Evaluation and management of patients with nocturia

Association between Nocturnal Frequency and Erectile Function in Eugonadal Men with Benign Prostatic Obstruction: A Cross Sectional Study

Purpose

We aimed to evaluate the association between nocturnal frequency and erectile dysfunction in patients with benign prostatic obstruction.

Materials and Methods

To evaluate the association, we simultaneous evaluated urodynamic study, prostate ultrasound, nocturnal tumescence test (nocturnal penile tumescence) for sleep-related erection (SRE) and two questionnaires, international prostate symptom score (IPSS) and 5-item version of the international index of erectile function (IIEF-5). Patients with hypogonadism or nocturnal polyuria were excluded.

Results

Forty-six patients were registered over 4 years. The mean age, prostate size, IPSS score, and IIEF-5 score were 67.65±5.51 years, 65.10±22.12 mL, 24.67±7.89, and 9.50±7.01, respectively. Among the IPSS subscores, nocturia was most significantly related to the total IIEF-5 score (p<0.001). More severe nocturia was associated with less frequent SRE (p=0.003) and shorter total duration of SRE (p=0.002), which in turn elucidated that nocturia was significantly related to the total amount of rigidity signals (rigidity activity unit, RAU) or tumescence signals (tumescence activity unit, TAU). Among objective urodynamic parameters, bladder compliance also correlated to RAU and TAU. Individual subjective erectile function (IIEF-5) was significantly related to both RAU and TAU.

Conclusions

Sleep fragmentation due to benign prostate obstruction related nocturnal frequency caused by reduced bladder compliance could decrease the frequency and duration of SRE, which decreases the total amount of SRE and reflects the patient's relevant erectile function.

Management of nocturia in the female

Nocturia is a common but overlooked lower urinary tract symptom that substantially reduces patient health and quality of life. Though traditionally viewed as occurring predominantly in males, nocturia has been found to be equally as prevalent in females. The recent emphasis on the importance of nocturia has resulted in a surge of research studies, providing a foundation for current and future management decisions. In this review, we describe the current recommendations for the female patient in light of the most recently published studies, including a unique interest in predicting treatment response.

Medication adherence in the management of nocturia: challenges and solutions

OBJECTIVE

Nocturia affects millions of men and women. No prior reviews or meta-analyses have explored the issue of adherence in nocturia patients. The objective of our study was to examine the attributes and their interaction that might impact pharmacological adherence in nocturia care using a conceptual model of adherence.

MATERIALS AND METHODS

A literature search of the Medline, PubMed, Embase, PsycInfo, and CINAHL databases for studies published between January 1990 and June 2014 was conducted. We developed a conceptual model in order to facilitate our review.

RESULTS

Currently, multiple treatment options for nocturia exist, depending on the underlying cause. Adherence to nocturia treatment and outcomes are complex and intertwined, and nonadherence to nocturia treatment is common. In 15 studies meeting eligibility criteria, behavioral and pharmacologic interventions for nocturia were associated with reduced nocturia symptoms. Urinary symptoms that are associated with nocturia need individualized management depending on renal and hepatic function, medical comorbidities, and ongoing medication use in a patient. Another important factor related to adherence is the bother. Although nocturia is defined as nighttime-voiding frequency of one or more, not all persons may find this bothersome. The degree of bother is subjective, and may change from person to person. However, there is no information related to the association between bother and adherence to medication or behavioral treatments for nocturia. Medication dosing convenience, preference, and cost play important roles in adherence. We present a patient-centered conceptual model that brings together the various dimensions of medication adherence for nocturia.

CONCLUSION

Few studies have explored adherence to medication and related factors in the care of nocturia. Our conceptual model can aid development of interventions to improve adherence to nocturia medications.