VOIDING FREQUENCY IN A SAMPLE OF ASYMPTOMATIC AMERICAN MEN

Impact of acetic acid addition on nitrogen speciation and bacterial communities during urine collection and storage

The rate of urea hydrolysis in nonwater urinals is influenced by the volume of urination events and the frequency of urinal use. Inhibition of urea hydrolysis with acetic acid addition has been demonstrated at the laboratory scale but it was not able to fully represent the conditions of a real restroom with real urine collection. The goal of this study was to understand the effects of acid addition for control of urea hydrolysis on nutrient concentrations and bacterial communities in human urine during collection and storage. Three control logics were used to determine the schedule of acid addition: (i) acid addition after every urination event, (ii) acid addition during periods of high building occupancy, and (iii) acid addition during periods of low building occupancy. Wifi logins were used to approximate building occupancy and to create the control logics used in the study. All three control logics were able to inhibit urea hydrolysis. The bacterial communities were identified to determine the impact of acid addition on the community structure. The collection of urine by nonwater urinals alone did not reduce the presence of enteric bacteria commonly found when collecting urine with urine-diverting toilets. Acid addition reduced the community diversity and created conditions for higher relative abundances of the order Enterobacteriales. Finally, results from stored acidified urine showed that urea hydrolysis inhibition is reversible and is influenced by the amount of acid added at the urinal. The amount of acid added can influence the rate of hydrolysis in the storage tanks and can be used to select for urea- or ammonia-nitrogen for nutrient recovery. This study is the first of its kind to inhibit urea hydrolysis in nonwater urinals in a real restroom with real urine, and is the first to identify the bacterial communities in urine collected solely with nonwater urinals.

Can 7 or 30-Day Recall Questions Capture Self-Reported Lower Urinary Tract Symptoms Accurately?

PURPOSE

Self-reported measurement tools often provide a recall period, eg "In the past 7 days…" For lower urinary tract symptoms the concordance of end of day (daily) reports with 7 and 30-day recalled reports is unknown to our knowledge. We evaluated how accurately 7 or 30-day recall questions capture lower urinary tract symptoms.

MATERIALS AND METHODS

The 261 female and 254 male participants were recruited from a total of 6 United States tertiary care sites. We evaluated 18 items representing 7 symptoms covering storage, voiding and post-micturition symptoms. Item responses on the daily forms were averaged for a 7 or a 30-day period and compared to the corresponding 7 or 30-day recall version of the item. Analyses were item and gender specific. Within person concordance was assessed using the Pearson correlation. Bias (systematic overreporting or underreporting) was calculated as the difference between the recalled item and the averaged daily item score, and reported as a percent of the item scale.

RESULTS

All correlations exceeded 0.60. Correlations between averaged daily reports and recalled reports ranged from 0.72 to 0.89 for 7 days and from 0.71 to 0.91 for 30 days among women, and from 0.68 to 0.90 and 0.68 to 0.95, respectively, among men. Most items did not show systematic bias and the median percent bias did not exceed 10% for any item. However, bias exceeding ±10% for some items was observed in a subset of individuals.

CONCLUSIONS

Recalled reports during the 7 and 30 days tracked well with averaged daily reports for men and women. Systematic bias was minimal, suggesting that 7 and 30-day recall periods for self-reported lower urinary tract symptoms are reasonable.

Increased urinary bladder volume improves the detectability of urinary stones at the ureterovesical junction in non-enhanced computed tomography (NECT)

OBJECTIVES

To evaluate the influence of the urinary bladder volume on the detectability of urolithiasis at the ureterovesical junction (UVJ) using a low-dose CT (LD-CT) with iterative reconstruction (IR) and a standard-dose CT (SD-CT) without IR in a large cohort.

METHODS

Four hundred patients (278 males (69.5%), mean 44.6 ± 14.7 years) with urolithiasis at the UVJ were investigated either by an LD-CT with IR (n = 289, 72%) or an SD-CT without IR (n = 111, 28%) protocol. The detectability of distal urolithiasis was assessed by a dichotomous assessment (definite or questionable) by two radiologists in consensus and by a quantitative analysis of the signal density distribution across a line drawn parallel to the distal ureter. Based on the resulting graph, minimum/maximum density values and mean/maximum upslopes and downslopes were derived and calculated automatically. In all patients, the total bladder volume was calculated by a slice-by-slice approach on axial CT images.

RESULTS

Patients with definite stones showed significantly higher urinary bladder volumes compared to patients with questionable stones in both LD-CT and SD-CT (p < 0.01). These results were independent of stones' length and patients' BMI values. Using cutoffs of 92 ml for LD-CT and 69 ml for SD-CT, high positive predictive values/accuracy rates of 96%/85% (LD-CT) and 98%/86% (SD-CT) were observed to identify definite urinary stones.

CONCLUSIONS

Urinary bladder volume has a significant impact on the detectability of distal urolithiasis. Moderate bladder filling by pre-CT hydration with subsequent CT scan at the time of high urge to void increases the detectability of urinary stones at the UVJ in clinical routine.

KEY POINTS

• Urinary bladder volume significantly affects the detectability of distal urolithiasis • Higher bladder volumes are associated with improved detectability of distal urinary stones • Oral pre-CT hydration for urolithiasis is easily applicable and cost-effective.

Voiding cystourethrography after prostatectomy: spectrum of appearances

PURPOSE

This article reviews current prostatectomy techniques and then techniques for fluoroscopic voiding cystourethrography (VCUG) evaluation of the prostate and bladder after prostatectomy. Both normal post-prostatectomy appearances and complications will be reviewed.

CONCLUSION

VCUG is a useful evaluation for both common and uncommon post-prostatectomy complications and appropriate interpretation of the VCUG complications is important to aid the urologist's clinical decision making.

A pilot study on the disinfection efficacy of localized UV on the flushing-generated spread of pathogens

The process of toilet-flushing can generate flushing-associated water droplets which can potentially expose humans to pathogen-laden aerosols. Very little is known about such aerosol dissemination or the means for minimizing exposure to these aerosols. This study has evaluated the efficacy of ultraviolet waveband C (UV-C) for disinfection of flushing-generated pathogen-laden aerosols through tests with localized disinfection systems for airborne and surface contaminations. Three types of bacteria were chosen for investigation: Staphylococcus epidermidis, Escherichia coli, and Salmonella typhimurium. Tests were conducted with UV-C tubes of 5 W and 10 W. High levels of disinfection efficacies were observed, ranging from 76% to 97% for bacteria-laden aerosols at sources of emission, and efficiencies of 53% to 79% for surface samples in localized systems. The results from the localized systems were further compared with those obtained with an upper-room ultraviolet germicidal irradiation (UVGI) system. As it is important to note, the UV-C doses and ozone emissions for the localized systems were found well below the limits recommended in current guidelines. This research has shown that the disinfection of flushing-generated pathogen-laden aerosols in proximity to the source of emission was more effective than at the more distant sites where aerosols may be dispersed to the environment.

Mimicking and Inhibiting Urea Hydrolysis in Nonwater Urinals

Nonwater urinals are critical in the implementation of building-scale water conservation and urine diversion systems. However, because of the composition of urine and the prevalence of the urease enzyme that hydrolyzes urea, minerals readily precipitate in nonwater urinals and pipes. This leads to clogging, malodor, and possible replacement of nonwater urinals with flush urinals. Accordingly, the goal of this research was to provide an improved understanding of the urea hydrolysis process in nonwater urinals to benefit water conservation and phosphate recovery efforts. Acetic acid addition was used in nonwater urinals to inhibit the urea hydrolysis reaction by lowering the pH, thereby making the precipitation of calcium- and magnesium-containing minerals less favorable. Of the acids tested, 2.5 mL of 2500 mequiv/L acetic acid added after every urination event was able to inhibit urea hydrolysis in synthetic urine and real urine as indicated by the pH and conductivity of the effluent urine. Acid addition also allowed for 43% more phosphate recovery via struvite precipitation in the acetic acid addition synthetic urine than the synthetic urine with no acid addition.

[Objective and subjective requirement of aids and appliances in patients with neurogenic lower urinary tract dysfunction : Multicenter study to determinate the daily necessity of urological aids and appliances]

BACKGROUND

The provision of urological appliances for patients with neurogenic lower urinary tract dysfunction (NLUTD) is essential. Hitherto existing standard guidelines for the estimation of monthly material requirements are based solely on estimates.

OBJECTIVE

The goal of this work was to define the objective and subsequently subjective requirements for urological appliances on a scientifically validated basis.

MATERIALS AND METHODS

Data concerning bladder management and daily consumption of urological appliances for patients with NLUTD were collected through a standardized survey at six different centers in Germany during the period of October to December 2014 and statistically evaluated.

RESULTS

In all, 767 patient records were analyzed: 543 men and 221 woman (N/A = 3). The daily disposable catheter consumption of 577 patients who exclusively used intermittent catheterization was 5.13. Patients who used other means of bladder emptying (n = 31) in addition to catheterization consumed on average 3.17 catheters. The margin of deviation was larger for children. Of the 608 patients with intermittent catheterization, 94 (15.5 %) required additional paddings as absorbent aids (on average 2.29 paddings per day), 34 patients (5.6 %) additionally used pants (2.55 per day) and 46 patients (7.6 %) utilized condom catheters (3.81 per day) between catheterization. Among all surveyed patients, 126 (16.4 %) used paddings (5.03 per day) and 51 patients (6.6 %) pants (3.03 per day). Of all male respondents 82 (15.1 %) used condom catheters (2.80 urinary sheaths per day).

CONCLUSION

Applying twice the standard deviation of the mean as a measure of assessing the objective requirement of urological appliances and aids for adult patients with NLUTD allows the following daily thresholds to be defined: 1-9 disposable catheters, 0-7 urinary sheaths, 1-9 paddings and 0-7 pants. These thresholds can serve as a basis for estimating the subjective need. They allow for a scientifically validated benchmark for an economically feasible and patient-tailored supply with urological aids and appliances. Individually required appliances and aids have to be recognized. Verifiable quality standards need to be developed.

Reliability of 24-h void frequency as an index of hydration status when euhydrated and hypohydrated

BACKGROUND/OBJECTIVES

Void frequency (VF) is significantly correlated to hydration status, but it is unknown whether VF is reliable when an individual is repeatedly euhydrated (EU) or hypohydrated (HY). The purpose of this study was to test the reliability of VF when individuals were EU or HY on multiple occasions.

SUBJECTS/METHODS

Fourteen males (age 22±2 years, mass 79.1±12.8 kg) completed three EU trials achieved with 24-h ad libitum fluid intake, and 14 males (age 22±2 years, mass 78.6±10.4 kg) completed three HY trials achieved with 24-h fluid restriction. Twenty-four hour urine was collected and analyzed for specific gravity (USG) and VF. Subjects voided at a 'normal urgency' (rated a '2' on a 0-4 perceptual scale) throughout each 24-h period.

RESULTS

Twenty-four hour USG was greater and VF was lower when HY (1.026±0.003 and 5±2, respectively) versus EU (1.014±0.003 and 7±2; both P<0.05). Intra-class correlations for VF between the three trials at each hydration status were deemed acceptable (0.863 and 0.849 for EU and HY, respectively). Within-subject coefficients of variation for VF were 15±9 and 21±14% for the EU and HY trials.

CONCLUSIONS

VF is a reliable index of 24-h hydration status when healthy young males are EU or HY and voiding at a consistent 'urgency'.

Men's preferences for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia: a discrete choice experiment

OBJECTIVE

To explore and quantify men's preferences and willingness to pay (WTP) for attributes of medications for lower urinary tract symptoms associated with benign prostatic hyperplasia using a discrete choice experiment.

SUBJECTS AND METHODS

Men in the UK aged ≥45 years with moderate-to-severe lower urinary tract symptoms/benign prostatic hyperplasia (based on self-reported International Prostate Symptom Score ≥8) were recruited. An online discrete choice experiment survey was administered. Eligible men were asked to consider different medication scenarios and select their preferred medication according to seven attributes: daytime and nighttime (nocturia) urinary frequency, urinary urgency, sexual and nonsexual side effects, number of tablets/day, and cost/month. A mixed-logit model was used to estimate preferences and WTP for medication attributes.

RESULTS

In all, 247 men completed the survey. Men were willing to trade-off symptom improvements and treatment side effects. Men preferred medications that reduced urinary urgency and reduced day- and nighttime urinary frequency. Men preferred medications without side effects (base-case level), but did not care about the number of tablets per day. WTP for symptomatic improvement was £25.33/month for reduced urgency (urge incontinence to mild urgency), and £6.65/month and £1.39/month for each unit reduction in night- and daytime urination frequency, respectively. The sexual and nonsexual side effects reduced WTP by up to £30.07/month. There was significant heterogeneity in preferences for most attributes, except for reduced urinary urgency from urge incontinence to mild urgency and no fluid during ejaculation (dry orgasm).

CONCLUSION

To compensate for side effects, a medicine for lower urinary tract symptoms/benign prostatic hyperplasia must provide a combination of benefits, such as reduced urgency of urination plus reduced nighttime and/or reduced daytime urination.

Diagnosis and surgical treatment of stress urinary incontinence

Stress urinary incontinence (SUI) is a major problem affecting more than 20% of the nation's female population, with increasing prevalence as our population continues to age. Incontinence places a great burden on individuals, and the economic effect is large. Stress urinary incontinence occurs when there is involuntary leakage of urine during coughing, laughing, sneezing, or physical activity. It can be diagnosed during physical examination and by using low-cost office diagnostics. Although nonsurgical treatments provide some benefit, surgical interventions have demonstrated superiority with respect to subjective and objective cure and better long-term improvement. Corrective surgeries for SUI can be grouped into four categories: 1) slings (midurethral slings and slings placed at the ureterovesical junction), 2) retropubic urethropexy, 3) urethral bulking agents, and 4) artificial sphincters. The success and failure of each approach needs to be assessed in the context of individual patients and their circumstances. Slings and retropubic urethropexy are considered first-line surgical options. Since the advent of minimally invasive retropubic midurethral slings such as the tension-free vaginal tape, transobturator tension-free vaginal tape, and single-incision sling, retropubic urethropexy have fallen out of favor. Warnings about mesh use may contribute to a resurgence of retropubic urethropexy procedures such as the Burch procedure. A Burch procedure should still be considered for patients who have an aversion to mesh or if they are undergoing concurrent abdominal approach surgery. Urethral bulking agents are usually reserved for patients with a fixed, nonmobile urethra who cannot tolerate an operative experience or have failed previous antiincontinence procedures. Artificial sphincters should be considered an operation of last resort.

Validation of voiding diary for stratification of bladder pain syndrome according to the presence/absence of cystoscopic abnormalities: a two-centre prospective study

OBJECTIVE

To assess the value of the voiding diary in the management of patients with bladder pain syndrome for predicting the presence or absence of cystoscopic abnormalities.

PATIENTS AND METHODS

From November 2009 to March 2011, 54 consecutive patients (39 women and 15 men) with bladder pain syndrome, as defined by the European Society for the Study of Interstitial Cystitis/Bladder Pain Syndrome (ESSIC) criteria, were prospectively enrolled in this two-centre study. All patients completed a home voiding diary on 3 consecutive days, which included analysis of voiding frequency, voided volume and severity of pre- and post-voiding pain. The variables were evaluated on a numeric pain scale (NPS). All patients then underwent standardized cystoscopy under anaesthesia. Patients were stratified into two groups: a group with or a group without cystoscopic abnormalities. Voiding diary variables were compared using Student's t-test.

RESULTS

Cystoscopic abnormalities were found in 33 patients. The group of patients with cystoscopic abnormalities had significantly more severe frequency (P = 0.034), especially nocturnal frequency (P = 0.009), a significantly lower mean voiding volume and lower sd from the mean (P = 0.011 and P = 0.014), and a significantly lower mean post-voiding NPS score (P = 0.039).

CONCLUSION

On analysis of the voiding diaries, we found that different patient profiles were associated with the cystoscopic appearance of the bladder. A clinical voiding score was proposed to predict the cystoscopic appearance of the bladder on the basis of the voiding diary in bladder pain syndrome but needs to be validated on an independent population.

Bladder health across the life course

Influences on bladder health begin during infancy and continue throughout the lifespan. Bladder anatomy and physiology change as individuals age, and the risk and propensity for bladder conditions, including lower urinary tract symptoms, throughout life are related to factors specific to age, sex, and life events. Bladder habits and dysfunctions at one stage of life may affect bladder health in subsequent stages. However, bladder problems are neither a normal part of aging nor inevitable at any stage of life. Many of the factors that negatively impact bladder health at all ages may be modifiable, and healthy bladder habits may prevent or reverse bladder dysfunctions that can occur naturally or in response to life events. There are opportunities to further define and promote healthy bladder habits through focused research and heightened public awareness of the importance of bladder health, which may lead to improvements in overall health and quality of life. It is our hope that this paper will inform and encourage public health initiatives and research programs aimed at this goal.

Estimation of internal exposure to uranium with uncertainty from urinalysis data using the InDEP computer code

The National Institute for Occupational Safety and Health (NIOSH) is currently studying mortality in a cohort of 6409 workers at a former uranium processing facility. As part of this study, over 220 000 urine samples were used to reconstruct organ doses due to internal exposure to uranium. Most of the available computational programs designed for analysis of bioassay data handle a single case at a time, and thus require a significant outlay of time and resources for the exposure assessment of a large cohort. NIOSH is currently supporting the development of a computer program, InDEP (Internal Dose Evaluation Program), to facilitate internal radiation exposure assessment as part of epidemiological studies of both uranium- and plutonium-exposed cohorts. A novel feature of InDEP is its batch processing capability which allows for the evaluation of multiple study subjects simultaneously. InDEP analyses bioassay data and derives intakes and organ doses with uncertainty estimates using least-squares regression techniques or using the Bayes' Theorem as applied to internal dosimetry (Bayesian method). This paper describes the application of the current version of InDEP to formulate assumptions about the characteristics of exposure at the study facility that were used in a detailed retrospective intake and organ dose assessment of the cohort.

A cutoff value based on analysis of a reference population decreases overestimation of the prevalence of nocturnal polyuria

PURPOSE

We sought criteria for nocturnal polyuria in asymptomatic, nonurological adults of all ages by reporting reference values of the ratio of daytime and nighttime urine volumes, and finding nocturia predictors.

MATERIALS AND METHODS

Data from a database of frequency-volume charts from a reference population of 894 nonurological, asymptomatic volunteers of all age groups were analyzed. The nocturnal polyuria index and the nocturia index were calculated and factors influencing these values were determined by multivariate analysis.

RESULTS

The nocturnal polyuria index had wide variation but a normal distribution with a mean ± SD of 30% ± 12%. The 95th percentile of the values was 53%. Above this cutoff a patient had nocturnal polyuria. This value contrasts with the International Continence Society definition of 33% but agrees with several other reports. On multivariate regression analysis with the nocturnal polyuria index as the dependent variable sleeping time, maximum voided volume and age were the covariates. However, the increase in the nocturnal polyuria index by age was small. Excluding polyuria and nocturia from analysis did not alter the results in a relevant way. The nocturnal voiding frequency depended on sleeping time and maximum voided volume but most of all on the nocturia index.

CONCLUSIONS

The prevalence of nocturnal polyuria is overestimated. We suggest a new cutoff value for the nocturnal polyuria index, that is nocturnal polyuria exists when the nocturnal polyuria index exceeds 53%. The nocturia index is the best predictor of nocturia.

A healthy bladder: a consensus statement

A panel of experts in urology, urogynecology, nursing, and behavioral therapy convened in 2010 to discuss the importance of a healthy bladder on overall health. They determined that a consensus statement was necessary to raise awareness among the general public, healthcare providers, payors, and policymakers, with the goals of minimizing the impact of poor bladder health and stimulating primary prevention of bladder conditions. In this statement, 'healthy' bladder function is described, as well as internal and external factors that influence bladder health. It is suggested that primary prevention strategies should be aimed at providing education regarding normal lower urinary tract structures and functioning to the public, including patients and healthcare providers. This education may promote the achievement of optimal bladder health by increasing healthy bladder habits and behaviors, awareness of risk factors, healthcare seeking, and clinician engagement and reducing stigma and other barriers to treatment. Promoting optimal bladder health may reduce the personal, societal and economic impact of bladder conditions, including anxiety and depression and costs associated with conditions or diseases and their treatment. While adopting healthy bladder habits and behaviors and behaviors may improve or maintain bladder health, it is important to recognize that certain symptoms may indicate the presence of conditions that require medical attention; many bladder conditions are treatable with a range of options for most bladder conditions. Lastly, the authors propose clinical directives based on persuasive and convergent research to improve and maintain bladder health. The authors hope that this statement will lead to promotion and achievement of optimal bladder health, which may improve overall health and help minimize the effects of bladder conditions on the public, healthcare professionals, educators, employers, and payors. The advisors are in consensus regarding the recommendations for improving and maintaining bladder health presented herein.

Bladder diary measurements in asymptomatic males: frequency, volume per void, and 24-hr volume

AIMS

To collect bladder diary frequency and volume measurements from asymptomatic males and to use these data to develop clinical reference values.

MATERIALS AND METHODS

Computer processed three-day bladder diaries were collected from 92 males (median age: 46.2 years; range: 20.6-84.6 years) defined as "asymptomatic" by questionnaire. Minimum (V(min)), maximum (V(max)), and average (V(avg)) volume per void (Vol/Void), 24-hr frequency (F(24)), and 24-hr volume (V(24)) were studied. Relationships of Vol/Void and F(24) to age and V(24) and of V(24) to age were investigated by regression analysis.

RESULTS

V(max) and V(avg) increased as V(24) increased and decreased with increasing age (P < 0.0005). We found no significant relationship between V(min) and age, but V(min) increased with increasing V(24) (P < 0.0005). F(24) increased with increasing V(24) and increasing age (P < 0.0005). We found a concave downward, curvilinear relationship between age and V(24), which, while it did not reach statistical significance, was very similar in shape to age versus V(24) relationships found by other studies of larger datasets.

CONCLUSIONS

Our results suggest that reference values of F(24) and Vol/Void should be adjusted for their relationships to the patient's age and V(24). Regression equations expressing these relationships can be used to make these adjustments. From frequency histograms of residuals the difference between the patient's actual and expected reference measurement can be ranked within the reference population as a percentile. We illustrate this method by using our results to calculate age- and V(24)-adjusted 5% "normal limit" tables of F(24), V(avg), and V(max).

Prevalence of nocturia in a Korean population aged 40 to 89 years

AIMS

The purpose of this study was to evaluate the prevalence of nocturia in Korea, to examine the relationship between nocturia and demographic variables, and to determine the impact of nocturia on daily living.

METHODS

A national telephone survey using quota sampling methods was conducted in Korea. The clinically validated computer-assisted telephone interview approach was used for the survey.

RESULTS

Of 2005 subjects (1,005 women and 1,000 men) interviewed, 33.5% reported voiding once per night and 48.2% twice or more per night. Nocturia increased with age among both genders and was more common among young women than young men. In all subjects, multivariate analysis indicated that female gender, older age and an overweight condition were independent risk factors. Body mass index was associated with an increased likelihood of nocturia in male but not in female subjects. In female subjects, the likelihood of at least one night-time void was related to delivery number (odds ratio 1.17, 95% confidence interval 1.04-1.32). An impact of nocturia on daily life was reported by 14.6% of subjects and only 3.8% (4.0% of men and 3.7% of women) sought medical care. Commonly reported reasons for not seeking medical care were the belief that nocturia is a normal consequence of aging or is not a disease (92.8% of subjects reporting an impact of nocturia on daily life).

CONCLUSIONS

Although nocturia is highly prevalent in the Korean population, it has only a minor impact on daily living, and few individuals seek medical care. Our study provides a valuable insight into the need for tailored nocturia education addressed to the population who view the condition as trivial.

Iodine nutrition: iodine content of iodized salt in the United States

Adequacy of iodine nutrition in the United States has lately been of concern. A major source of dietary iodine for the U.S. population is iodized salt. The U.S. Food and Drug Administration (USFDA) recommends 60-100 mg Kl/kg salt, equivalent to 46-76 mg l/kg salt. All U.S. iodized salt contains 45 mg l/kg according to labels. We collected samples of table salt from freshly opened containers from U.S. volunteers. A sample was sent to us when the can was first purchased. Subsets of volunteers sent further samples when the salt container became half-empty through normal use and a further final sample when the container was nearly finished. We also looked at iodine distribution homogeneity within individual containers, loss of iodine from salt upon exposure to humidity and sunlight, and upon short-term heating (dry and in solution) as may be encountered in cooking. Measurements were made in 0.01% w/v salt solutions by induction coupled plasma-mass spectrometry with 72Ge as an internal standard. The median and mean (+/-sd) I content in freshly opened top-of-the-can salt samples was 44.1 and 47.5 +/- 18.5 mg/kg (n=88, range 12.7-129 mg l/kg) and geometric mean and standard deviation of 44.70 and 1.41. Forty-seven of 88 samples fell below the USFDA recommended I content while 6 exceeded it. The homogeneity in a single can of salt varied greatly: in 5 samples taken from the same container from different depths, the iodine content varied by as little as 1.2x (8.3% coefficient of variance (CV)) to as much as 3.3x (49.3% CV) from one container/brand to another. Iodine is significantly lost upon high humidity storage but light or dry heat has little effect. There is much recent literature on iodine sufficiency and uptake inhibitors; there is also much misinformation and disinformation. We review the relevant literature and discuss our results with reference to the United States.

Voiding patterns in men and women with lower urinary tract symptoms combined with nocturia

AIM

We evaluated differences between men and women with lower urinary tract symptoms (LUTS) combined with nocturia.

METHODS

A total of 71 age-matched female-male pairs (median 58, range 20-81 years) who had moderate to severe LUTS and nocturia of more than once per night were enrolled in this study.

RESULTS

In the younger group (<50 years), the International Prostate Symptom Score (I-PSS) results of the sexes were not significantly different. However, although total I-PSS results in the elderly group (> or =50 years) were not significantly different, quality of life index scores for women were higher (P = 0.002). On frequency-volume (FV) charts, mean total daytime voided volume (DVV) was significantly higher in younger men than in younger women (P = 0.017), but the mean nocturnal polyuria index (NPi) for women was higher than that for men (P = 0.047). However, maximum DVV (P = 0.009), mean DVV (P < 0.0001), total DVV (P < 0.0001), and mean nocturnal urine volume (P = 0.009) were significantly higher in elderly men than in elderly women. However, numbers of daytime voids were not different.

CONCLUSION

Elderly women with LUTS have lower functional bladder capacities than elderly men, as suggested by their smaller mean voided volumes. However, no significant differences were observed between numbers of daytime voids, which was probably due to the smaller total daytime voided volumes of elderly women. In addition, although NPi for younger women and nocturnal urine volume for elderly men was higher, no other differences were observed in terms of other night-time parameters.

Current diagnosis of interstitial cystitis: an evolving paradigm

Our approaches to the diagnosis of interstitial cystitis (IC) are evolving as a result of recent advances in our knowledge of the disease. With increasing awareness of IC prevalence and presentation, clinicians are identifying cases of IC earlier in the disease process. A diagnosis of IC can now be established without applying each step of the traditional diagnostic paradigm, which was designed to identify "classic" cases of IC. In this article, we present an updated paradigm for the diagnosis of IC based on recent clinical data and consensus discussions conducted at the International Consultation on Interstitial Cystitis in Japan (ICICJ) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)/Interstitial Cystitis Association (ICA) research symposium in 2003. The diagnosis is established on the basis of a thorough physical examination and the patient's history of urgency/frequency and/or pain in the absence of bacterial infection or malignancy. Use of a symptom questionnaire to capture and record the presence of all IC symptoms is helpful in establishing the diagnosis. In this evolving paradigm, all other diagnostic measures are optional. Evidence-based medicine does not require the use of either cystoscopy or urodynamics in a workup for IC.

What Is a Clinician To Do—Believe the Patient or her Urinary Diary?

PURPOSE

We determined if patient recall of incontinence episodes correlates with urinary diary record.

MATERIALS AND METHODS

Women with 1 or more urge incontinence episode per week completed 2, 7-day diaries, the Urinary Distress Inventory and Incontinence Impact Questionnaire, and responded to 2 recall questions.

RESULTS

The median number of incontinence episodes participants recalled (6.5, 5) was higher than those recorded in the diary (1.9, 1.1) at both points. Incontinence episodes in 2, 7-day diaries correlated strongly (rho = 0.921, p <0.005) while participant recall of incontinence episodes correlated weakly (rho = 0.309, p <0.059). When subjects reported being only slightly or not bothered by urge incontinence, recall and diary record correlated strongly (rho = 0.812, p = 0.014). With increasing bother (moderate or great), recall and diary were not significantly correlated (rho = 0.528, p = 0.115).

CONCLUSIONS

Women with urge incontinence either overestimate or under record incontinence episode frequency in the urinary diary. This effect is more pronounced in women who are more bothered by incontinence.

What is the value of cystoscopy with hydrodistension for interstitial cystitis?

OBJECTIVES

To determine the utility of cystoscopy with hydrodistension for the diagnosis and therapy of interstitial cystitis. Cystoscopy with hydrodistension is the most commonly performed diagnostic test and procedure in patients with interstitial cystitis.

METHODS

Eighty-four consecutive patients with interstitial cystitis (68 women and 16 men) were studied retrospectively. The patients underwent history and physical examination, urinalysis, and urine culture and filled in a voiding diary and pain urgency frequency questionnaire. Cystoscopy with hydrodistension was performed in 47 patients. Patients who had and had not undergone hydrodistension were compared. Patients who underwent hydrodistension were characterized and followed up for response.

RESULTS

The mean patient age was 41 years, mean daily voided volume was 98 mL, mean number of nocturnal episodes was 3, and pain urgency frequency score was 21. Comparing patients undergoing versus not undergoing hydrodistension, pain was reported in 61% versus 25% (P = 0.03), vaginal pain in 62% versus 32% (P = 0.02), and dyspareunia or ejaculatory pain in 67% versus 29% (P < 0.01), respectively. All other parameters were statistically similar. Of the patients undergoing hydrodistension, 43 had follow-up and 24 (56%) reported improvement (mean duration of 2 months). Of the patients with and without improvement, no difference was found in mean age (40 versus 46 years, P = 0.20), duration of symptoms (7 versus 7 years, P = 0.92), anesthetic capacity (722 versus 721 mL, P = 0.99), or glomerulation grade (P = 0.61), respectively.

CONCLUSIONS

Cystoscopy with hydrodistension provided little useful information above and beyond the history and physical examination findings. As therapy, 56% of patients reported improvement, but the duration was short lived.

How do urinary diaries of women with an overactive bladder differ from those of asymptomatic controls?

OBJECTIVE

To quantify clinically important differences in common diary variables between asymptomatic controls and women with symptoms of overactive bladder (OAB), controlling for the effects of age and race.

PATIENTS, SUBJECTS AND METHODS

The 24-h urinary diaries of 49 women with symptoms of OAB were compared to those of age- and race-matched asymptomatic controls. Control subjects did not have a physical examination.

RESULTS

The 49 patients with OAB symptoms had a median (range) age of 51 (20-85) years, a body mass index of 25 (17-46) kg/m(2) and a parity of 2 (0-5). The median number of voids was significantly greater in women with OAB than asymptomatic controls (P < 0.001). The median value for mean voided volume was significantly lower in women with OAB than asymptomatic controls (P = 0.014). There was no difference in the maximum voided volume, total voided volume, daytime or night-time diuresis rates, voids per litre intake, or total fluid intake.

CONCLUSIONS

This preliminary study suggests that a median reduction of three voids/24 h and an increase of 70 mL in the mean voided volume might be clinically important goals in therapeutic trials for treating OAB symptoms. This remains to be confirmed by further studies linking improvements in quality of life and the overall impression of bladder health with these quantitative diary variable changes.

International Prostate Symptom Scores in young asymptomatic American men

OBJECTIVE

To establish 'normal' ranges of responses to the International Prostate Symptom Score (IPSS) questionnaire from a sample of young, asymptomatic men, as the IPSS is useful both clinically and in research studies, but there are little or no data on the normal ranges of the IPSS.

SUBJECTS AND METHODS

During a previously conducted study of 284 ambulatory men who considered themselves to have normal urinary function, asymptomatic men completed a 24-h urinary diary and the IPSS questionnaire. Diary variables and the IPSS were analysed using nonparametric Kruskal-Wallis and Spearman's tests.

RESULTS

The IPSS was recorded for 243 men aged < 50 years; 153 (63%) were Caucasian, 67 (28%) African-American, 11 (5%) Hispanic and 11 (5%) Asian. Although all men denied lower urinary tract symptoms during study screening, the total IPSS increased with age. Of men aged 18-29 years, 2% reported 'moderate' symptoms (IPSS > 7) compared to 12% of men aged 40-49 years (P = 0.002). No subject reported 'severe' symptoms (IPSS > 19). When responses to individual IPSS questions were analysed, all item scores except frequency (question 2) and hesitancy (question 6) increased with age. Nocturia (question 7) was often reported, and 11% of men aged 18-29 and 31% of men aged 40-49 years reported two or more nightly voids.

CONCLUSIONS

In this study, the consistently increasing positive IPSS with ageing in almost all symptom categories suggests underlying changes in urinary habits even in this asymptomatic group. Studies of normal urinary habits remain critically important to understanding normal and abnormal function, both for the design of research studies and for counselling patients.

GENDER DIFFERENCES IN 24-HOUR URINARY DIARIES OF ASYMPTOMATIC NORTH AMERICAN ADULTS

PURPOSE

Two previously published studies from our center have described the urinary habits of asymptomatic men (284) and women (300) as revealed by 24-hour urinary diaries. Those gender specific studies found that urinary diary variables are affected by age and race. By comparing the data from those studies we determined the effect of gender on voiding habits.

MATERIALS AND METHODS

In this secondary analysis we matched each female urinary diary to that of a male of similar age and race. Diary variables were compared using paired sign tests with results considered significant at the 5% level.

RESULTS

A total of 141 matched pairs were studied. The population age ranged from 18 to 68 years and was racially diverse (56% black, 31% white, 7% Hispanic and 6% Asian). Men had higher total fluid intake and mean voided volume than women (p <0.001 and 0.04, respectively). Women voided more frequently than men (p = 0.006) and had more voids per liter of fluid intake (p <0.001). No gender differences were found for body mass index, nighttime or daytime diuresis rates, total urine volume, maximum voided volume or rates of nocturia.

CONCLUSIONS

This analysis suggests that there are significant gender effects on 24-hour diary variables, with females tending to void more often and at lower mean volumes. The results of our study may be useful in the design of research studies or for patient counseling.