Nocturia: morbidity and management in adults

Identifying men with global polyuria on a nocturnal-only voiding diary

AIMS

Nocturnal polyuria (NP) and global polyuria (GP) are not mutually exclusive. However, by rate, the common criteria for GP (40 mL/kg/24 hours [117 mL/kg/hour in a 70-kg individual] or 3000 mL/24 hours [125 mL/h]) are more stringent than those for NP (90 mL/hour during the sleep period or NP index [NPi; nocturnal volume/24-hour volume] > 0.33 [no minimum rate]). It remains unclear whether total nocturnal urine volume (NUV) may reliably delineate between NP patients with and without comorbid GP.

METHODS

A clinical database of men with lower urinary tract symptoms was searched for voiding diaries completed by patients reporting greater than or equal to 1 nocturnal void(s). Four separate analyses were performed using all combinations of the two NP and two GP criteria listed above. For each analysis, patients were included if they met the criteria for NP, and then stratified by presence or absence of GP (ie, NP + GP vs isolated NP).

RESULTS

Median NUV was greater among patients with NP + GP for all criteria combinations. Sensitivities greater than or equal to 80%/90%/100% for NP + GP were observed at 1275/1230/1085 mL for {NPi > 0.33 + 24-hour volume > 3000 mL}; 1075/1035/1035 mL for {NPi > 0.33 + 24-hour volume > 40 mL/kg}; 900/745/630 mL for {NUP > 90 mL/hour + 24-hour volume > 3000 mL}; and 1074/1035/990 mL for {NUP > 90 mL/hour + 24-hour volume > 40 mL/kg}.

CONCLUSIONS

An inordinate NUV among men with NP is fairly sensitive for comorbid GP. In the appropriate clinical setting, nocturnal-only diaries may suffice in the evaluation and follow-up of patients with NP, so long as outlying nocturnal volumes prompt a 24-hour diary/urine collection.

The role of nocturia in the quality of life of men with lower urinary tract symptoms

OBJECTIVES

To determine the role of treatment-associated improvement in nocturia in health-related quality of life (HRQL) in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia, and secondarily to confirm the role of nocturia in HRQL at baseline and to compare the effects of watchful waiting, transurethral microwave treatment (TUMT) and transurethral resection of the prostate (TURP) to those of α1-adrenoceptor antagonists (α-blockers) on nocturia.

PATIENTS AND METHODS

We retrospectively analysed using multiple regression a large single-centre database of patients receiving routine care for treatment-associated alterations of symptoms and HRQL (assessed at baseline, 2611 men) and 6-12 months after initiation of treatment (1258 men).

RESULTS

Among the symptoms assessed using the International Prostate Symptom Score, nocturia (together with urgency and weak stream) had the strongest correlation with HRQL at baseline and after treatment. Watchful waiting, α-blockers, TUMT and TURP reduced nocturia episodes by a mean (sd) of 7 (53)%, 17 (40)%, 32 (47)% and 75 (23)%, respectively. The treatment-associated improvements in nocturia (together with those of weak stream) had the strongest association with those of HRQL.

CONCLUSIONS

We conclude that among all LUTS assessed in the IPSS, nocturia has one of the strongest associations with HRQL, and that treatment-associated improvements in nocturia contribute considerably to overall improvements in HRQL.

Impact of nocturia on health-related quality of life and medical outcomes study sleep score in men

Purpose

To evaluate the impact of nocturia on health-related quality of life and sleep in men.

Methods

From January 2008 to December 2008, 284 patients with lower urinary tract symptoms were selected for this study. The participants completed a series of questionnaires on health-related quality of life (the overactive bladder questionnaire, or OAB-q), the Medical Outcomes Study (MOS) sleep scale, and the frequency volume chart.

Results

The patient population had a mean age of 60.0±13.4 years (range, 40 to 79 years). The mean duration of symptoms was 28.8±34.6 months. The mean number of voiding episodes per night was measured as follows: 88 patients (31.0%) reported no nocturia, 60 patients (21.1%) reported 2>voids/night ≥1, 56 patients (19.7%) reported 3>voids/night ≥2, and 80 patients (28.2%) reported ≥3 voids/night. The mean number of nocturia episodes increased with age (P=0.001), and the number of nocturia episodes was significantly associated with the OAB-q symptom score (P=0.001) and symptom bother (P=0.001). Among the categories of the MOS sleep scale, sleep index I (P=0.020), sleep disturbance (P=0.010), adequacy of sleep (P=0.005), and somnolence (P=0.041) were significantly associated with an increased number of nocturia episodes.

Conclusions

The number of nocturia episodes increased with age in men. Nocturia appeared to be associated with further negative effects on sleep quality, health-related quality of life, and symptom bother.

Age related change of nocturia in women

Purpose

The precise etiology and classification of nocturia in women is not enough. We evaluated age related changes and classified the type of nocturia by age in women.

Methods

We included 118 women 20 years or older with nocturia at least one time during night time. Subjects were divided into three groups by the age: group 1, under 40 years; group 2, 40 through 59 years; group 3, 60 years and above. The causes of nocturia and its pattern changed by age in women were evaluated using 3 days frequency volume chart. Nocturia was devided into three types: nocturnal polyuria, decreased nocturnal bladder capacity and mixed type.

Results

The mean age was 57.2±11.8 and the mean nocturnal frequency was 2.7±1.8. In all age group, noctural polyuria was the major cause for noturia (40.8%), followed by low nocturnal bladder capacity (23.7%). As a major cause of nocturia, there was a significant increase of the incidence of nocturnal polyuria in aged people: group 1, 32.4%; group 2, 41.0%; group 3: 47.6% (P<0.04).

Conclusions

Nocturnal polyuria and decreased nocturnal bladder capacity are the major causes of nocturia in women. Nocturnal polyuria was the major cause of nocturia with age over 60 years old. In aged women, nocturnal polyuria should be considered as a main cuase of nocturia and treated based on these result.

The impact of nocturia on older people - implications for nursing practice

Nocturia is the most common and under-recognized urinary symptom, experienced by the majority of older people and increasing in prevalence with advancing age. It is associated with a range of debilitating effects including sleep disturbances, falls and instability, depression, and social isolation, yet it is accepted by many as a natural consequence of ageing. However nocturia, like most other lower urinary tract symptoms, is responsive to a range of simple lifestyle advice and behavioural interventions that may be delivered by nurses. This article calls for a raised awareness of this 'silent condition' to enable nurses to recognize nocturia, identify its impact on individuals and initiate and deliver intervention to improve the health and well-being of older people.

Nocturia and associated morbidity in a Danish population of men and women aged 60-80 years

OBJECTIVE

To evaluate the association between nocturia and medical diseases, medication, urinary incontinence (UI), recurrent cystitis, smoking, alcohol, parity, hysterectomy, pelvic organ prolapse surgery, UI surgery, and prostate surgery.

SUBJECTS AND METHODS

The previously validated questionnaire the Nocturia, Nocturnal Enuresis and Sleep-interruption Questionnaire was sent to 2000 women and 2000 men aged 60, 65, 70, 75, and 80 years. The population was selected at random from The Danish Civil Registration System.

RESULTS

Using multiple logistic regressions UI and age were significantly associated with nocturia irrespective of severity. Nocturia of > or =1 voids was significantly associated with body mass index (BMI), hypertension, and smoking; and nocturia of > or =2 voids with gender, BMI, diabetes and recurrent cystitis, as well as between nocturia of > or =3 voids and gender, lung disease, diabetes, use of diuretics and recurrent cystitis. Summarising the associations in an ordinal regression analysis UI (odds ratio (OR) 2.17, 95% CI 1.76-2.68), recurrent cystitis (OR 1.97, 95% CI 1.30-2.97) and diabetes (OR 1.89, 95% CI 1.32-1.65) had the strongest associations with nocturia.

CONCLUSIONS

Our results show that various disorders are associated with nocturia. However, the associations are strongly dependent on the severity of the nocturia.

Beyond the lower urinary tract: the association of urologic and sexual symptoms with common illnesses

OBJECTIVE

In addition to being prevalent and bothersome, urologic and sexual symptoms may be related to chronic medical illnesses. We investigate the relationship between ten urologic and sexual symptoms and four major illnesses (type II diabetes, cardiac disease, hypertension, and depression).

METHODS

We analyzed data from the Boston Area Community Health (BACH) survey, a community-based epidemiologic study of urologic symptoms and risk factors. BACH used a two-stage stratified cluster sampling design to recruit 5,506 adults aged 30-79 (2301 men, 3205 women; 1770 black, 1877 Hispanic, and 1859 white).

RESULTS

In bivariate analyses, most urologic and sexual symptoms were associated with type II diabetes, cardiac disease, hypertension, and depression. However, in multivariate models adjusting for all four illnesses, gender, race/ethnicity, age, alcohol intake, smoking, physical activity, and body mass index there were fewer significant associations. We found that all urologic symptoms were significantly related to at least one illness, with depression increasing the odds of all urologic and sexual symptoms studied.

CONCLUSIONS

Urinary tract specialists should consider factors outside the urinary tract that may be contributing to urologic symptoms. It remains unknown whether treatment of medical and psychological illnesses can result in meaningful improvement in urologic symptoms, or conversely, whether urinary tract symptoms can provide valuable insight into an individual's overall health status.