disorder should be managed according to local guidance. Referral to endocrinology is needed if there is hyperthyroidism, hyperparathyroidism, or morning urine osmolarity <600 mOsm/l after overnight fluid avoidance. CONCLUSIONS Endocrine disease can result in nocturia via varied salt and water regulation pathways. The aim of management is to identify and treat causative factors, but secondary effects can restrict improvements in nocturia. PATIENT SUMMARY People with altered hormone function can suffer from severe sleep disturbance because of a need to pass urine caused by problems in controlling water and salt levels. An expert panel recommended the best ways to assess and treat these problems on the basis of the rather small amount of up-to-date published research available.
Collapse
Affiliation(s)
- Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lorna Duncan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ahmed Ahmed
- Endocrinology and Diabetes Department, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Amy Gimson
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Older Person's Unit, Royal United Hospital NHS Foundation Trust Bath, Combe Park, Bath, UK
| | - Jonathan Rees
- Tyntesfield Medical Group, Backwell Medical Centre, Bristol, UK
| | - Ed Strong
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Nikki Cotterill
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Alyson L Huntley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Robert C Andrews
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| |
Collapse
|
28
|
The Challenges of Real-life Bladder Diary Use and Interpretation. Eur Urol Focus 2022; 8:11-17. [PMID: 35058169 DOI: 10.1016/j.euf.2022.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 01/25/2023]
Abstract
The International Consultation on Incontinence Questionnaire bladder diary records the amount and type of drinks, urine output, bladder sensation, and pad use for assessing nocturia and storage urinary symptoms. Instructions before completion, checks after completion, and training of staff in diary analysis are essential.
Collapse
|
29
|
Drake MJ, Rees J, Henderson EJ. Nocturia Is an Orphan Symptom Seeking Caring Specialties Willing To Adopt. Eur Urol Focus 2022; 8:1-3. [DOI: 10.1016/j.euf.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 11/04/2022]
|
30
|
Hypothesis: Disrupted Regulation of the Intracranial Vascular and Cerebrospinal Fluid Circulations Causes Nocturia. Eur Urol Focus 2022; 8:60-65. [DOI: 10.1016/j.euf.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
|
31
|
Son HS, Kim JH. Lower Urinary Tract Symptoms are common after Artificial Urinary Sphincter implantation. Urology 2022; 165:343-350. [DOI: 10.1016/j.urology.2022.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/15/2022] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
|
32
|
Rubilotta E, Castellani D, Gubbiotti M, Balzarro M, Pirola GM, Righetti R, Curti P, Giannantoni A, Cerruto MA, Antonelli A. Nocturnal polyuria in men performing uroflowmetry for lower urinary tract symptoms. Arch Ital Urol Androl 2021; 93:445-449. [PMID: 34933542 DOI: 10.4081/aiua.2021.4.445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/05/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To assess the prevalence of nocturnal polyuria (NP) in males performing uroflowmetry (UF) for lower urinary tract symptoms (LUTS), the impact of NP on UF outcomes, and bladder emptying, the association between NP and LUTS. MATERIALS AND METHODS Men scheduled for UF were recruited in two Centres. Data collected were medical history, IPSS, UF, post-void residual urine volume (PVR), 3-day frequency-volume charts (FVC). The NP index was used to assess NP with a threshold of ≥ 33%. The relationship between NP and patient's aging was assessed. RESULTS 162 patients were included in the analysis. Mean age was 70.95 ± 8.04 years. The prevalence of NP was 54.9% (89/162). 110 (68%) patients reported nocturia, and among these, NP was documented in 76 (69%). Nocturia was found in 85% (76/89) of the population with NP. Total IPSS score, IPSS items #1, #2 and #7 showed a significant difference in men with NP compared with those without. Maximum flow rate and PVR did not significantly change comparing men with or without NP. Mean voiding volume (VV) of the night-time micturitions was significantly higher in men with NP compared to those without NP (532.1 ± 275.6 ml vs 175 ± 168.7 ml respectively, p < 0001), while mean VV day-time micturitions and mean VV at UF did not change between groups. CONCLUSIONS NP had a high prevalence in men with LUTS performing UF. Aged males were more commonly affected by NP. Data demonstrated a strong relationship between NP and nocturia and increased urinary frequency while voiding symptoms were poorly related to NP.
Collapse
Affiliation(s)
| | | | - Marilena Gubbiotti
- Department of Urology, San Donato Hospital, Usl Toscana Sud-Est, Arezzo.
| | | | | | - Rita Righetti
- Department of Urology, AULSS 9, Ospedale Mater Salutis, Legnago.
| | - Pierpaolo Curti
- Department of Urology, AULSS 9, Ospedale Mater Salutis, Legnago.
| | - Antonella Giannantoni
- Functional and Surgical Urology Unit, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, Siena.
| | | | | |
Collapse
|
33
|
Kim J, Chung E. Pharmacotherapeutic options in the treatment of nocturia: update on current oral drug therapies. Expert Opin Pharmacother 2021; 23:405-411. [PMID: 34913416 DOI: 10.1080/14656566.2021.2016698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Nocturia is a common urinary complaint among patients presenting with lower urinary tract symptoms and in recent years, there is a greater emphasis to tailor the treatment for nocturia in a more holistic and multidisciplinary manner given the potential multifactorial causes for nocturia. AREAS COVERED Current oral drug therapies can be classified into three main groups, namely, decreasing polyuria, targeting bladder capacity, and improving sleep-wake and circadian rhythm. The authors focus this article on these oral therapies and provide their expert opinion. EXPERT OPINION Treatment strategies should always involve lifestyle changes and behavioral modifications, with the targeted treatment of underlying medical conditions that may cause nocturia. Desmopressin remains the only drug approved specifically for the treatment of nocturia. Medications targeting the bladder and prostate can have secondary benefits in minimizing nocturnal frequency and urgency especially if the drug is taken at nighttime. Treatment of an underlying sleep disorder or circadian disorder can often help to increase total sleep time and quality, and perhaps reducing the nocturnal diuresis and nocturia episodes. Future studies in nocturia should improve the identification and diagnosis of underlying mechanisms that lead to nocturia, so treatment can become more streamlined, while at the same time, explore the role of various pharmacotherapeutic agents and novel therapy to reduce or eliminate nocturia.
Collapse
Affiliation(s)
- Jason Kim
- University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - Eric Chung
- University of Queensland, Princess Alexandra Hospital, Brisbane, Australia.,AndroUrology Centre, Brisbane, Australia.,AndroUrology Centre, Sydney, Australia.,Macquarie University Hospital, Sydney, Australia
| |
Collapse
|
34
|
Gazdovich S, Sabbagh P, Cornu JN. Authors' reply re: The association between nocturia, hormonal symptoms and bladder parameters in women: an observational study: Nocturia in women is often the tip of the iceberg. BJOG 2021; 129:831. [PMID: 34519171 DOI: 10.1111/1471-0528.16878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Stephanie Gazdovich
- Department of Urology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.,University of Montreal, Montreal, Quebec, Canada
| | - Paul Sabbagh
- Department of Urology, University Hospital of Rouen, Rouen, France.,Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Jean-Nicolas Cornu
- Department of Urology, University Hospital of Rouen, Rouen, France.,Centre Hospitalier Universitaire de Rouen, Rouen, France
| |
Collapse
|
35
|
Kanematsu A. Editorial Comment to Desmopressin response in nocturnal enuresis without nocturnal polyuria in Japanese children. Int J Urol 2021; 28:969. [PMID: 34245046 DOI: 10.1111/iju.14626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Akihiro Kanematsu
- Department of Urology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| |
Collapse
|
36
|
Diagnostic Potential of Low Serum Platelet, Albumin and Prolong PT-INR for Overactive Bladder and Nocturia in Chronic Hepatitis-Related Liver Cirrhosis. J Clin Med 2021; 10:jcm10132838. [PMID: 34198972 PMCID: PMC8268050 DOI: 10.3390/jcm10132838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/10/2021] [Accepted: 06/24/2021] [Indexed: 01/16/2023] Open
Abstract
Overactive bladder (OAB) is defined as urgency, usually with frequency, nocturia, and incontinence. Patients with liver cirrhosis often present with urinary complaints. The possible reason for this is fluid redistribution, which may induce OAB resulting from portal hypertension and ascites. We conducted this study to investigate predictors of OAB in cirrhotic patients. A total of 164 patients with chronic viral hepatitis-related liver cirrhosis were enrolled and 158 (96.3%) completed the Overactive Bladder Symptoms Score (OABSS) questionnaire. Age, severity of liver cirrhosis, comorbidities, serum sodium level, use of diuretics, body mass index and renal function were also recorded. In the study cohort, the prevalence of OAB was 31.01% and the prevalence of urge incontinence (OAB wet) was 18.3%. Patients with an urgency score ≥2 in OABSS had a significantly lower platelet level (p = 0.025) regardless of the use of diuretics. In addition, 98 patients (62%) with nocturia and 29 patients (18%) with urge incontinence had significantly lower levels of serum albumin (p = 0.028 and 0.044, respectively). In conclusion, patients with liver cirrhosis have a high prevalence of overactive bladder. A low platelet and low serum albumin level in these patients may be predictors for overactive bladder. And longer PT-INR is also a possible biomarker for nocturia.
Collapse
|
37
|
Deger M, Surmelioglu O, Kuleci S, Izol V, Akdogan N, Onan E, Tanrisever I, Aridogan IA. Risk factors associated with nocturia in patients with obstructive sleep apnea syndrome. Int J Clin Pract 2021; 75:e13724. [PMID: 32959453 DOI: 10.1111/ijcp.13724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/11/2020] [Indexed: 11/29/2022] Open
Abstract
AIM To evaluate the risk factors associated with nocturia in patients with obstructive sleep apnea syndrome (OSAS). MATERIALS AND METHODS Patients aged over 18 years who had been diagnosed with OSAS using polysomnography (PSG) from January to December 2019 were evaluated. The number of nocturia episodes had been assessed in a 3-day bladder diary. We analysed the age, sex, body mass index (BMI) score, apnea-hypopn ea index (AHI) score and severity, hypertension, diabetes mellitus, smoking and heart diseases in all patients. RESULTS A total of 124 patients with a mean age of 49.9 ± 11.6 years (range: 25-81 years) were included in the study. Ninety-two (75.8%) patients had nocturia. The mean number of nocturia episodes of patients with nocturia was 2.4 ± 1.3. To determine factors affecting the risk of nocturia, the logistic regression analysis was performed. Patient age and BMI scores were found as the most effective risk factors determining nocturia (P < .05). The odds of patient age were 1.06 (odds ratio: 1.12; 95% confidence interval: 1.01-1.11; P = .010) times higher for patients with nocturia. Every 1-unit increase in the BMI score increased the risk of nocturia 1.12 times. In the study period, 48 patients with nocturia had undergone the continuous positive airway pressure (CPAP) therapy or surgical treatment. The mean number of nocturia episodes of these patients was 2.3 ± 1.4 before treatment and 1.7 ± 2.2 after treatment, showing a significant decrease (P = .032). Although the total daily urine volume increased significantly with the treatment, the total night-time urine volume decreased significantly at night (P = .016 and P = .024, respectively). CONCLUSION The age and BMI score were the risk factors associated with nocturia in patients with OSAS.
Collapse
Affiliation(s)
- Mutlu Deger
- Department of Urology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Ozgur Surmelioglu
- Department of Otorhinolaryngology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Sedat Kuleci
- Department of Chest Diseases, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Volkan Izol
- Department of Urology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Nebil Akdogan
- Department of Urology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Elvan Onan
- Department of Otorhinolaryngology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Ilda Tanrisever
- Department of Otorhinolaryngology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | | |
Collapse
|
38
|
Bozkurt O, Irer B, Kizilay F, Erbatu O, Sen V, Cinar O, Ongun S, Cihan A, Ozdemir T, Tasdemir D, Ucer O. Mechanisms and grading of nocturia: Results from a multicentre prospective study. Int J Clin Pract 2021; 75:e13722. [PMID: 32969572 DOI: 10.1111/ijcp.13722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/11/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To identify the pathophysiological mechanisms of nocturia and the correlation of these mechanisms with nocturia severity. METHODOLOGY After approval by the local ethics committee, all patients with nocturia (≥1 nocturnal void/night) were included and filled the Overactive Bladder questionnaire, Nocturia Quality of Life, Incontinence Questionnaire - Male Lower Urinary Tract Symptoms (male), International Consultation on Incontinence Questionnaire - Female Lower Urinary Tract Symptoms (female) and 3-day frequency-volume chart. Patients were divided into three groups according to the severity of nocturia: group 1 consisted of patients with mild (1-2 voids/night), group 2 with moderate (3-4 voids/night) and group 3 with severe nocturia (>4 voids/night). Comparative analysis was performed between groups, and P < .05 was deemed as statistically significant. RESULTS About 68.1%, 64.1% and 8.7% of the patients had nocturnal polyuria (NP), reduced bladder capacity and global polyuria, respectively. 42.7% of the patients had mixed nocturia. 6.1% of the patients did not comply with the aforementioned subtypes and defined as isolated nocturia. Regarding the severity of nocturia, 155 (41%) patients had mild, 167 (45%) patients had moderate and 57 (15%) patients had severe nocturia. Increased nocturia severity was related with decreased quality of life; higher age, urinary tract symptom scores, nocturnal urine volume, evening fluid consumption and beta-blocker medication rates. Increased nocturia severity was also associated with higher NP, global polyuria and reduced bladder capacity rates. CONCLUSIONS Nocturia mechanisms may vary between mild and moderate to severe nocturia groups according to the present study. Nocturia grading with identification of subtypes may help for better standardisation of the diagnostic and treatment approaches as well as for the design of future clinical trials.
Collapse
Affiliation(s)
- Ozan Bozkurt
- Department of Urology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Bora Irer
- Department of Urology, Izmir Metropolitan Municipality Esrefpasa Hospital, Izmir, Turkey
| | - Fuat Kizilay
- Department of Urology, Ege University School of Medicine, Izmir, Turkey
| | - Oguzcan Erbatu
- Department of Urology, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Volkan Sen
- Department of Urology, Manisa City Hospital, Manisa, Turkey
| | - Onder Cinar
- Department of Urology, Bulent Ecevit University School of Medicine, Zonguldak, Turkey
| | - Sakir Ongun
- Department of Urology, Balikesir University School of Medicine, Balikesir, Turkey
| | - Ahmet Cihan
- Department of Urology, Nigde Omer Halisdemir University School of Medicine, Nigde, Turkey
| | - Turan Ozdemir
- Department of Urology, Ege University School of Medicine, Izmir, Turkey
| | - Dogu Tasdemir
- Department of Urology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Oktay Ucer
- Department of Urology, Celal Bayar University School of Medicine, Manisa, Turkey
| |
Collapse
|
39
|
Monaghan TF, Dmochowski RR, Verbalis JG, Wein AJ, Lazar JM, Birder LA, Everaert K, Weiss JP, Bliwise DL. First voided volume: A novel approach to characterize nocturia. Neurourol Urodyn 2021; 40:848-854. [PMID: 33604915 DOI: 10.1002/nau.24633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/15/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023]
Abstract
AIMS Nocturnal polyuria syndrome (NPS) denotes nocturnal polyuria (NP) in the absence of identifiable contributory factors. The trajectory of nocturnal urine production (NUP; typically expressed as ml/hour) may be useful in delineating between NP patients with versus without NPS, but changes in absolute urine volume, the directly measured substrate for behavioral and pharmacologic interventions targeting nocturnal urine production, have not been well characterized. This study compares the ratio of the first nocturnal voided volume (FNVV) to the nocturnal average voided volume (NAVV) in patients with versus without NPS. METHODS Secondary analysis of 24-h voiding diaries from male patients greater than or equal to 18 years of age with two or more nocturnal voids and NP using two different criteria for NP: NUP greater than or equal to 90 ml/h and nocturnal polyuria index (NPi) greater than or equal to 0.33. Patients with diabetes insipidus and CPAP-adherent obstructive sleep apnea (OSA) were excluded. Patients were divided into 2 groups: secondary NP (OSA, congestive heart failure, and chronic kidney disease) and NPS (absence of edema, diuretic use, and the aforementioned comorbidities). FNVV was defined as the volume of urine accompanying the first nocturic episode. NAVV was defined as nocturnal urine volume/(number of nocturnal voids + 1). The nocturnal urine trajectory ratio (NUTR) was defined as FNVV/NAVV. RESULTS At NUP greater than or equal to 90 ml/h, NUTR was significantly greater in patients with (n = 73) versus without (n = 28) NPS (1.10 [0.89-1.33] vs. 0.91 [0.55-1.15], p = .012). At NPi greater than or equal to 0.33, NUTR was likewise significantly greater in patients with (n = 92) versus without (n = 32) NPS (1.09 [0.90-1.33] vs. 0.91 [0.57-1.17], p = .010). CONCLUSIONS The volume of urine produced in the early hours of sleep is central to identification of NPS in patients with nocturia.
Collapse
Affiliation(s)
- Thomas F Monaghan
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Roger R Dmochowski
- Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joseph G Verbalis
- Division of Endocrinology and Metabolism, Department of Medicine, Georgetown University Medical Center, Washington DC, USA
| | - Alan J Wein
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason M Lazar
- Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Lori A Birder
- Departments of Medicine and Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
40
|
Nocturia and hormone therapy: impact on sleep? ACTA ACUST UNITED AC 2021; 28:482-483. [PMID: 33596029 DOI: 10.1097/gme.0000000000001749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
41
|
Azuero J, Santander J, Trujillo CG, Caicedo JI, Zuluaga L, Becerra AM, Daza F, Rondón M, Plata M. Potential associations of adult nocturia. Results from a national prevalence study. Neurourol Urodyn 2021; 40:819-828. [PMID: 33550620 DOI: 10.1002/nau.24624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/03/2021] [Accepted: 01/04/2021] [Indexed: 12/21/2022]
Abstract
AIM To determine the prevalence of nocturia and associated risk factors in the Colombian population aged ≥18 years old. METHODS This is a cross-sectional population-based study conducted in 1060 participants in Colombia. Nocturia was assessed with the Spanish version of the ICIQ-OAB, using the ICS terminology. Descriptive statistics were used to evaluate nocturia prevalence. Logistic regression analysis was carried out to determine the association of nocturia with predefined variables. RESULTS The prevalence of nocturia was 55.9% and it was more common in women than men (53.96% vs. 46.04%; p = .004). At least three episodes of nocturia were observed in 20.37% of the participants who had a severe alteration in their quality of life (p < .01). The bivariate model showed an association between nocturia and obesity (odds ratio [OR], 1.69; 90% confidence interval [CI]: 1.22-2.34), diabetes mellitus (OR, 2.99; 90% CI: 1.86-4.83), high blood pressure (OR, 2.04; 90% CI: 1.52-2.72), cardiovascular disease (OR, 1.75; 90% CI: 1.08 - 2.83), depression (OR, 1.89; 90% CI: 1.23-2.89), obstructive sleep apnea (OR, 1.70; 90% CI: 1.17 - 2.46), and childhood enuresis (OR, 1.45; 90% CI: 1.04-2.02). The multivariate model showed an association with obesity (OR, 2.0; 95% CI: 1.14 - 3.51) in women, as well as age ≥ 65 years (OR, 3.18; 95% CI: 1.26 - 8.02) and erectile dysfunction (OR, 3.44; 95% CI: 1.21 - 9.72) in men. Childhood enuresis was significantly associated with nocturia in both genders (OR, 1.61; 95% CI: 1.09 - 2.40 in women and OR, 1.66; 95% CI: 1.09-2.52 in men). CONCLUSION There is a significant prevalence of nocturia in our population and a clear association with impaired quality of life. We consider important to inquire about history of childhood enuresis to define the risk of presenting nocturia in adulthood. Nocturia was associated with multiple comorbidities. Obesity and erectile dysfunction play an important role as modifiable risk factor.
Collapse
Affiliation(s)
- Julian Azuero
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad de los Andes School of Medicine, Bogotá, Colombia
| | - Jessica Santander
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad de los Andes School of Medicine, Bogotá, Colombia
| | - Carlos Gustavo Trujillo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad de los Andes School of Medicine, Bogotá, Colombia
| | - Juan Ignacio Caicedo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad de los Andes School of Medicine, Bogotá, Colombia
| | - Laura Zuluaga
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad de los Andes School of Medicine, Bogotá, Colombia
| | - Ana María Becerra
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad de los Andes School of Medicine, Bogotá, Colombia
| | - Fabián Daza
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad de los Andes School of Medicine, Bogotá, Colombia
| | - Martin Rondón
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Mauricio Plata
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad de los Andes School of Medicine, Bogotá, Colombia
| |
Collapse
|
42
|
Factors Associated with Decisions for Initial Dosing, Up-Titration of Propiverine and Treatment Outcomes in Overactive Bladder Syndrome Patients in a Non-Interventional Setting. J Clin Med 2021; 10:jcm10020311. [PMID: 33467690 PMCID: PMC7830207 DOI: 10.3390/jcm10020311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 11/16/2022] Open
Abstract
Two doses of propiverine ER (30 and 45 mg/d) are available for the treatment of overactive bladder (OAB) syndrome. We have explored factors associated with the initial dosing choice (allocation bias), the decision to adapt dosing (escalation bias) and how dosing relative to other factors affects treatment outcomes. Data from two non-interventional studies of 1335 and 745 OAB patients, respectively, receiving treatment with propiverine, were analyzed post-hoc. Multivariate analysis was applied to identify factors associated with dosing decisions and treatment outcomes. Several parameters were associated with dose choice, escalation to higher dose or treatment outcomes, but only few exhibited a consistent association across both studies. These were younger age for initial dose choice and basal number of urgency and change in incontinence episodes for up-titration. Treatment outcome (difference between values at 12 weeks vs. baseline) for each OAB system was strongly driven by the respective baseline value, whereas no other parameter exhibited a consistent association. Patients starting on the 30 mg dose and escalating to 45 mg after 4 weeks had outcomes comparable with those staying on a starting dose of 30 or 45 mg. We conclude that dose escalation after 4 weeks brings OAB patients with an initially limited improvement to a level seen in initially good responders. Analysis of underlying factors yielded surprisingly little consistent insight.
Collapse
|
43
|
Wolff DT, Adler KA, Weinstein CS, Weiss JP. Managing Nocturia in Frail Older Adults. Drugs Aging 2020; 38:95-109. [PMID: 33230803 DOI: 10.1007/s40266-020-00815-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2020] [Indexed: 12/17/2022]
Abstract
This review discusses the available evidence in the current evaluation and treatment of nocturia in frail older adults. No evidence specifically evaluates the use of behavioral interventions in the treatment of the frail older adult with nocturia, but their use is supported in other cohorts. Behavioral modifications and optimal management of comorbidities remain the first-line treatment for all age groups and should be emphasized in the frail due to their favorable safety profile. No studies specific to the frail older adult support the use of pharmacotherapy. Some evidence exists for the efficacy of several agents in the older adult; however, this is difficult to extrapolate to the frail, and safety concerns abound. Desmopressin may be effective in the older adult, but a high risk of hyponatremia raises concerns for its safety, and therefore it is not recommended in the frail. α-Antagonists may have limited efficacy in men with known benign prostatic hyperplasia (BPH); they are relatively well tolerated, although the risk of orthostatic hypotension in the frail should be considered. β3-agonist trials suggest limited clinical utility. Antimuscarinics are not found to be useful in this cohort and are contraindicated in the frail older adult given the ability of antimuscarinics to cause cognitive impairment, delirium, and falls. No data examine the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the frail older adult. Additionally, the American Geriatrics Society Beers Criteria recommends against the use of muscarinics in those over the age of 75 years and therefore their use is not supported.
Collapse
Affiliation(s)
- Dylan T Wolff
- Department of Urology, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA.
| | - Kerry A Adler
- Department of Urology, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Corey S Weinstein
- Department of Urology, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| |
Collapse
|
44
|
Takai S, Matsukawa Y, Hashizume N, Gotoh M. A small pilot study to evaluate the accuracy and feasibility of a novel automated voiding diary device for recording urine output measurements. Neurourol Urodyn 2020; 40:272-277. [PMID: 33137844 DOI: 10.1002/nau.24547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/27/2020] [Accepted: 10/06/2020] [Indexed: 11/10/2022]
Abstract
AIMS Recording a voiding diary can be bothersome for patients and is sometimes inaccurate and unhygienic. This study aimed to develop and assess the accuracy and convenience of a novel device that automatically records the voiding diary by measuring pre- and post-void body weight. METHODS We used this novel device for seven healthy volunteers and ten hospitalized patients. The examinees got on the device before and after voiding and the device recorded the voiding diary automatically. The examinees also manually recorded a voiding diary by collecting their urine in a cup and measuring its volume and weight. We examined the correlation between the traditional and the automated voiding diary to confirm the accuracy of voiding measurements using this device. Additionally, we investigated which measurement method was preferred by the participants. RESULTS In the healthy volunteers group, there was a strong correlation between the voided urine weight recorded by the device and voided urine weight measured manually by the examinee (R2 = 0.9935). In the patients group, there was a strong (R2 = 0.9117) but lower correlation than that of the volunteers group, with an error of ±25 g 62% of the time, and ±50 g 82% of the time, respectively. All of the healthy volunteers and seven of the ten patients preferred using the automated voiding diary. CONCLUSIONS This novel device recorded a reasonably accurate voiding diary for everyday clinical practice.
Collapse
Affiliation(s)
- Shun Takai
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihisa Matsukawa
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuya Hashizume
- Shimadzu Corporation, Technology Research Laboratory, Kyoto, Japan
| | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
45
|
Palmieri B, Iannitti T, Morales-Medina JC, Vadalà M. Monocentric single-arm study of desmopressin acetate efficacy on nocturnal polyuria in the elderly. Int J Clin Pract 2020; 74:e13612. [PMID: 32668490 DOI: 10.1111/ijcp.13612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/08/2020] [Indexed: 11/29/2022] Open
Abstract
AIM OF THE STUDY We designed a retrospective, monocentric, observational study to assess the efficacy and short-term side effect profile of desmopressin, a synthetic analogue of antidiuretic hormone, in 42 elderly patients affected by nocturnal polyuria (NP), a subset of nocturia (nocturnal overproduction of urine at night), which is characterised by nocturnal urine volume (NVU) exceeding 33% of the 24-hours total urine output. METHODS USED TO CONDUCT THE STUDY The subjects had NP and included 25 males, which had benign prostatic hyperplasia (12 out of 25 had been surgically or endoscopically operated) and 15 females that had increased urinary frequency, night-time voiding, loss of bladder control and recurrent bladder infections, due to perineal wall weakness and vaginal or bladder prolapse. Patients recorded the number of voids during waking hours using a digital continuous urine meter. The quality of life (QoL) and efficacy of desmopressin were assessed at baseline and 12 weeks after treatment using the International Consultation on Incontinence Questionnaire Nocturia Quality of Life Module (ICIQ-Nqol) and International Prostate Symptom Score questionnaire (IPPS-Q8). The dosage of desmopressin acetate varied according to the discretion of the physician, usually beginning with one tablet before going to bed at night for 3 months. The dose was increased at 1-week intervals if a reduction in the NVU or night-time frequency was not achieved. RESULTS OF THE STUDY We found that desmopressin treatment reduced the nocturnal voided volume (P < .0001), ICIQ-Nqol (P < .0001) and IPPS-Q8 (P < .0001). No significant serum sodium alterations or modifications in serum creatine, potassium, or body weight were observed in all the patients. No adverse effects were observed. CONCLUSIONS DRAWN FROM THE STUDY AND CLINICAL IMPLICATIONS Our findings show efficacy of desmopressin in the elderly for NP treatment supporting further clinical trials in larger cohorts of patients.
Collapse
Affiliation(s)
- Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia, Modena (MO), Italy
- Second Opinion Medical Network, Modena (MO), Italy
| | - Tommaso Iannitti
- Charles River Discovery Research Services UK Limited, Portishead, UK
| | - Julio Cesar Morales-Medina
- Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala CP 90000, AP 62, Tlaxcala, México
| | - Maria Vadalà
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia, Modena (MO), Italy
- Second Opinion Medical Network, Modena (MO), Italy
| |
Collapse
|
46
|
Baines G, Da Silva AS, Cardozo L, Bach F, Parsons M, Robinson D, Toozs-Hobson P. Defining nocturnal polyuria in women. Neurourol Urodyn 2020; 40:265-271. [PMID: 33085813 DOI: 10.1002/nau.24546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 11/11/2022]
Abstract
AIMS Nocturnal polyuria (NP) is defined by the International Continence Society (ICS) as "excessive production of urine during the main sleep period" and is one of the main causes of nocturia. The ICS recognized that "excessive" is not clearly defined and that this needs to be highlighted in both clinical and research settings. The aim of this study was to identify different definitions of NP and apply them to a population of women attending the Urogynaecology clinic. METHODS This was a retrospective study of complete bladder diaries collected from women attending a tertiary Urogynaecology Unit. Six different definitions were identified and were divided into "absolute," "relative," and "functional definitions." Prevalence data were calculated and values generated for sensitivity, specificity, positive and negative predictive values when related to women voiding ≥ 2 times per night. RESULTS Complete bladder diaries were obtained from 1398 women, over 6 years, with a mean age of 57 years. Prevalence varied across the definitions from 21.5% (absolute definition) to 77% (relative definition). Sensitivity ranged from 43% (absolute) to 87% (relative). The definitions that showed the highest combined sensitivity and specificity were the functional definitions. CONCLUSION From this study it is clear that more work needs to be done to arrive at a consensus for defining NP to enable accurate diagnosis and development of treatment pathways. We propose that a relative definition may provide a more clinically relevant method of defining NP.
Collapse
Affiliation(s)
| | | | | | - Fiona Bach
- Birmingham Women's Hospital, Birmingham, England
| | | | | | | |
Collapse
|
47
|
Okumura K, Obayashi K, Tai Y, Yamagami Y, Negoro H, Kataoka H, Kurumatani N, Saeki K. Association between NT-proBNP and nocturia among community-dwelling elderly males and females: A cross-sectional analysis of the HEIJO-KYO study. Neurourol Urodyn 2020; 40:112-119. [PMID: 33085835 DOI: 10.1002/nau.24550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 11/12/2022]
Abstract
AIMS To investigate the association between B-type natriuretic peptide (BNP) and nocturia among community-dwelling males and females. METHODS A total of 1096 participants (mean age 71.9 ± 7.1 years, 518 [47.2%] males) were included in the study. The number of nocturnal voids was recorded in a self-reported urination diary, and nocturia was defined as two or more voids per night. Daytime serum concentration of the N-terminal fragment of BNP precursor (NT-proBNP) was measured. Multivariable logistic regression analysis was performed to determine the association between NT-proBNP and nocturia. RESULTS Nocturia was observed in 23.5% of females and 37.1% of males. Higher NT-proBNP (log pg/ml) was associated with nocturia in both gender groups (females: odds ratio [OR]: 1.67, 95% confidence interval [95% CI], 1.21-2.34, p = .002; males: OR: 1.26, 95% CI, 1.01-1.59, p = .046), independent of confounding variables including night-time blood pressure, mean voided volume, and chronic kidney disease. Although the increase in prevalence of nocturia with higher NT-proBNP was equivalent in both genders, some effect of gender on the relationship between NT-proBNP and nocturia was observed (p = .037). Nocturnal urine volume was also significantly and independently associated with NT-proBNP level (females: β = 32.9 ml, 95% CI, 5.63-60.2, p = .018; males: β = 34.6 ml, 95% CI, 9.40-59.9, p = .007). CONCLUSIONS This study revealed higher serum NT-proBNP is significantly and independently associated with the prevalence of nocturia in both males and females. This is an exploratory cross-sectional study and the analyses are post hoc, so further research works are needed to clarify the causality and clinical value.
Collapse
Affiliation(s)
- Kazuki Okumura
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Kenji Obayashi
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Yoshiaki Tai
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan.,Department of General Medicine, Nara Medical University School of Medicine, Nara, Japan
| | - Yuki Yamagami
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | | | - Hiroshi Kataoka
- Department of Neurology, Nara Medical University School of Medicine, Nara, Japan
| | - Norio Kurumatani
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Keigo Saeki
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| |
Collapse
|
48
|
Nocturnal Urine Production in Women With Global Polyuria. Int Neurourol J 2020; 24:270-277. [PMID: 33017897 PMCID: PMC7538286 DOI: 10.5213/inj.2040166.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/18/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Low nocturnal urine production (NUP) may be sufficient to rule out global polyuria (GP) in men. This study determines the sensitivity of indices for nocturnal polyuria (NP), defined as nocturnal polyuria index (NPi; nocturnal urine volume/24-hour urine volume) ≥0.33 or NUP ≥90 mL/hr, for detecting GP in women. METHODS Data were analyzed from 2 prospective protocols involving subjects recruited from a urology ambulatory care unit and a continence clinic. Women ≥18 years with nocturia were included if they met either of 2 common criteria for GP: (1) ≥40 mL/kg/24 hr or (2) ≥3,000 mL/24 hr. RESULTS Thirty-one women were included (NPi, 28.6 [21.3-40.7]; NUP, 100.8 [68.3-135.8] mL/hr). At the ≥40 mL/kg/24-hr cutoff, 40% and 63% of women reporting ≥1 nocturnal void(s) (n=30) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively. Additionally, 53% and 71% of subjects reporting ≥2 nocturnal voids (n=17) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively. At the ≥3,000 mL/24-hr cutoff, 38% and 69% of women reporting ≥1 nocturnal void(s) (n=13) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively, and 63% and 88% of subjects reporting ≥2 nocturnal voids (n=8) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively. By extension, 37%-62% of women with nocturia and GP did not have NP by NPi ≥0.33 criteria, and 12%-37% did not have NP by NUP ≥90 mL/hr criteria. CONCLUSION Indices of excess nighttime urination do not reliably predict GP in women. A full-length voiding diary may be particularly important in the evaluation of women with nocturia. Nocturia in women merits further consideration as a distinct entity.
Collapse
|
49
|
Monaghan TF, Wagg AS, Bliwise DL, Agudelo CW, Michelson KP, Rahman SN, Epstein MR, Haddad R, Everaert K, Lazar JM, Weiss JP. Association between nocturia and frailty among elderly males in a veterans administration population. Aging Clin Exp Res 2020; 32:1993-2000. [PMID: 31760609 DOI: 10.1007/s40520-019-01416-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/12/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND The relationship between frailty and nocturnal voiding is poorly understood. AIM To characterize the association between frailty, as defined by a frailty index (FI) based upon the Canadian Study of Health and Aging (CSHA) criteria, and nocturia, defined by measures of nocturnal urine production. METHODS Real-world retrospective analysis of voiding diaries from elderly males with lower urinary tract symptoms (LUTS) at an outpatient urology clinic. Males ≥ 65 years with ≥ 2 nocturnal voids were included. A modified FI was calculated from the LUTS database, which captured 39 variables from the original CSHA FI. Patients were divided into 3 groups by modified FI: low (≤ 0.077) (n = 59), intermediate (> 0.077 and < 0.179) (n = 58), and high (≥ 0.179) (n = 41). Diary parameters were compared using the Kruskal-Wallis test and pairwise comparisons with the Wilcoxon rank-sum test and Bonferroni adjustment. RESULTS The high frailty group was characterized by higher nocturnal urine volume (NUV), maximum voided volume (MVV), nocturnal maximum voided volume (NMVV), and nocturnal urine production (NUP). The presence of comorbid diabetes mellitus did not explain this effect. CONCLUSION Elderly males seeking treatment for LUTS with a high frailty burden are disproportionately affected by excess nocturnal urine production. Future research on the mechanistic relationship between urine production and functional impairment is warranted.
Collapse
Affiliation(s)
- Thomas F Monaghan
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Adrian S Wagg
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Christina W Agudelo
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Kyle P Michelson
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Syed N Rahman
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Matthew R Epstein
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
- Department of Urology, Temple University Hospital, Philadelphia, PA, USA
| | - Rebecca Haddad
- Department of Urology, Ghent University Hospital, Ghent, Belgium
- Sorbonne Université, UPMC Univ Paris 06, AP-HP GRC 01, Groupe de Recherche Clinique en Neuro-Urologie (GREEN), Service de Rééducation Neurologique, AP-HP, Hôpitaux Universitaires Est Parisien, Paris, France
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Jason M Lazar
- Department of Medicine, Division of Cardiovascular Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jeffrey P Weiss
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| |
Collapse
|
50
|
Juul KV, Andersson FL, Yamaguchi O. Achieving clinically meaningful quality of life benefits in nocturia takes time: Results from a long-term, multicenter phase 3 study of desmopressin in Japanese patients. Low Urin Tract Symptoms 2020; 13:129-138. [PMID: 32914581 DOI: 10.1111/luts.12347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/11/2020] [Accepted: 08/07/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the long-term efficacy, quality of life (QoL), and safety of desmopressin orally disintegrating tablets (ODTs) in Japanese patients with nocturia. METHODS A long-term, multicenter phase 3 study was conducted that enrolled Japanese male and female patients with nocturia (NCT03051009). Male patients received desmopressin 25- or 50-μg ODTs, and female patients received desmopressin 25-μg ODTs for up to 1 year. The primary endpoint was safety. Secondary endpoints included change from baseline in number of nocturnal voids, time to first awakening to void, and QoL assessments (nocturia-specific zQoL [N-QoL], Insomnia Severity Index [ISI], and Hsu bother score). RESULTS Overall, 503 patients were enrolled. Reductions from baseline in mean number of nocturnal voids were observed in all treatment groups from week 1 (-0.62 to -1.00), with improvements continuing through week 52 (-1.39 to -1.71). Changes from baseline above or approximating a clinically meaningful improvement were seen by week 52 in the disease-specific N-QoL total score (improved by 11.5-22.6), ISI (improved by -3.9 to -7.1), and Hsu bother scores (improved by -1.5 to -2.0). Adverse events (AEs) were reported in 54.9% of desmopressin-treated patients. Most AEs were mild or moderate in severity. CONCLUSIONS Desmopressin ODTs (25 and 50 μg) demonstrated long-term efficacy, improved QoL, and were well tolerated in Japanese male and female patients with nocturia treated for up to 1 year. Clinically meaningful improvements in patients' QoL, assessed by N-QoL, sleep quality, and bother, occur later than objective symptom improvements, such as voids.
Collapse
Affiliation(s)
- Kristian V Juul
- Ferring International Pharmascience Center, Copenhagen, Denmark
| | | | - Osamu Yamaguchi
- Division of Lower Urinary Tract Symptom Research, Nihon University School of Engineering, Koriyama, Japan
| |
Collapse
|