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Vrooman OPJ, van Kerrebroeck PEV, van Balken MR, van Koeveringe GA, Rahnama'i MS. Nocturia and obstructive sleep apnoea. Nat Rev Urol 2024:10.1038/s41585-024-00887-7. [PMID: 38783115 DOI: 10.1038/s41585-024-00887-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/25/2024]
Abstract
Nocturia, the need to urinate at night, is a common symptom in patients with obstructive sleep apnoea (OSA). Continuous positive airway pressure treatment can reduce nocturia in some patients, but the underlying mechanisms are complex and not fully understood. OSA affects the autonomic nervous system, oxidative stress and endothelial damage. Furthermore, the commonly held theory attributing polyuria to a false signal of cardiac overload and response natriuresis has limitations. A comprehensive approach to the management of nocturia in OSA, considering factors such as comorbidities, medication use, alcohol consumption and lifestyle, is needed. Effective management of nocturia in OSA requires a multidisciplinary approach, and urologists should be aware of the potential effect of OSA on physiology and refer patients for further testing at a sleep centre. In addition to continuous positive airway pressure, other interventions such as oral appliances and surgical obstruction treatment could be beneficial for some patients. Overall, understanding the complex interplay between OSA and nocturia is crucial for optimizing patient outcomes.
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Affiliation(s)
- Olaf P J Vrooman
- Department of Urology, Hospital Rijnstate Arnhem, Arnhem, Netherlands.
| | | | | | | | - Mohammad S Rahnama'i
- Department of Urology Nij Smellinghe Hospital, Drachten, Netherlands
- Society of Urological research and education (SURE), Maastricht, Netherlands
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2
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Brown A, Ferguson L, Castillo J, Nguyen HXT, Ervin C, Whishaw DM, Bower W. Determinants of Bladder Care at Night in a Subacute Ward for Aged Patients: An Observational Study. J Wound Ostomy Continence Nurs 2024; 51:146-151. [PMID: 38215216 DOI: 10.1097/won.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
PURPOSE The purpose of this study was to evaluate how bladder care at night correlates to patients' mobility status. DESIGN This was an observational study. SUBJECTS AND SETTING The sample comprises 63 aged care subacute patients who were observed over 3 consecutive nights in an inpatient subacute aged care ward located in Melbourne, Australia. Half of the participants were female; their mean age was 82.0 (standard deviation 8.2) years. Data were collected from December 2020 to March 2021. METHODS Outcome variables included demographic and pertinent clinical characteristics, type and timing of toileting and/or bladder care provided, and mobility classification. Descriptive statistics were used to summarize the frequency of nocturnal bladder care provided each night and as a mean over the 3 nights. The relationship between the type of care units provided and other variables was explored using a 1-way analysis of variance; values ≤.05 were deemed statistically significant. RESULTS Findings indicate that 27% (n = 17), 41% (n = 26), and 48% (n = 30) of participants required assistance to move in bed, sit up in bed, and stand from sitting, respectively. Care episodes for both incontinence and assistance with voiding were significantly associated with functional mobility in bed ( F = 5.52, P < .001; F = 2.14, P = .02) and with ambulation independence ( F = 3.52, P = .001; F = 2.04, P = .03) but not with age or ambulation distance. CONCLUSIONS Care provided for urinary incontinence during the night was related to the need for physical support of ambulation and poor mobility in bed. Targeted input from a multidisciplinary team is warranted to facilitate change of practice at night.
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Affiliation(s)
- Adelle Brown
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Laura Ferguson
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Jasper Castillo
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Huong Xuan Thi Nguyen
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Claire Ervin
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - David Michael Whishaw
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Wendy Bower
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
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Song Y, Zhang Y, Liu Y, Zhang J, Lu J, Wang X, Zhang N, Ma G. Analysis on fluid intake and urination behaviors among the elderly in five cities in China: a cross-sectional study. Front Nutr 2024; 10:1280098. [PMID: 38249613 PMCID: PMC10797079 DOI: 10.3389/fnut.2023.1280098] [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: 08/19/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Background Fluid intake in the elderly may influence urination behaviors and further influence their health status. This study investigated the behaviors of fluid intake, urination and their relationships among the elderly in China. Methods Stratified random sampling was used to recruit the elderly participants who met the inclusion criteria from five cities in China. Participants' total fluid intake (TFI) level was investigated using a validated 7-day 24 h fluid intake questionnaire. Their urination behaviors in real time were also recorded using a validated 7-day 24 h urination behavior record. Results A total of 524 participants completed the study, including 233 males and 291 females. The average age was 69.7 years. The median daily TFI was 1,241 mL, with a frequency of 8.1 times per day. Approximately 73.3% of the participants did not reach the amount of adequate fluid intake (1.7 L for males and 1.5 L for females) recommended in China. Fluid intake in the morning, afternoon, and evening among participants was 594 mL, 305 mL and 342 mL, with a frequency of 3.0 times, 1.7 times, and 2.0 times, respectively. The median urination frequency was 7.4 times per day. The percentage of participants who urinated >7 times during the day was 44.3%. The percentage of participants who urinated ≥1 time at night was 77.5%. Age and BMI were not the main influence factors for fluid intake and urination behaviors. The preliminary analysis showed that higher TFI, plain water intake, dairy products intake, and fluid intake frequency were significantly associated with higher urination frequency (t = 6.553, p < 0.05; t = 5.291, p < 0.05; t = 4.667, p < 0.05; t = 13.413, p < 0.05). Higher fluid intake per time was significantly associated with lower urination frequency (t = -3.562, p < 0.05). Correlations between TFI, fluid intake frequency, fluid intake in night, fluid intake frequency in night and urination at night were also found (r = 0.114, p < 0.05; r = 0.091, p < 0.05; r = 0.146, p < 0.05; r = 0.331, p < 0.05). Conclusion Fluid intake was inadequate in terms of the elderly participants. Participants with higher fluid intake and frequency in night had a greater incidence of nocturia. Thus, correcting fluid intake behaviors can improve urination behavior and promote health. Clinical trial registration https://www.chictr.org.cn/searchprojEN.html, identifier CTR1900023355.
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Affiliation(s)
- Yongye Song
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Yue Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Yan Liu
- YIDO AI Technology (Shandong) Co., Ltd., Jinan, China
| | - Jianfen Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
- Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, Beijing, China
| | - Junbo Lu
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Xing Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Na Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
- Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, Beijing, China
| | - Guansheng Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
- Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, Beijing, China
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Yesil H, Akkoc Y, Yıldız N, Gok H, Bardak AN, Ersoz M, Kutlay S, Bugdaycı D, Paker N, Tunc H, Koklu K, Alemdaroglu E, Koyuncu E, Ozisler Z, Gunes S, Alkan H, Tezer T, Bas A, Turkoglu MB, Yazar Z, Hepguler S. Assessment of nocturnal polyuria in patients with spinal cord injury at three different mobilization phases: A multicenter cross-sectional study. J Spinal Cord Med 2024; 47:143-147. [PMID: 34935598 PMCID: PMC10795577 DOI: 10.1080/10790268.2021.2009674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To determine the prevalence of nocturnal polyuria (NP) in patients with spinal cord injury (SCI) during three different particular phases, and investigate the impact of injury level and injury type on the prevalence of NP. DESIGN A cross-sectional study. SETTING Neurogenic Bladder Study Group from six different rehabilitation centers across the country. PARTICIPANTS 40 patients with SCI. OUTCOME MEASURES Patients were divided into three groups according to mobilization phase; 1st group included patients confined to bed (n = 14), 2nd group included patients sitting on a wheelchair (n = 19) and 3rd group included patients standing with an assistive ambulation device (n = 7). NP was assessed by nocturnal polyuria index (NPi) and nocturnal urine production (NUP) indexes. RESULTS No significant difference was found between the groups (P = 0.312 for NPi and P = 0.763 for NUP) in terms of the presence of NP according to their mobilization phase. The night and 24-hour urine volumes showed no significant difference between the groups (P = 0.907 and P = 0.395 respectively). The NPi and NUP values did not show a significant difference between male and female patients (P = 0.826, P = 0.364 respectively), patients with the injury level of ≥T6 and CONCLUSION In this study, NP was found to be a common problem in patients with SCI regardless of their mobilization phase, injury level and injury type. It was revealed that both NPi and NUP parameters could be used to determine the prevalence of NP in this patient group.
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Affiliation(s)
- Hilal Yesil
- Department of Physical Medicine and Rehabilitation, Afyonkarahisar Health Sciences University, Afyon, Turkey
| | - Yesim Akkoc
- Department of Physical Medicine and Rehabilitation, Ege University, Izmir, Turkey
| | - Necmettin Yıldız
- Department of Physical Medicine and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Haydar Gok
- Department of Physical Medicine and Rehabilitation, Ankara University, Ankara, Turkey
| | - Ayse Nur Bardak
- Department of Physical Medicine and Rehabilitation, Istanbul Physical Therapy and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Murat Ersoz
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
- Department of Physical Medicine and Rehabilitation, Ankara Yildirim Beyazıt University, Ankara, Turkey
| | - Sehim Kutlay
- Department of Physical Medicine and Rehabilitation, Ankara University, Ankara, Turkey
| | - Derya Bugdaycı
- Department of Physical Medicine and Rehabilitation, Istanbul Physical Therapy and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Nurdan Paker
- Department of Physical Medicine and Rehabilitation, Istanbul Physical Therapy and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Hakan Tunc
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Kurtulus Koklu
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Ebru Alemdaroglu
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Engin Koyuncu
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Zuhal Ozisler
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Secilay Gunes
- Department of Physical Medicine and Rehabilitation, Ankara University, Ankara, Turkey
| | - Hakan Alkan
- Department of Physical Medicine and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Tevfik Tezer
- Department of Physical Medicine and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Aysenur Bas
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | | | - Zeynep Yazar
- Department of Physical Medicine and Rehabilitation, Ege University, Izmir, Turkey
| | - Simin Hepguler
- Department of Physical Medicine and Rehabilitation, Ege University, Izmir, Turkey
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Chen M, He W, Cai S, Chen Z, Ye H, Jin Z, Lv X. Association of nocturia with cardiovascular and all-cause mortality: a prospective cohort study with up to 31 years of follow-up. Front Public Health 2023; 11:1292362. [PMID: 38186694 PMCID: PMC10768185 DOI: 10.3389/fpubh.2023.1292362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Background Nocturia is a highly prevalent and under-considered condition and impacts the quality of life for many individuals. The long-term impact of nocturnal voiding on mortality, especially mortality from cardiovascular disease, remains unknown. The current study aimed to evaluate the relationship of nocturnal voiding episodes with cardiovascular and all-cause mortality among adults in the United States. Methods This is a prospective cohort study of a nationally representative sample of 13,862 U.S. adults aged 20 years or older who participated in the National Health and Nutrition Examination Survey III (1988-1994). Nighttime urination frequency was reported during an in-house interview. All-cause and cause-specific mortality were ascertained by linking to National Death Index mortality data through December 31, 2019. The associations of nocturia with cardiovascular and all-cause mortality were estimated using weighted Cox proportional hazards regression models. Results Throughout a median follow-up of 26.7 years, 5,029 deaths were reported, comprising 1,720 deaths from cardiovascular disease. In the fully adjusted model, participants who reported once, twice, and three or more times nocturnal voiding episodes have a higher risk of cardiovascular mortality (HR1, 1.22 [95% CI, 0.997-1.49], HR2, 1.47 [95% CI, 1.13-1.91], and HR ≥ 3, 1.96 [95% CI, 1.52-2.53]) as well as all-cause mortality (HR1, 1.12 [95% CI, 0.90-1.39], HR2, 1.54 [95% CI, 1.23-1.93], and HR ≥ 3, 2.48 [95% CI, 1.81-3.40]), compared to those without nocturia, and heart disease-specific mortality (HR1, 1.33 [95% CI, 1.08-1.64], HR2, 1.62 [95% CI, 1.25-2.10], and HR≥3, 2.07 [95% CI, 1.61-2.67]). Nevertheless, there was no significant relationship between the number of nocturia episode changes and stroke-specific mortality. Conclusion Nocturia was associated with a significantly augmented risk of overall and heart disease-specific mortality in a dosage-dependent manner. Early recognition and taking precautions may benefit individuals with nocturia by promoting quality of life and cardiac health.
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Affiliation(s)
- Min Chen
- Wuhan University of Science and Technology Medical College, Wuhan, China
| | - Wangan He
- Department of Cardiology, China Resources and Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Shaoqian Cai
- Department of Cardiology, China Resources and Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Zhi Chen
- Wuhan University of Science and Technology Medical College, Wuhan, China
| | - Huarong Ye
- China Resources and Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Zhigang Jin
- Department of Cardiology, China Resources and Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Xuexiang Lv
- Department of Cardiology, China Resources and Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
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Kyoda Y, Ichihara K, Muranaka I, Sakai Y, Nakamura M, Shinkai N, Kozen N, Yorozuya W, Morooka D, Maruo K, Tachikawa K, Shibamori K, Nofuji S, Fujino K, Kato S, Yoshida T, Shindo T, Maehana T, Hashimoto K, Kobayashi K, Tanaka T, Masumori N. Efficacy of cognitive behavioral therapy using self-check sheet for patients with nocturia in real-world clinical practice. Low Urin Tract Symptoms 2023; 15:225-230. [PMID: 37614063 DOI: 10.1111/luts.12498] [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: 05/09/2023] [Revised: 06/30/2023] [Accepted: 07/26/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES We previously demonstrated the efficacy of cognitive behavioral therapy (CBT) using a self-check sheet for patients with nocturia in a randomized controlled study. Additionally, we investigated the efficacy of the intervention in real-world clinical practice. METHODS Two hundred forty-three outpatients with complaint of nocturia who practiced CBT for 4 weeks using a self-check sheet were included in this trial, which took place from April 2021 to March 2022 in 20 institutions. RESULTS Of the 243 patients, 215 who achieved 50% or more of the behavioral therapy tasks were included in the analysis. Their mean age ± SD was 77.1 ± 7.7. A significant decrease was observed in nighttime frequency at 4 weeks after CBT using self-check sheets (pre 3.3 and post 2.8, p < .001). Nighttime frequency was decreased one or more times and was defined as treatment success in 102 patients (47.4%). Pretreatment nighttime frequency in the treatment-success group was significantly higher than that of the failure group (3.5 ± 1.0 vs. 3.2 ± 1.0, p = .013). In multivariate logistic regression analysis, predictive factors of treatment success were pretreatment nocturnal frequency of four or more (odds ratio [OR] 1.82, 95% confidence interval [CI] 1.01-3.30; p = .046) and the absence of diabetes mellitus (OR 3.08, 95% CI 1.34-7.06; p = .008). CONCLUSIONS CBT using a self-check sheet requiring less time, less labor, less cost, and less medication is very beneficial for both patients and medical staff in real-world clinical practice.
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Affiliation(s)
- Yuki Kyoda
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
- Yakumo General Hospital, Yakumo, Japan
- Hokkaido Prefectural Haboro Hospital, Haboro, Japan
- Rumoi Municipal Hospital, Rumoi, Japan
| | | | - Ippei Muranaka
- Hokkaido Social Work Association Obihiro Hospital, Obihiro, Japan
| | | | | | | | | | | | | | | | | | - Kosuke Shibamori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
- Kuriyama Red Cross Hospital, Kuriyama, Japan
- Hokkaido Social Work Association Toya Hospital, Toyako, Japan
- JCHO Noboribetsu Medical Center, Noboribetsu, Japan
| | - Seisuke Nofuji
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
- Kuriyama Red Cross Hospital, Kuriyama, Japan
- Hokkaido Social Work Association Toya Hospital, Toyako, Japan
- JCHO Noboribetsu Medical Center, Noboribetsu, Japan
| | - Keiko Fujino
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
- Kuriyama Red Cross Hospital, Kuriyama, Japan
- Hokkaido Social Work Association Toya Hospital, Toyako, Japan
- JCHO Noboribetsu Medical Center, Noboribetsu, Japan
| | | | | | - Tetsuya Shindo
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takeshi Maehana
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kohei Hashimoto
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ko Kobayashi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
- Nemuro City Hospital, Nemuro, Japan
| | - Toshiaki Tanaka
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
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7
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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.
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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
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8
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Zheng C, Ge Y, Chen X, Shao W, Wang G, Zhang B, Zhang W. Association between sleep status and lower urinary tract symptoms among men aged 40 or older in Zhengzhou. Sleep Biol Rhythms 2022; 20:337-344. [PMID: 38469426 PMCID: PMC10900034 DOI: 10.1007/s41105-022-00373-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022]
Abstract
A cross-sectional study based on the community was conducted to explore the association between sleep status and LUTS among middle and old-aged men. Male residents in Zhengzhou aged 40 or older were recruited. Participants received the Pittsburgh Sleep Quality Index questionnaire and the International Prostate Symptom Score questionnaire to evaluate sleep status and the severity of lower urinary tract symptoms (LUTS), respectively. Logistic regression analyses and linear regression analyses were performed to evaluate the relationship between sleep quality and sleep duration and LUTS. A total of 5785 participants were enrolled. Multivariable analyses showed a positive relationship between sleep quality and LUTS (β 0.716, 95% CI 0.647-0.784), and poor sleepers were significantly associated with moderate or severe LUTS (OR 2.486, 95% CI 2.095-2.950). U-shaped dose-response relationship revealed that sleeping less than 5.8 h/day and more than 7.9 h/day was related to moderate or severe LUTS and more than 7.9 h/day of sleep duration was associated with poor voiding and storage symptoms (P for nonlinearity < 0.001). Similar relationship was observed between sleep status and nocturia. It showed a significantly positive relationship between sleep quality and LUTS. U-shaped dose-response relationships between sleep duration and LUTS were observed.
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Affiliation(s)
- Caifang Zheng
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan China
| | - Yongchao Ge
- Department of Urology, The Third People’s Hospital of Zhengzhou, Zhengzhou, 450000 Henan China
| | - Xiaorui Chen
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan China
| | - Weihao Shao
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan China
| | - Gaili Wang
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan China
| | - Bowen Zhang
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan China
| | - Weidong Zhang
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan China
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9
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Viaene AM, Roggeman S, Vanhaute OA, Raes A, Colman R, Everaert K. Nocturnal bladder emptying and Quality of Life in patients with spinal cord injury. Eur J Phys Rehabil Med 2022; 58:397-404. [PMID: 34652085 PMCID: PMC9980489 DOI: 10.23736/s1973-9087.21.07104-5] [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: 11/08/2022]
Abstract
BACKGROUND Little is known about the relationship between sleep disruption due to nocturnal bladder emptying and Quality of Life in patients with spinal cord injury. AIM The aim of this study was to evaluate the possible influence of number of nocturnal bladder emptying, bladder emptying method and nocturnal incontinence on the Quality of Life of patients with spinal cord injury. DESIGN The design of this paper is a cross-sectional descriptive study. SETTING The setting is in- and outpatient. POPULATION Seventy-nine patients aged between 18 and 77 years with SCI in a first rehabilitation period or follow-up. METHODS Patients were asked to complete Short Form-36 and Incontinence Quality of Life questionnaires and a medical information form. Independent samples t-tests and ANOVA were used to compare scores between groups. RESULTS The response rate was 71 out of 79 (89%; 51 males and 20 females). 16 paraplegic and 4 tetraplegic patients were chronic, 29 paraplegic and 22 tetraplegic patients were in rehabilitation therapy or had finished this treatment recently. The paraplegic group had a significantly better Short Form-36 total score and emotional function score, while the tetraplegic group had a significantly better Incontinence Quality of Life total score and avoidance and limiting behavior score. The paraplegic patients with 0-1 nocturnal bladder emptying had better Short Form-36-derived Quality of Life than those with ≥2 emptying. Quality of Life score was not associated with gender, leg oedema, incontinence, or acute/chronic group. Incontinence Quality of Life score was significantly better for patients with incomplete spinal cord injury. Fully completed questionnaires were returned by 36 patients; at least 1 item was missing for 35 participants. CONCLUSIONS General Short Form-36-derived Quality of Life was better for the paraplegic population. Incontinence-related Quality of Life was better in tetraplegic patients, most of whom used suprapubic catheterization. Paraplegic patients had compromised sleep and Quality of Life when the patient had to wake up two or more times at night to empty the bladder by voiding or intermittent catheterization. The high number of incomplete responders indicates the shortcomings of Quality-of-Life questionnaires for wheelchair-bound patients with spinal cord injury. CLINICAL REHABILITATION IMPACT The use of suprapubic catheterization should be considered to improve Quality of Life for tetraplegic patients. For paraplegic patients, we must focus urological policy on aiming to reduce the number of nighttime bladder emptying to one or none.
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Affiliation(s)
- Annick M Viaene
- Department of Physical Medicine and Orthopedic Surgery, Ghent University Hospital, Ghent, Belgium -
| | - Saskia Roggeman
- Department of Urology, Ghent University Hospital, Ghent, Belgium.,Department of Research and Policy, Psychiatric Center Sint-Jan-Baptist, Zelzate, Belgium
| | - Omer A Vanhaute
- Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium
| | - Ann Raes
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Roos Colman
- Unit of Biostatistics, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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10
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Multimodal behavioural therapy as a first line treatment in nocturnal polyuria. An interventional prospective study. (Betnoc trial). Ann Med Surg (Lond) 2021. [DOI: 10.1016/j.amsu.2021.102511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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11
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Miller CD, Monaghan TF, Robins DJ, Weiss JP. Does traditional pharmacotherapy augment behavioral modification in the treatment of nocturia? Neurourol Urodyn 2021; 40:1133-1139. [PMID: 33973671 DOI: 10.1002/nau.24692] [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: 01/18/2021] [Revised: 03/31/2021] [Accepted: 04/15/2021] [Indexed: 11/07/2022]
Abstract
AIMS To assess the efficacy of traditional first-line non-antidiuretic pharmacotherapy for nocturia in the real-world outpatient urology setting. METHODS We retrospectively analyzed voiding diaries from adult men treated for lower urinary tract symptoms (LUTS) at an outpatient urology clinic to identify pairs of voiding diaries with ≥1 nocturnal void at baseline and a corresponding follow-up diary completed within 1 year. We compared the odds of nocturia improvement (decrease of ≥1 nocturnal void) in patients started on LUTS pharmacotherapy versus behavioral modification alone. RESULTS Two hundred and thirteen diary pairs from 93 patients were included. Fifty-seven diary pairs were identified from patients prescribed at least one LUTS drug on the initial visit and 156 diary pairs were identified from patients receiving behavioral modification alone. All standard voiding diary parameters were assessed, and only maximum voided volume differed at baseline (240 ml [interquartile range: 200-330 ml] vs. 280 ml [200-400 ml] with and without pharmacotherapy, respectively, p = 0.04). The odds of nocturia improvement did not significantly differ between pharmacotherapy and behavioral modification treatment groups (crude odds ratio [OR]: 1.16 [95% confidence interval: 0.63-2.16], p = 0.63; maximum voided volume [MVV]-adjusted OR: 1.19 [0.63-2.22], p = 0.59). In contrast, improvement in 24-h urinary frequency was more likely with pharmacotherapy versus behavioral modification alone (crude OR: 2.36 [1.22-4.56], p = 0.01; MVV-adjusted OR: 2.05 [1.05-4.01], p = 0.04). Results were consistent on subgroup analyses restricted to first diary pairs from each patient. CONCLUSION Despite improvement in 24-h voiding frequency, there was no evidence that adjunctive pharmacotherapy provided a benefit in the treatment of nocturia in men receiving behavioral counseling.
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Affiliation(s)
- Connelly D Miller
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.,Department of Urology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York, USA
| | - Thomas F Monaghan
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.,Department of Urology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York, USA
| | - Dennis J Robins
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.,Department of Urology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.,Department of Urology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York, USA
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12
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Miyazato M, Ashikari A, Nakamura K, Nakamura T, Yamashiro K, Uema T, Uehara M, Masuzaki H, Saito S, Maeda S, Ishida H, Matsushita M. Effect of a mobile digital intervention to enhance physical activity in individuals with metabolic disorders on voiding patterns measured by 24-h voided volume monitoring system: Kumejima Digital Health Project (KDHP). Int Urol Nephrol 2021; 53:1497-1505. [PMID: 33909235 PMCID: PMC8280019 DOI: 10.1007/s11255-021-02867-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/17/2021] [Indexed: 11/09/2022]
Abstract
Purpose To evaluate the effect of a mobile digital intervention on voiding patterns, we performed 24-h voided volume monitoring in individuals with metabolic disorders. Methods Participants with metabolic disorders were grouped into either the intervention group (n = 17), who had access to a smartphone app (CARADA), or the non-intervention group (n = 11), who did not. Urine monitoring was conducted for 24 h using a novel digital self-health monitoring system for urine excretion (s-HMSU). Body weight, abdominal circumference, blood pressure, and biomarkers were measured. Results Physical findings and blood test results at baseline and 6 months indicated no significant between-group differences. Night-time frequency did not change between baseline and 6 months in the intervention group but significantly worsened at 6 months in the non-intervention group, as compared to baseline (1.0 ± 0.7 vs. 1.5 ± 0.5, p < 0.05). The change in night-time frequency over 6 months did not differ between the intervention and non-intervention groups. Furthermore, the change in hours of undisturbed sleep over 6 months did not differ between the two groups. However, compared with baseline, nocturnal polyuria index tended to worsen at 6 months in the non-intervention group. Conclusion Our study results suggest that mobile digital intervention might be useful for behavioral therapy to improve night-time frequency and urine production and that s-HMSU might be beneficial for confirming the prevention of progress in individuals with metabolic disorders, which can aid in modifying lifestyle.
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Affiliation(s)
- Minoru Miyazato
- Department of Systems Physiology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
| | - Asuka Ashikari
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Koshi Nakamura
- Department of Public Health and Hygiene, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takehiro Nakamura
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kiyoto Yamashiro
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tsugumi Uema
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Moriyuki Uehara
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hiroaki Masuzaki
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Seiichi Saito
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shiro Maeda
- Department of Advanced Genomic and Laboratory Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.,Division of Clinical Laboratory and Blood Transfusion, University of the Ryukyus Hospital, Okinawa, Japan
| | - Hajime Ishida
- Department of Human Biology and Anatomy, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Masayuki Matsushita
- Department of Molecular and Cellular Physiology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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13
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Kyoda Y, Okada M, Kato R, Matsuki M, Ito N, Takahashi A, Tanuma Y, Tachiki H, Fukuta F, Hashimoto K, Kobayashi K, Tanaka T, Masumori N. Does cognitive behavioral therapy using a self-check sheet improve night-time frequency in patients with nocturia? Results of a multicenter randomized controlled trial. Int J Urol 2021; 28:444-449. [PMID: 33458939 DOI: 10.1111/iju.14489] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 12/14/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine whether cognitive behavioral therapy using a self-check sheet is effective in improving night-time frequency of patients with nocturia. METHODS We carried out a multicenter, open-labeled, randomized controlled trial in eight institutions. Patients having two or more episodes of nocturia were randomly assigned to either cognitive behavioral therapy with completion of frequency volume charts regularly (cognitive behavioral therapy group) or frequency volume charts regularly alone (frequency volume charts group). The cognitive behavioral therapy checklist was composed of eight items: wake up time/bedtime, mealtime, napping, alcohol/caffeine intake, water intake, salt intake, exercise and taking a bath. A physician explained cognitive behavioral therapy within 5 min using a brief manual. The patients in the cognitive behavioral therapy group filled out the self-check sheet every day. The primary end-point was the difference in night-time frequency based on the International Prostate Symptom Score Q7 at 4 weeks. RESULTS Of the 100 first-visit patients randomly allocated, 37 in the cognitive behavioral therapy group and 41 in the frequency volume charts group completed the protocol. No difference was observed in the mean ± standard deviation of night-time frequency at 4 weeks between the cognitive behavioral therapy group (2.6 ± 1.0) and the frequency volume charts group (3.1 ± 1.2; P = 0.056). However, when six patients with achievement of cognitive behavioral therapy of <50% were excluded from the analysis, night-time frequency at 4 weeks was significantly lower in the cognitive behavioral therapy group (2.5 ± 1.0) than in the frequency volume charts group (3.1 ± 1.2; P = 0.027). CONCLUSIONS The efficacy of cognitive behavioral therapy using a self-check sheet for nocturia remains to be shown. However, strictly practicing cognitive behavioral therapy might be beneficial to these patients.
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Affiliation(s)
- Yuki Kyoda
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Manabu Okada
- Department of Urology, Obihiro Kyokai Hospital, Obihiro, Hokkaido, Japan
| | - Ryuichi Kato
- Department of Urology, Muroran City General Hospital, Muroran, Hokkaido, Japan
| | - Masahiro Matsuki
- Department of Urology, Kushiro Red Cross Hospital, Kushiro, Hokkaido, Japan
| | - Naoki Ito
- Department of Urology, NTT-East Sapporo Hospital, Sapporo, Hokkaido, Japan
| | - Atsushi Takahashi
- Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Hokkaido, Japan
| | - Yasushi Tanuma
- Department of Urology, Hakodate Kyokai Hospital, Hakodate, Hokkaido, Japan
| | - Hitoshi Tachiki
- Department of Urology, Steel Memorial Muroran Hospital, Muroran, Hokkaido, Japan
| | - Fumimasa Fukuta
- Department of Urology, Steel Memorial Muroran Hospital, Muroran, Hokkaido, Japan
| | - Kohei Hashimoto
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Ko Kobayashi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Toshiaki Tanaka
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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14
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Monaghan TF, Michelson KP, Wu ZD, Gong F, Agudelo CW, George CD, Alwis US, Epstein MR, Mekki P, Flores VX, Bliwise DL, Everaert K, Vande Walle J, Weiss JP, Lazar JM. Sodium restriction improves nocturia in patients at a cardiology clinic. J Clin Hypertens (Greenwich) 2020; 22:633-638. [PMID: 32049435 PMCID: PMC8029872 DOI: 10.1111/jch.13829] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 10/15/2023]
Abstract
This study aims to determine whether dietary sodium restriction counseling decreases nocturnal voiding frequency in cardiology patients with concomitant nocturia. Patients who had established care at a cardiology clinic from 2015 to 2018 reporting ≥1 average nocturnal void(s) underwent a comprehensive sodium intake interview by their cardiologist, who provided them with individualized strategies for dietary sodium reduction and assessed adherence at follow-up. Average nocturnal voiding frequency and dietary adherence were documented in the medical record. A nocturia database was compiled for retrospective analysis. A total of 74 patients were included. Patients considered to be adherent with dietary sodium restriction at follow-up (n = 56) demonstrated a decrease in median nocturia frequency (2.5 [2.3-3.0] vs 1.0 [1.0-2.0] voids, P < .001). Among nonadherent patients (n = 18), median nocturia frequency did not significantly change from baseline to follow-up (2.0 [1.5-3.8] vs 2.0 [1.5-4.8] voids, P = .423). Median changes were significantly different between the adherent and nonadherent groups (P < .001). Examination of second follow-up available from 37 patients showed a continued effect. In conclusion, adherence with dietary sodium counseling appears to improve nocturia. Accordingly, dietary modification may represent an important adjunct therapy to lifestyle and pharmacologic interventions for decreasing nocturia frequency. Reduction in nocturnal voiding frequency may also reflect an additional benefit of dietary sodium restriction in accordance with best practice standards for cardiovascular disease.
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Affiliation(s)
- Thomas F. Monaghan
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Kyle P. Michelson
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Zhan D. Wu
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Fred Gong
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Christina W. Agudelo
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Christopher D. George
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | | | - Matthew R. Epstein
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Pakinam Mekki
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Viktor X. Flores
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Donald L. Bliwise
- Department of NeurologyEmory University School of MedicineAtlantaGAUSA
| | - Karel Everaert
- Department of UrologyGhent University HospitalGhentBelgium
| | - Johan Vande Walle
- Department of Pediatric NephrologyGhent University HospitalGhentBelgium
| | - Jeffrey P. Weiss
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Jason M. Lazar
- Division of Cardiovascular MedicineDepartment of MedicineSUNY Downstate Health Sciences UniversityBrooklynNYUSA
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15
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Nocturia in Women With Type 2 Diabetes Mellitus: A Cross-sectional, Correlation Study. J Wound Ostomy Continence Nurs 2020; 47:265-272. [PMID: 32195774 DOI: 10.1097/won.0000000000000635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE The first aim of this study was to compare nighttime voiding frequency (nocturia), serum hemoglobin A1c level, peripheral neuropathy score, and global sleep quality score in younger (>40 to <65 years) versus older (≥65 years) women with type 2 diabetes mellitus (DM). Additional aims were to identify factors associated with clinically relevant nocturia (≥2 episodes/night) and to analyze relationships between nocturia frequency, glycemic control, peripheral neuropathy, and sleep quality in these women. DESIGN Cross-sectional study. SETTING AND SUBJECTS Participants were 118 women older than 40 years and with type 2 DM. Their mean age was 65.25 (SD = 9.66) years; the mean duration since diagnosis of type 2 DM was 10.96 (SD = 7.66) years. The study setting was 2 metabolism and endocrinology outpatient departments located in Taipei City and Taoyuan, Taiwan. METHODS Data were collected using a questionnaire that queried sociodemographic information, lower urinary tract symptoms, and sleep quality. We also assessed peripheral neuropathy and lower extremity edema and obtained pertinent information from participants' medical records. Independent t tests, multivariate logistic regression analyses, Spearman's rank correlation coefficients, and one-way analysis of variance were used to address the 3 study aims. RESULTS Analyses found that older women (aged ≥65 years) had a significantly higher nighttime voiding frequency, a higher peripheral neuropathy score, and a higher sleep quality score than younger (>40 to <65 years) women. Multivariate logistic regression analyses identified 4 factors associated with clinically relevant nocturia advanced age, elevated hemoglobin A1c level, suspected peripheral neuropathy, and lower extremity edema. Significant correlation coefficients were found between nighttime voiding frequency and serum hemoglobin A1c levels, peripheral neuropathy scores, and sleep quality scores. Analyses also found that women with a greater nocturia frequency had higher hemoglobin A1c levels, peripheral neuropathy scores, and sleep quality scores. CONCLUSIONS Healthcare professionals should screen for nocturia in women with type 2 DM and provide appropriate management for those experiencing nocturia.
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16
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Sigalos JT, Kohn TP, Cartagenova L, Dao Z, Gondokusumo JC, Santiago J, Kohn JR, Pickett SM, Pastuszak AW, Lipshultz LI. Shift Workers With Shift Work Disorder Have Worse Lower Urinary Tract Symptoms. Urology 2019; 128:66-70. [PMID: 30817957 DOI: 10.1016/j.urology.2019.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/13/2019] [Accepted: 02/19/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To examine the association between shift work or shift work disorder (SWD) and lower urinary tract symptoms (LUTS). Nonstandard shift workers are defined as those working shifts outside of a normal 7 AM-6 PM work day. METHODS Men presenting to a single andrology clinic between July 2014 and June 2017 completed questionnaires that included questions about work schedules, shift work status, SWD[1][1], personal well-being via the Patient Health Questionnaire-9, and LUTS (International Prostate Symptom Score [IPSS]). Men who had previously undergone prostate surgery were excluded. Shift work and SWD on IPSS was assessed via multivariate linear regression. RESULTS Of the 2571 men who completed all questionnaires, 619 (24.1%) reported working nonstandard shifts in the past month. Of these, 196 (31.7%) had high risk of SWD as determined by a questionnaire. When controlling for age, medications, surgical intervention for benign prostatic hyperplasia, comorbidities, and testosterone (T) levels, nonstandard shift work overall was not associated with worse LUTS (P = .82). However, nonstandard shift workers at high risk for SWD had IPSS scores that were clinically significantly higher (3.74 points ± 0.57 standard error) than nonstandard shift workers without SWD (P <.0001). CONCLUSION Nonstandard shift workers at high risk for SWD have worse LUTS than those without SWD. However, no association between nonstandard shift work and LUTS was found.
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Affiliation(s)
| | - Taylor P Kohn
- John's Hopkins Brady Urological Institute, Baltimore, MD
| | | | | | | | | | - Jaden R Kohn
- John's Hopkins Department of Obstetrics and Gynecology, Baltimore, MD
| | | | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
| | - Larry I Lipshultz
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX
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17
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Viaene A, Roggeman S, Goessaert AS, Kessler TM, Mehnert U, Besien VV, De Muynck M, Everaert K. Conservative treatment for leg oedema and the effect on nocturnal polyuria in patients with spinal cord injury. BJU Int 2019; 123:E43-E50. [DOI: 10.1111/bju.14672] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Annick Viaene
- Department of Physical Medicine and Rehabilitation; Ghent University Hospital; Gent Belgium
| | - Saskia Roggeman
- Department of Urology; Ghent University Hospital; Ghent University; Gent Belgium
| | - An-Sofie Goessaert
- Department of Urology; Ghent University Hospital; Ghent University; Gent Belgium
| | - Thomas M. Kessler
- Department of Neuro-Urology; Spinal Cord Injury Center & Research; Balgrist University Hospital; University of Zürich; Zürich Switzerland
| | - Ulrich Mehnert
- Department of Neuro-Urology; Spinal Cord Injury Center & Research; Balgrist University Hospital; University of Zürich; Zürich Switzerland
| | - Vickie Van Besien
- Department of Rehabilitation Sciences and Physiotherapy; Ghent University Hospital; Gent Belgium
| | - Martine De Muynck
- Department of Physical Medicine and Rehabilitation; Ghent University Hospital; Gent Belgium
| | - Karel Everaert
- Department of Urology; Ghent University Hospital; Ghent University; Gent Belgium
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18
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Viaene A, Denys MA, Goessaert AS, Claeys J, Raes A, Roggeman S, Everaert K. Evaluation of the occurrence and diagnose definitions for nocturnal polyuria in spinal cord injured patients during rehabilitation. Eur J Phys Rehabil Med 2019; 55:40-46. [DOI: 10.23736/s1973-9087.17.04851-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Zhang AY, Xu X. Prevalence, Burden, and Treatment of Lower Urinary Tract Symptoms in Men Aged 50 and Older: A Systematic Review of the Literature. SAGE Open Nurs 2018; 4:2377960818811773. [PMID: 33415211 PMCID: PMC7774430 DOI: 10.1177/2377960818811773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 10/17/2018] [Indexed: 11/18/2022] Open
Abstract
We conducted a systematic review of literature from the years 2000 through 2017 on the prevalence and burden of lower urinary tract symptoms (LUTS) in men aged 50 and older, and medical treatments of and alternative nonmedical approaches to LUTS. EBSCOhost (Medline with Full Text) was searched for observational, experimental, and review studies in peer-reviewed journals in the English language. Our review found that LUTS were highly prevalent in the world and estimated to affect 2.3 billion people in 2018, with 44.7% being men. Men with LUTS suffer from not only burdensome symptoms such as nocturia and urgency but also adverse psychological consequences (e.g., anxiety and depression) and financial burden. Current medical treatments are clinically effective, but their efficacy is compromised by side effects and low compliance rates. Alternative nonmedical treatments for LUTS were also sought worldwide. There is evidence that lifestyle modifications such as pelvic muscle exercises and bladder training, physical activity, dietary modification, and nutritional supplements can alleviate LUTS and improve patient quality of life; however, evidence based on rigorous methodology remains minimal and cannot be generalized across populations. Evidence of effectiveness of weight loss programs to reduce LUTS is inconclusive. We conclude that although behavioral treatment is a promising approach to alleviating LUTS, especially when combined with medical treatments, well-designed randomized controlled and longitudinal clinical trials on behavioral treatments of LUTS are still needed. Minimally invasive procedures and neuromodulation therapy also show positive results of alleviating LUTS but require further research as well.
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Affiliation(s)
- Amy Y Zhang
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Xinyi Xu
- University Hospitals Cleveland Medical Center Seidman Cancer Center, Cleveland, OH, USA
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20
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Managing nocturia: The multidisciplinary approach. Maturitas 2018; 116:123-129. [PMID: 30244773 DOI: 10.1016/j.maturitas.2018.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 01/10/2023]
Abstract
Nocturia, defined as waking at night to pass urine, is a common condition which increases with age. Whilst nocturia is known to have an important effect on quality of life, more recent evidence has linked the symptom with significant morbidity and mortality due to the effects of sleep deprivation on glucose metabolism and the immune system. The causes of nocturia are multifactorial and may be related to urine overproduction, storage disorders and primary sleep disorders. The commonest underlying pathology, however, is nocturnal polyuria, which may be associated with a number of medical conditions. This review explores the underlying causes of nocturia and nocturnal polyuria and, by doing so, describes a multidisciplinary approach to managing patients effectively.
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Yoo S, Park J, Cho SY, Cho MC, Jeong H, Son H. Usefulness of the frequency-volume chart over the International Prostate Symptom Score in patients with benign prostatic hyperplasia in view of global polyuria. PLoS One 2018; 13:e0197818. [PMID: 29995878 PMCID: PMC6040686 DOI: 10.1371/journal.pone.0197818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/09/2018] [Indexed: 11/19/2022] Open
Abstract
Purpose We aimed to determine the usefulness of the frequency-volume chart over the International Prostate Symptom Score in patients with benign prostatic hyperplasia. Furthermore, we investigated the clinical characteristics suggesting that patients could benefit from frequency-volume chart assessment in addition to International Prostate Symptom Score assessment. Methods A total of 193 patients with benign prostatic hyperplasia were analyzed. The relationship between the information obtained from the frequency-volume chart and the International Prostate Symptom Score was assessed. Because the urine output per kilogram per hour was not associated with any question in the International Prostate Symptom Score questionnaire, patients were divided into 2 groups according to the presence of global polyuria, defined as urine output >40 mL·kg-1·h-1. Multivariable analysis was performed to determine the predictors of global polyuria, and the results were externally validated using 397 patients with benign prostatic hyperplasia. Results Although the other information obtained from the frequency-volume chart correlated with the International Prostate Symptom Score, the urine output was not associated with the International Prostate Symptom Score. Based on these results, patients were dichotomized into the global polyuria group (n = 19, 9.8%) and the non-global polyuria group. Although the patient characteristics did not differ between the 2 groups, the number of voids was higher in patients with global polyuria. Multivariable analysis showed that diabetes mellitus (odds ratio: 3.497, p = 0.039) and increased number of voids (odds ratio: 1.320, p < 0.001) were significant predictors of global polyuria. On external validation, the area under curve for the model was 0.723. Conclusions Global polyuria cannot be suspected using the International Prostate Symptom Score, although it worsens the lower urinary tract symptoms of patients with benign prostatic hyperplasia. Assessment with the frequency-volume chart needs to be considered in diabetic patients with increased number of voids.
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Affiliation(s)
- Sangjun Yoo
- Department of Urology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Juhyun Park
- Department of Urology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Sung Yong Cho
- Department of Urology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Min Chul Cho
- Department of Urology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hyeon Jeong
- Department of Urology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hwancheol Son
- Department of Urology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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Furukawa S, Sakai T, Niiya T, Miyaoka H, Miyake T, Yamamoto S, Maruyama K, Tanaka K, Ueda T, Senba H, Torisu M, Minami H, Tanigawa T, Matsuura B, Hiasa Y, Miyake Y. Dietary intake habits and the prevalence of nocturia in Japanese patients with type 2 diabetes mellitus. J Diabetes Investig 2018; 9:279-285. [PMID: 28667795 PMCID: PMC5835452 DOI: 10.1111/jdi.12709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/24/2017] [Accepted: 06/28/2017] [Indexed: 12/16/2022] Open
Abstract
AIMS/INTRODUCTION No reports have been published on the association between dietary intake habits and nocturia in the diabetes population. We therefore evaluated this issue among Japanese patients with diabetes mellitus. MATERIALS AND METHODS Study participants in the present study were 785 Japanese patients with type 2 diabetes mellitus. Self-administered questionnaires were used to assess each type of dietary intake habit. Vegetable intake habit was assessed by the following question: "Do you have vegetables or seaweed every day?" We used the following two outcomes: (i) nocturia: ≥2 voids per night; and (ii) severe nocturia: ≥3 voids per night. Adjustment was made for age, sex, body mass index, glycated hemoglobin, hypertension, dyslipidemia, smoking, drinking, exercise habit, stroke, ischemic artery disease, diabetic nephropathy, diabetic neuropathy and diabetic retinopathy. RESULTS The prevalence of nocturia, severe nocturia, and vegetable intake habit was 39.9%, 14.4% and 67.3%, respectively. After adjusting for confounding factors, vegetable intake habit was independently inversely associated with nocturia and severe nocturia: the adjusted odds ratios were 0.67 (95% confidence interval [CI] 0.48-0.94) and 0.46 (95% CI 0.30-0.71), respectively. Among male patients, vegetable intake habit was independently inversely associated with severe nocturia, but not nocturia: the adjusted OR was 0.51 (95% CI 0.29-0.88). Among female patients, vegetable intake habit was independently inversely associated with nocturia and severe nocturia: the adjusted ORs were 0.44 (95% CI 0.24-0.79) and 0.34 (95% CI 0.15-0.78), respectively. CONCLUSIONS We found an inverse association between vegetable intake habit and nocturia in Japanese patients with type 2 diabetes mellitus.
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Affiliation(s)
- Shinya Furukawa
- Department of Epidemiology and Preventive MedicineEhime University Graduate School of MedicineEhimeJapan
- Epidemiology and Medical Statistics UnitTranslational Research CenterEhime University HospitalEhimeJapan
| | - Takenori Sakai
- Department of Internal MedicineYawatahama General City HospitalEhimeJapan
| | - Tetsuji Niiya
- Department of Internal MedicineMatsuyama Shimin HospitalEhimeJapan
| | - Hiroaki Miyaoka
- Department of Internal MedicineSaiseikai Matsuyama HospitalEhimeJapan
| | - Teruki Miyake
- Department of Gastroenterology and MetabologyEhimeJapan
| | - Shin Yamamoto
- Department of Lifestyle‐Related Medicine and EndocrinologyEhime University Graduate School of MedicineEhimeJapan
| | - Koutatsu Maruyama
- Laboratory of Community Health and Nutrition, Special Course of Food and Health ScienceDepartment of BioscienceGraduate School of AgricultureEhime UniversityEhimeJapan
| | - Keiko Tanaka
- Department of Epidemiology and Preventive MedicineEhime University Graduate School of MedicineEhimeJapan
- Epidemiology and Medical Statistics UnitTranslational Research CenterEhime University HospitalEhimeJapan
| | - Teruhisa Ueda
- Department of Internal MedicineEhime Prefectural Central HospitalEhimeJapan
| | - Hidenori Senba
- Department of Epidemiology and Preventive MedicineEhime University Graduate School of MedicineEhimeJapan
- Department of Gastroenterology and MetabologyEhimeJapan
| | - Masamoto Torisu
- Department of Internal MedicineSaiseikai Saijo HospitalEhimeJapan
| | - Hisaka Minami
- Department of Internal MedicineEhime Niihama HospitalEhimeJapan
| | - Takeshi Tanigawa
- Department of Public HealthJuntendo University School of MedicineTokyoJapan
| | - Bunzo Matsuura
- Department of Lifestyle‐Related Medicine and EndocrinologyEhime University Graduate School of MedicineEhimeJapan
| | - Yoichi Hiasa
- Department of Gastroenterology and MetabologyEhimeJapan
| | - Yoshihiro Miyake
- Department of Epidemiology and Preventive MedicineEhime University Graduate School of MedicineEhimeJapan
- Epidemiology and Medical Statistics UnitTranslational Research CenterEhime University HospitalEhimeJapan
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23
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Bradley CS, Erickson BA, Messersmith EE, Pelletier-Cameron A, Lai HH, Kreder KJ, Yang CC, Merion RM, Bavendam TG, Kirkali Z. Evidence of the Impact of Diet, Fluid Intake, Caffeine, Alcohol and Tobacco on Lower Urinary Tract Symptoms: A Systematic Review. J Urol 2017; 198:1010-1020. [PMID: 28479236 PMCID: PMC5654651 DOI: 10.1016/j.juro.2017.04.097] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE Diet, fluid intake and caffeine, alcohol and tobacco use may have effects on lower urinary tract symptoms. Constructive changes in these modifiable nonurological factors are suggested to improve lower urinary tract symptoms. To better understand the relationship between nonurological factors and lower urinary tract symptoms, we performed a systematic literature review to examine, grade and summarize reported associations between lower urinary tract symptoms and diet, fluid intake and caffeine, tobacco and alcohol use. MATERIALS AND METHODS We performed PubMed® searches for eligible articles providing evidence on associations between 1 or more nonurological factors and lower urinary tract symptoms. A modified Oxford scale was used to grade the evidence. RESULTS We reviewed 111 articles addressing diet (28 studies), fluid intake (21) and caffeine (21), alcohol (26) and tobacco use (44). The evidence grade was generally low (6% level 1, 24% level 2, 11% level 3 and 59% level 4). Fluid intake and caffeine use were associated with urinary frequency and urgency in men and women. Modest alcohol use was associated with decreased likelihood of benign prostatic hyperplasia diagnosis and reduced lower urinary tract symptoms in men. Associations between lower urinary tract symptoms and ingestion of certain foods and tobacco were inconsistent. CONCLUSIONS Evidence of associations between lower urinary tract symptoms and diet, fluid intake and caffeine, alcohol and tobacco use is sparse and mostly observational. However, there is evidence of associations between increased fluid and caffeine intake and urinary frequency/urgency, and between modest alcohol intake and decreased benign prostatic hyperplasia diagnosis and lower urinary tract symptoms. Given the importance of these nonurological factors in daily life, and their perceived impact on lower urinary tract symptoms, higher quality evidence is needed.
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Affiliation(s)
| | | | | | | | - H Henry Lai
- Washington University School of Medicine, St. Louis, Missouri
| | - Karl J Kreder
- University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | - Robert M Merion
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Tamara G Bavendam
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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Cohn JA, Kowalik CG, Reynolds WS, Kaufman MR, Milam DF, Dmochowski RR, Wein AJ. Desmopressin acetate nasal spray for adults with nocturia. Expert Rev Clin Pharmacol 2017; 10:1281-1293. [DOI: 10.1080/17512433.2017.1394185] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Joshua A. Cohn
- Department of Urology, Einstein Healthcare Network, Philadelphia, PA USA
| | - Casey G. Kowalik
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - W. Stuart Reynolds
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melissa R. Kaufman
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Douglas F. Milam
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Roger R. Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alan J. Wein
- Division of Urology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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25
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Abstract
BACKGROUND Nocturia is the bothersome symptom of awakening one or more times per night to void. Desmopressin is a commonly used medication for treating nocturia. OBJECTIVES To assess the effects of desmopressin as compared to other interventions in the treatment of nocturia in men. SEARCH METHODS We performed a comprehensive search of medical literature with no restrictions on the language of publication or publication status. The date of the latest search of all databases was August 2017. SELECTION CRITERIA We included randomized or quasi-randomized trials. Inclusion criteria were men with nocturia defined as one or more voids per night. Trials of children, adults with primary or secondary enuresis or underlying distinct disorders were excluded. DATA COLLECTION AND ANALYSIS Two review authors independently classified studies and abstracted data from the included studies. We performed statistical analyses using a random-effects model and interpreted data according to the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS We included 14 studies with 2966 randomized men across five comparisons. Desmopressin versus placebo: based on short-term follow-up (up to three months), desmopressin may have a similar effect on the number of nocturnal voids (mean difference (MD) -0.46, 95% confidence interval (CI) -0.94 to 0.01; low-quality evidence). We are uncertain about the effect of desmopressin on major adverse events at short-term follow-up (risk ratio (RR) 0.97, 95% CI 0.10 to 9.03; very low-quality evidence). For intermediate-term follow-up (three to 12 months), desmopressin may reduce the number of nocturnal voids in an appreciable number of participants (MD -0.85, 95% CI -1.17 to -0.53; low-quality evidence). Desmopressin may result in little or no difference in major adverse events at intermediate-term follow-up (RR 3.05, 95% CI 0.13 to 73.39; low-quality evidence). We found no evidence on quality of life. Subgroup analyses suggest a larger effect with oral, higher-dose formulations of desmopressin and in men with documented nocturnal polyuria. Desmopressin versus behavior modification: there were no data regarding the effect on the number of nocturnal voids, quality of life, or major adverse events. Desmopressin versus alpha-blocker: based on short-term follow-up, desmopressin likely has a similar effect on the number of nocturnal voids (MD 0.30, 95% CI -0.20 to 0.80; moderate-quality evidence) and quality of life (MD 0.00, 95% CI -0.35 to 0.35; moderate-quality evidence). There were no major adverse events in either study group. Desmopressin plus alpha-blocker versus alpha-blocker alone: based on short-term follow-up, combination therapy likely results in a small, unimportant reduction in the number of nocturnal voids (MD -0.47, 95% CI -0.73 to -0.21; moderate-quality evidence) and quality of life (MD -0.29, 95% CI -0.51 to -0.07; moderate-quality evidence). The risk of major adverse events may be similar (RR 0.30, 95% CI 0.01 to 7.32; low-quality evidence). Desmopressin plus alpha-blocker versus alpha-blocker plus an anticholinergic: based on short-term follow-up, combination therapy likely results in little or no difference in the number of nocturnal voids (MD -0.43, 95% CI -0.97 to 0.11; moderate-quality evidence). We found no evidence on quality of life. There were no major adverse events in either study group. AUTHORS' CONCLUSIONS Desmopressin may reduce the number of nocturnal voids in an appreciable number of participants compared to placebo in intermediate-term (three to 12 months) follow-up without increase in major adverse events. We found no evidence to compare its effects to behavior modification. The effect on the number of nocturnal voids is likely similar to that of alpha-blockers short-term with very infrequent major adverse events. There appears to be no added benefit in the combined use of desmopressin with an alpha-blocker or an anticholinergic. The findings of this review were limited by short-term follow-up, study limitations, and imprecision.
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Affiliation(s)
- Julia Han
- University of FloridaDepartment of UrologyPO Box 100247Room N205GainesvilleFloridaUSA32610
| | - Jae Hung Jung
- Yonsei University Wonju College of MedicineDepartment of Urology20 Ilsan‐roWonjuGangwonKorea, South26426
| | - Caitlin J Bakker
- University of MinnesotaHealth Sciences Libraries303 Diehl Hall, 505 Essex Street SEMinneapolisMinnesotaUSA55455
| | - Mark H Ebell
- University of GeorgiaDepartment of Epidemiology and Biostatistics, College of Public HealthAthensGeorgiaUSA
| | - Philipp Dahm
- Minneapolis VA Health Care SystemUrology SectionOne Veterans DriveMail Code 112DMinneapolisMinnesotaUSA55417
- University of MinnesotaDepartment of Urology420 Delaware Street SEMMC 394MinneapolisMinnesotaUSA55455
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26
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Denys MA, Goessaert AS, Dejaeghere B, Decalf V, Hoebeke P, Everaert K. A different way to study frequency volume charts in patients with nocturia. Neurourol Urodyn 2017; 37:768-774. [DOI: 10.1002/nau.23344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/29/2017] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Brecht Dejaeghere
- Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
| | - Veerle Decalf
- Department of Urology; Ghent University Hospital; Ghent Belgium
| | - Piet Hoebeke
- Department of Urology; Ghent University Hospital; Ghent Belgium
| | - Karel Everaert
- Department of Urology; Ghent University Hospital; Ghent Belgium
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27
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Scovell JM, Pastuszak AW, Slawin J, Badal J, Link RE, Lipshultz LI. Impaired Sleep Quality is Associated With More Significant Lower Urinary Tract Symptoms in Male Shift Workers. Urology 2016; 99:197-202. [PMID: 27639796 DOI: 10.1016/j.urology.2016.05.076] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 05/16/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the association between sleep quality and severity of lower urinary tract symptoms (LUTS) in men working nonstandard shifts, a population at risk of poor sleep quality. METHODS Men who presented to a single andrology clinic between July and October 2014 and worked nonstandard shifts completed the International Prostate Symptom Score (IPSS) and responded to questions regarding their work habits, sleep quality, and physical or cognitive function. We assessed the relationship between age, sleep quality, physical or cognitive function, and severity of LUTS. RESULTS A total of 228 men with a mean ± standard deviation age of 41.8 ± 5.7 (range 21-76) years reported working nonstandard shifts, with the majority working these shifts for more than 1 year (81%). Men with difficulties falling asleep reported more severe LUTS than men who did not have difficulty falling asleep (IPSS score 9 vs 6, P <.001). Men who reported difficulty staying asleep or falling back asleep after awakening also reported more severe LUTS (IPSS scores 6 vs 13, P = .004; 5 vs 13, P <.001, respectively). Men with a decreased sense of well-being or decreased physical or cognitive function also reported more severe LUTS (IPSS score 6 vs 9, P <.0010; 6 vs 10, P = .016, respectively). All findings were independent of subject age. CONCLUSION Men working nonstandard shifts who have difficulty falling asleep, staying asleep, and falling back asleep report more severe LUTS than men without similar sleep difficulties. Men with a decreased sense of well-being or decreased physical or cognitive function also report worse LUTS. These findings implicate sleep quality as a possible risk factor for LUTS symptom severity.
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Affiliation(s)
- Jason M Scovell
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX
| | - Alexander W Pastuszak
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX.
| | - Jeremy Slawin
- Department of Urology, NYU Langone Medical, New York, NY
| | | | - Richard E Link
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX
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28
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Desmopressin for treating nocturia in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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29
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Okuyama M, Nishida M. [The physical signs of impending dehydration among elderly people in nursing homes: The association with axillary skin temperature, humidity, intraoral moisture content, and salivary components]. Nihon Ronen Igakkai Zasshi 2016; 53:379-386. [PMID: 27885225 DOI: 10.3143/geriatrics.53.379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE The aim of the present study was to examine the association between impending dehydration among elderly people in nursing homes and physical signs, including the axillary skin temperature, humidity, intraoral moisture content, and salivary components. METHODS The study included 78 elderly individuals who required long-term care in a nursing home (11 men and 67 women; average age, 86.6±7.3 years). The elderly subjects were classified in two groups according to their serum osmolality levels: those with levels between the upper limit reference value (292 mOsm/kg H2O) and the diagnostic reference value of dehydration (300 mOsm/kg H2O) were classified into the boundary zone group and those with levels of <292 mOsm/kg H2O were classified into the normal range group. The following parameters were measured: basic attributes (age, gender and level of care required), body mass index, diet, daily fluid intake per kilogram of body weight, physiological indicators (blood pressure, pulse rate, body temperature, axillary skin temperature, humidity, total body water, body water rate, internal liquid rate, external solution rate, blood components, intraoral water amount, and salivary components), and the indoor environment (room temperature and humidity). We then performed a statistical analysis to compare the boundary zone group with the normal range group. After adjusting for age and the daily fluid intake per kilogram of body weight (<25 ml/≥25 ml), we performed a logistic regression analysis (the boundary zone group was used as an independent variable) for variables that had significance levels of <0.05 (except for blood components). RESULTS The univariate analysis revealed significant differences in the following parameters: the serum sodium, chloride, and creatinine levels; the blood sugar level; the urea nitrogen/creatinine ratio; the axillary skin temperature; and room humidity. Only the axillary skin temperature showed a significant association in the final model of the logistic regression analysis (odds ratio, 3.664; 95% confidence interval, 1.101-12.197; p = 0.034). CONCLUSION As the axillary skin temperature increased by 1°C, there was a 3.67-fold risk of being classified into the boundary zone group instead of the normal range group. Thus, the axillary skin temperature was associated with impending dehydration.
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Affiliation(s)
- Mayumi Okuyama
- Department of Nursing, Faculty of Nursing, Sanyo Gakuen University
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30
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Oelke M, Adler E, Marschall-Kehrel D, Herrmann TRW, Berges R. Nocturia: state of the art and critical analysis of current assessment and treatment strategies. World J Urol 2015; 32:1109-17. [PMID: 25216925 DOI: 10.1007/s00345-014-1396-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This editorial of the topic issue of the World Journal of Urology provides a state of the art on nocturia which includes descriptions of the terminology, epidemiology, health-related quality of life, medical and financial consequences, pathophysiology, assessment tools and treatment strategies of nocturia. This summary also includes a flowchart on the pathophysiology of nocturia with illustration of the various causes of reduced bladder capacity, increased fluid intake or increased diuresis; a flowchart with the key findings of frequency-volume charts to determine the underlying pathophysiology; and a flowchart on the treatment of the various causes of nocturia. The editorial critically discusses current assessment and treatment strategies in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) and nocturia. The outcome of nocturia remains hidden in drug trials of patients with LUTS/BPH because nocturia-specific measures were not included. The authors recommend using frequency-volume charts, measurement of the hours of undisturbed sleep, and nocturia-specific quality of life questionnaires (e.g., ICIQ-N or N-Qol) in all future studies in patients with LUTS/BPH and nocturia.
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Affiliation(s)
- Matthias Oelke
- Department of Urology, OE 6240, Hannover Medical School, 30625, Hannover, Germany,
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Yazici CM, Kurt O. Combination therapies for the management of nocturia and its comorbidities. Res Rep Urol 2015; 7:57-63. [PMID: 25945323 PMCID: PMC4408945 DOI: 10.2147/rru.s51140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Nocturia is the most bothersome lower urinary tract symptom. It has a multifactorial etiology. It had been thought nocturia was a nonspecific symptom of lower urinary system dysfunction, but it has been determined that many diseases, related to different organ systems, might be reasons for this nonspecific symptom. Along with the importance of systemic diseases that cause nocturia, the symptom itself has adverse effects on patients’ health and quality of life. There are several studies reporting a direct relationship between nocturia and depression, cognitive dysfunction, mood disturbances, falls, and fractures. For this reason, it is important to treat nocturia both to increase quality of life and to decrease related complications. Treatment opportunities have been under investigation for 20 years. Most of the studies in the literature have reported the results of single-drug medication on nocturia, which may be insufficient for a situation that has such a multifactorial etiology. In this review, we evaluated the success of different treatment combinations on nocturia.
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Affiliation(s)
- Cenk Murat Yazici
- Department of Urology, Namik Kemal University School of Medicine, Tekirdag, Turkey
| | - Omer Kurt
- Department of Urology, Namik Kemal University School of Medicine, Tekirdag, Turkey
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Wolin KY, Grubb RL, Pakpahan R, Ragard L, Mabie J, Andriole GL, Sutcliffe S. Physical activity and benign prostatic hyperplasia-related outcomes and nocturia. Med Sci Sports Exerc 2015; 47:581-92. [PMID: 25010403 PMCID: PMC4342314 DOI: 10.1249/mss.0000000000000444] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH) and its associated lower urinary tract symptoms (LUTS), including nocturia, are extremely common among middle- and older-age American men. Although studies on physical activity (PA) and prevalent BPH-related outcomes suggest that PA may protect against the development of this common condition, only a few studies have examined the relation between PA and incident BPH-related outcomes and LUTS with mixed findings. In addition, although nocturia is the most commonly reported and most bothersome LUTS in men with or without evidence of BPH, few studies have examined the association of PA and nocturia independent of BPH. The purpose of this analysis was to examine the association of PA with BPH-related outcomes and nocturia in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening trial. METHODS We examined this association with both prevalent (n = 28,404) and incident (n = 4710) BPH-related outcomes (measured by self-report of physician diagnosis, BPH surgery, finasteride use, and clinical indicators) and nocturia. Poisson regression with robust variance was used to calculate prevalence ratios and relative risks. RESULTS PA was weakly positively associated with several prevalent BPH-related outcomes and was strongly inversely associated with prevalent nocturia. In incident analyses, PA was only associated with nocturia. Men who were active ≥1 h·wk(-1) were 13% less likely (95% confidence interval, 2%-22%) to report nocturia and 34% less likely (95% confidence interval, 15%-49%) to report severe nocturia as compared with men who reported no PA. The associations were similar for men with and without additional BPH-related outcomes, except for prevalent nocturia, where the association was stronger for men without other BPH-related outcomes. CONCLUSIONS Combined with other management strategies, PA may provide a strategy for the management of BPH-related outcomes, particularly nocturia.
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Affiliation(s)
- Kathleen Y Wolin
- 1Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL; 2Department of Surgery and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO; 3Westat, Rockville, MD; and 4Information Management Services, Inc., Rockville, MD
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Fujimura T, Yamada Y, Sugihara T, Azuma T, Suzuki M, Fukuhara H, Nakagawa T, Kume H, Igawa Y, Homma Y. Nocturia in men is a chaotic condition dominated by nocturnal polyuria. Int J Urol 2015; 22:496-501. [PMID: 25631284 DOI: 10.1111/iju.12710] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 12/12/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To characterize nocturia in men based on frequency volume chart data and symptom profiles assessed using the Core Lower Urinary Tract Symptom Score and Athens Insomnia Scale questionnaires. METHODS The Core Lower Urinary Tract Symptom Score and Athens Insomnia Scale questionnaires were administered to 299 consecutive treatment naïve men with nocturia (≥one time per night). Frequency volume chart data were recorded for 2 days. Correlations between nocturia and clinical characteristics including symptom scores, clinical diagnosis, Charlson Comorbidity Index, estimated glomerular filtration rate, uroflowmetry and prostate volume were analyzed. RESULTS Patients were divided into five groups: one time (n = 36), two times (n = 65), three times (n = 85), four times (n = 78) and five times (n = 34) of nocturia. Age, prevalence or severity of chronic kidney disease, hyperlipidemia, low bladder capacity, nocturnal polyuria, urgency, bladder pain and sleep disorders were significantly correlated with the severity of nocturia. The Spearman correlation analysis identified eight possible independent factors for nocturia: age, estimated glomerular filtration rate, urgency, bladder pain, sleep quality, sleepiness during the day, average voided volume and nocturnal volume divided by body weight. Logistic regression analysis showed that nocturnal volume divided by body weight was the strongest factor of nocturia, and ≥7, 9 and 9.7 mL/kg were practical cut-off values of three, four and five times per night of nocturia, respectively. CONCLUSIONS Nocturia in men is a chaotic condition dominated by nocturnal polyuria, and related to multiple factors including age, renal function, urgency, bladder pain, insomnia and bladder volume.
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Affiliation(s)
- Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Effect of combined systematized behavioral modification education program with desmopressin in patients with nocturia: a prospective, multicenter, randomized, and parallel study. Int Neurourol J 2014; 18:213-20. [PMID: 25558419 PMCID: PMC4280441 DOI: 10.5213/inj.2014.18.4.213] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 12/13/2014] [Indexed: 11/28/2022] Open
Abstract
Purpose The aims of this study were to investigate the efficacy of combining the systematized behavioral modification program (SBMP) with desmopressin therapy and to compare this with desmopressin monotherapy in the treatment of nocturnal polyuria (NPU). Methods Patients were randomized at 8 centers to receive desmopressin monotherapy (group A) or combination therapy, comprising desmopressin and the SBMP (group B). Nocturia was defined as an average of 2 or more nightly voids. The primary endpoint was a change in the mean number of nocturnal voids from baseline during the 3-month treatment period. The secondary endpoints were changes in the bladder diary parameters and questionnaires scores, and improvements in self-perception for nocturia. Results A total of 200 patients were screened and 76 were excluded from the study, because they failed the screening process. A total of 124 patients were randomized to receive treatment, with group A comprising 68 patients and group B comprising 56 patients. The patients' characteristics were similar between the groups. Nocturnal voids showed a greater decline in group B (-1.5) compared with group A (-1.2), a difference that was not statistically significant. Significant differences were observed between groups A and B with respect to the NPU index (0.37 vs. 0.29, P=0.028), the change in the maximal bladder capacity (-41.3 mL vs. 13.3 mL, P<0.001), and the rate of patients lost to follow up (10.3% [7/68] vs. 0% [0/56], P=0.016). Self-perception for nocturia significantly improved in both groups. Conclusions Combination treatment did not have any additional benefits in relation to reducing nocturnal voids in patients with NPU; however, combination therapy is helpful because it increases the maximal bladder capacity and decreases the NPI. Furthermore, combination therapy increased the persistence of desmopressin in patients with NPU.
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Nocturia in the Elderly. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0262-7] [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]
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Castro RA, Arruda RM, Bortolini MAT. Female urinary incontinence: effective treatment strategies. Climacteric 2014; 18:135-41. [PMID: 25307986 DOI: 10.3109/13697137.2014.947257] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Urinary incontinence is a dysfunction that tremendously affects women's quality of life, involving social, emotional and economic aspects. Although various treatments for urinary incontinence have been described, it is important to know which of them are truly effective. This review seeks to determine the current available therapies for women with stress urinary incontinence and overactive bladder syndrome, based on the best scientific evidence.
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Affiliation(s)
- R A Castro
- Sector of Urogynecology and Pelvic Floor Surgery, Department of Gynecology, Federal University of São Paulo , Brazil
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Abstract
Benign prostatic hyperplasia (BPH) is a highly prevalent and costly condition that affects older men worldwide. Many affected men develop lower urinary tract symptoms, which can have a negative impact on their quality of life. In the past, transurethral resection of the prostate (TURP) was the mainstay of treatment. However, several efficacious drug treatments have been developed, which have transformed BPH from an acute surgical entity to a chronic medical condition. Specifically, multiple clinical trials have shown that α adrenoceptor antagonists can significantly ameliorate lower urinary tract symptoms. Moreover, 5α reductase inhibitors, alone or combined with an α adrenoceptor antagonist, can reverse the natural course of BPH, reducing the risk of urinary retention and the need for surgical intervention. Newer medical regimens including the use of antimuscarinic agents or phosphodiesterase type 5 inhibitors, have shown promise in men with predominantly storage symptoms and concomitant erectile dysfunction, respectively. For men who do not adequately respond to conservative measures or pharmacotherapy, minimally invasive surgical techniques (such as transurethral needle ablation, microwave thermotherapy, and prostatic urethral lift) may be of benefit, although they lack the durability of TURP. A variety of laser procedures have also been introduced, whose improved hemostatic properties abrogate many of the complications associated with traditional surgery.
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Affiliation(s)
- John M Hollingsworth
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA Center for Healthcare Outcomes and Policy, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Timothy J Wilt
- Minneapolis VA Center for Chronic Diseases Outcomes Research, Minneapolis, MN 55417, USA University of Minnesota School of Medicine, Minneapolis, MN, USA
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Tyagi S, Resnick NM, Perera S, Monk TH, Hall MH, Buysse DJ. Behavioral treatment of chronic insomnia in older adults: does nocturia matter? Sleep 2014; 37:681-7. [PMID: 24899759 DOI: 10.5665/sleep.3568] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate the impact of nocturia on the therapeutic response of chronic insomnia to behavioral treatment in older adults. METHODS Secondary analysis of a randomized clinical trial designed to assess the efficacy of brief behavioral treatment of insomnia (BBTI) vs. an information-only control (IC) in 79 community-dwelling older adults with chronic insomnia. For the current analysis, participants were stratified into 2 groups: those with self-reported nocturia at baseline i.e., ≥ 1 void/night (N = 30; 16 IC, 14 BBTI) and those without nocturia (N = 49; 24 IC, 25 BBTI). We then determined the impact of BBTI on sleep, sleep quality, and nocturia as assessed by self-report, actigraphy, and polysomnography. RESULTS Individuals without baseline nocturia responded well to BBTI with significant decrease in sleep latency, wake after sleep onset, and total sleep time assessed by sleep diary and actigraphy; these changes were significantly greater than those in the IC group. In comparison, changes in the same sleep parameters among participants with nocturia were not significantly different from the IC control. Although BBTI showed significant improvement in sleep quality in groups with and without nocturia (as assessed by PSQI and sleep diary), the effect size of these improvements was larger in those without nocturia than in those with nocturia (PSQI d = 0.82 vs. 0.53, diary sleep quality d = 0.83 vs. 0.51). CONCLUSIONS These secondary analyses suggest that brief behavioral treatment of insomnia may be more efficacious in improving insomnia in participants without nocturia. Addressing nocturia may improve the efficacy of behavioral insomnia treatment.
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Affiliation(s)
- Shachi Tyagi
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine University of Pittsburgh, Pittsburgh, PA
| | - Neil M Resnick
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine University of Pittsburgh, Pittsburgh, PA
| | - Subashan Perera
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine University of Pittsburgh, Pittsburgh, PA
| | - Timothy H Monk
- Sleep & Chronobiology Center, Western Psychiatric Institute & Clinic, University of Pittsburgh, Pittsburgh, PA
| | - Martica H Hall
- Sleep & Chronobiology Center, Western Psychiatric Institute & Clinic, University of Pittsburgh, Pittsburgh, PA
| | - Daniel J Buysse
- Sleep & Chronobiology Center, Western Psychiatric Institute & Clinic, University of Pittsburgh, Pittsburgh, PA
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Peyronnet B, Pradère B, Bruyère F. Prise en charge de la nycturie : une entité nosologique au sein des troubles mictionnels de l’homme. Prog Urol 2014; 24:80-6. [DOI: 10.1016/j.purol.2013.08.310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 06/24/2013] [Accepted: 08/01/2013] [Indexed: 11/24/2022]
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Tani M, Hirayama A, Torimoto K, Matsushita C, Yamada A, Fujimoto K. Guidance on water intake effectively improves urinary frequency in patients with nocturia. Int J Urol 2014; 21:595-600. [PMID: 24405404 DOI: 10.1111/iju.12387] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 11/25/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate how guidance on water-intake impacts the degree of nocturia. METHODS A total of 67 male patients were enrolled in the present study. Patients were asked to adjust their water and food intakes so that their 24-h urine production/bodyweight would be equal or lower than 30 mL/kg. One month after the treatment, the therapeutic gain from and adverse effects of fluid restriction were examined by comparing the pretreatment and post-treatment value of various parameters. RESULTS Overall, 65 eligible patients were evaluated. In 44 patients (67%), the frequency of nocturia was improved to one or more times. The change in frequency of nocturia showed a positive correlation with the change in nocturnal urine volume. The change in nocturnal urine volume showed a positive correlation with the changes in 24-h urine production/bodyweight, 24-h drinking volume and daytime drinking volume. The changes in 24-h urine production/bodyweight and daytime drinking volume were independent factors influencing therapeutic effect. None of the participants reported any adverse event. CONCLUSIONS In patients with a 24-h urine production/bodyweight equal or higher than 30 mL/kg, guidance on water intake might be considered effective and safe as a lifestyle therapy. Water restriction should be carried out not only in the evening, but also during daytime.
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Affiliation(s)
- Mitsuru Tani
- Department of Urology, Nara Medical University School of Medicine, Nara, Japan
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Tyagi S, Resnick NM, Perera S, Monk TH, Hall MH, Buysse DJ. Behavioral treatment of insomnia: also effective for nocturia. J Am Geriatr Soc 2014; 62:54-60. [PMID: 24383406 PMCID: PMC4055528 DOI: 10.1111/jgs.12609] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To evaluate changes in self-reported nocturia in community-dwelling adults aged 60 and older who received behavioral treatment for chronic insomnia. DESIGN Secondary analysis of a randomized controlled trial of a behavioral intervention for sleep. SETTING Academic medical center. PARTICIPANTS Of the 79 enrollees, this analysis focused on 30 who, in addition to insomnia, also reported at least one nightly episode of waking up to void. INTERVENTION The brief behavioral treatment of insomnia (BBTI) group (n = 14) received instructions on reducing time in bed and setting a regular sleep schedule. The information control (IC) group (n = 16) received printed materials. A nurse clinician delivered both interventions. MEASUREMENTS Self-reported nocturnal awakenings to void assessed daily for 14 days at baseline and 4 weeks after the intervention. Participants who reported at least one episode of nocturia per night at baseline were included in this analysis. RESULTS In individuals with nocturia at baseline, the total number of nocturnal voids over the 14-day assessment period decreased by 6.5 ± 4.8 in the BBTI group and increased by 1.3 ± 7.3 in the IC group (P = .04, effect size 0.82). After adjusting for baseline nocturia episodes, the difference remained significant (P = .05). CONCLUSION In older adults with concurrent insomnia and nocturia, behavioral treatment directed solely at insomnia may also improve self-reported nocturia. Behavioral treatment of insomnia should be further investigated for its effect on nocturia in individuals with concurrent insomnia and nocturia.
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Affiliation(s)
- Shachi Tyagi
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine University of Pittsburgh
| | - Neil M Resnick
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine University of Pittsburgh
| | - Subashan Perera
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine University of Pittsburgh
| | - Timothy H Monk
- Sleep & Chronobiology Center, Western Psychiatric Institute & Clinic, University of Pittsburgh
| | - Martica H Hall
- Sleep & Chronobiology Center, Western Psychiatric Institute & Clinic, University of Pittsburgh
| | - Daniel J Buysse
- Sleep & Chronobiology Center, Western Psychiatric Institute & Clinic, University of Pittsburgh
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Comparison of nocturia response to desmopressin treatment between patients with normal and high nocturnal bladder capacity index. ScientificWorldJournal 2013; 2013:878564. [PMID: 24223034 PMCID: PMC3816078 DOI: 10.1155/2013/878564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 09/19/2013] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To compare efficacy of desmopressin for treatment of nocturia between patients with normal and high nocturnal bladder capacity index (NBCi). METHODS Retrospective analysis of adult patients treated with desmopressin for nocturia. Patients were analyzed according to high or normal NBCi value before treatment. RESULTS 55 patients were identified, aged 49-84, 47 males, 8 females, who started desmopressin 0.2 mg nocte between 2009 and 2011. Two groups (N: normal and H: high NBCi) were similar regarding number, gender, age, 24 h urine volume, and nocturnal urine volume. On treatment, nocturnal volume decreased by mean of 364 mL. Number of nightly voids decreased in N group from 3.11 to 1.50, in H from 3.96 to 1.44. Nocturnal polyuria and nocturia indices also decreased significantly. NBCi remained the same in N group (0.56 on therapy) and in H group decreased to mean 0.63. All on-treatment values were statistically similar in N and H groups. Pretreatment differences were abolished with treatment. NBCi was significantly correlated to nocturia reduction-larger reduction was observed in patients with higher NBCi. In 8/55 patients, hyponatremia was detected, but without clinical consequences. CONCLUSIONS The results indicate that the effectiveness of desmopressin on nocturia is not dependent upon the patient's pretreatment NBCi.
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Chronobiology of Micturition: Putative Role of the Circadian Clock. J Urol 2013; 190:843-9. [DOI: 10.1016/j.juro.2013.02.024] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2013] [Indexed: 12/13/2022]
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Weiss JP, Blaivas JG, Blanker MH, Bliwise DL, Dmochowski RR, Drake M, DuBeau CE, Hijaz A, Rosen RC, Van Kerrebroeck PEV, Wein AJ. The New England Research Institutes, Inc. (NERI) Nocturia Advisory Conference 2012: focus on outcomes of therapy. BJU Int 2013; 111:700-16. [PMID: 23360086 DOI: 10.1111/j.1464-410x.2012.11749.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A consensus statement published in 2011 summarised current research, clinical approaches, and treatment options for nocturia. Since that time, new research has refined our understanding of nocturia in clinically important ways and new evidence has been presented on the efficacy and outcomes of several treatment methods for this underreported, infrequently recognised, and undertreated problem in adults. This paper provides updated guidance to clinicians in light of recent advances in the field.
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Affiliation(s)
- Jeffrey P Weiss
- Department of Urology, SUNY Downstate College of Medicine, Brooklyn, NY 11203, USA.
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Harel M, Weiss JP. Evaluation and Management of Nocturia in Older Men. CURRENT BLADDER DYSFUNCTION REPORTS 2011. [DOI: 10.1007/s11884-011-0105-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Cho SY, Lee SL, Kim IS, Koo DH, Kim HJ, Oh SJ. Short-term effects of systematized behavioral modification program for nocturia: A prospective study. Neurourol Urodyn 2011; 31:64-8. [DOI: 10.1002/nau.21186] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 06/16/2011] [Indexed: 11/11/2022]
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Gungor I, Beji NK. Lifestyle changes for the prevention and management of lower urinary tract symptoms in women. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2011. [DOI: 10.1111/j.1749-771x.2011.01112.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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