Prise en charge de la nycturie : une entité nosologique au sein des troubles mictionnels de l’homme

Nocturia: its characteristics, diagnostic algorithm and treatment

Nocturia is the complaint that an individual has to wake up at night one or more times to urinate. It is a frequent condition among older adults and entails detrimental effects with regard to sleeping, sexual activity, comfort, depression, mental function and vitality. It is clinically important to distinguish it from global polyuria, defined as a urinary rate ≥ 125 ml/h (3000 ml/day), as well as from nocturnal polyuria, which is an abnormally large volume of urine during sleep associated with a decreased daytime urine production. A Frequency Volume Chart (FVC), overnight water deprivation test with renal concentrating capacity test, and the nocturnal bladder capacity index are some of the methods that help establish the underlying pathology of this condition and hence define an adequate treatment plan.

[The urethra of Napoleon, a conduit towards the end of the Empire?]

INTRODUCTION

Napoleon died of a cancer of the stomach. Another assumption can be proposed, that of an uronéphrologique pathology.

MATERIAL AND METHOD

It is about a historical study basing on the report of autopsy of Antommarchi and the assumptions formulated according to the urinary and nephrologic symptoms presented during his life.

RESULTS

Napoleon presented signs of nephropathy in a probable context of metabolic syndrome and many signs of dysurie early on probable stricture of the urethra related to the intensive practice of horse.

CONCLUSION

The urethra of Napoleon led France of the empire to the republic.

[Algorithms and urinary incontinence in the elderly. Assessment, treatment, recommendations and levels of evidence. Review]

OBJECTIVES

Search processing algorithms in a primary care setting, analyzing the specifics of care management for seniors suffering from urinary incontinence (UI), described the recommendations and levels of evidence of treatment.

METHODS

A literature review carried out via PubMed^® and websites of scientific societies with search keywords classified according to an algorithm.

RESULTS

One hundred algorithms have been discovered in the field of evaluation and treatment of UI. Screening for UI risk factors began early on in the treatment of reversible or chronic comorbidities, avoiding iatrogenic. Specific clinical features (red flags) required specialized advice. Non-pharmacological conservative treatment should be offered first in line for seniors: behavioral therapy, changes in lifestyle, walk, treatment of constipation. For women, pelvic floor muscle training combined biofeedback and functional electrical stimulation. After failure and persistence of UI with urgency, the information of the risk of a possible urinary retention or cognitive impairments preceded the prescription of an anticholinergic and the measurement of post-voiding residue done by ultrasounds. Older age is not a cons-indication for surgery UI least invasive. The cough test and Bonney maneuver can confirm a masked stress urinary incontinence and/or an associated prolapse. Cases of failure of UI, doubtful diagnosis or programmed surgery required urodynamic assessment.

CONCLUSION

Algorithms and recommendations of UI should remain a valuable aid to the clinical assessment, diagnosis and treatment of UI in the elderly.