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Monaghan TF, Wein AJ, Lazar JM, Bliwise DL. Melatonin for nocturia: Lessons learned from the sleep literature. Neurourol Urodyn 2024. [PMID: 38837267 DOI: 10.1002/nau.25517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 05/17/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Thomas F Monaghan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alan J Wein
- Department of Urology, Desai Sethi Urology Institute, University of Miami Health System, Miami, Florida, USA
| | - Jason M Lazar
- Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
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Monaghan TF, Fang A, Ksido LR, Hachicho C, Muneeb M, Rahman SN, Bou Kheir G, Lazar JM, Everaert K, Wein AJ, Weiss JP. Prevalence of Sleep CALM nocturia factors in a male veteran population. Neurourol Urodyn 2024; 43:1127-1133. [PMID: 38511613 DOI: 10.1002/nau.25410] [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: 10/06/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Nocturia is a complex and multifactorial condition, associated with several genitourinary abnormalities as well as a host of conditions beyond the urinary tract, and thus often poses a significant diagnostic challenge in real-world practice. Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications, the so-called "Sleep C.A.L.M." factors, are five common causes of nocturia requiring judicious evaluation according to current consensus guidelines. This study aims to assess the prevalence of the Sleep C.A.L.M. factors in a nocturia clinical population. METHODS Retrospective analysis of frequency-volume charts from men with ≥2 nocturnal voids as well as concurrent demographic, clinical, and medical history data to identify patients with each of the Sleep C.A.L.M. FACTORS Comorbidities and medications were classified as a single group. RESULTS A total of 213 subjects met the criteria for inclusion (median age 68.0 [63.5-75.5] years). The prevalence of 1) sleep disorders, 2) comorbidities and/or medication use, 3) actions (i.e., modifiable behaviors/lifestyle factors), and 4) lower urinary tract dysfunction was 31%, 31%, 19%, and 41%, respectively. Among included participants, 73% were found to have at least 1 Sleep C.A.L.M. factor, and 33% had multiple Sleep C.A.L.M. FACTORS Results were similar upon stratification by age and nocturnal polyuria status. CONCLUSIONS The Sleep C.A.L.M. factors are highly common among nocturia patients in the clinical urology setting. Although many of these factors are strongly associated with advanced age in community-based nocturia study samples, they appear common even among younger men in a nocturia patient population; the differential effect of age and individual Sleep C.A.L.M. factors on nocturia pathophysiology requires further investigation.
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Affiliation(s)
- Thomas F Monaghan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alexander Fang
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Lennox R Ksido
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Carla Hachicho
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Manahil Muneeb
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Syed N Rahman
- Department of Urology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - George Bou Kheir
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Jason M Lazar
- Division of Cardiovascular Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Alan J Wein
- Desai Sethi Urology Institute, Department of Urology, University of Miami Health System, Miami, Florida, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
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Athanasopoulos A. Nocturia due to nocturnal polyuria (NP). A common disorder. Arch Ital Urol Androl 2022; 94:366-368. [DOI: 10.4081/aiua.2022.3.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022] Open
Abstract
To the Editor,
Nocturia is a significantly underestimated medical problem that affects seriously patients' quality of life, work engagement, productivity, and overall life conditions per se. Nocturia is a common condition, proven to be the most bothersome for patients with Lower Urinary Tract Symptoms (LUTS). People with two or more events of micturition per night have a significant increase in mortality rate and an increased risk of fall-related fractures if they visit the toilet two or more times per night [...].
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Ikeda Y, Zabbarova I, de Rijk M, Kanai A, Wolf-Johnston A, Weiss JP, Jackson E, Birder L. Effects of vasopressin receptor agonists on detrusor smooth muscle tone in young and aged bladders: Implications for nocturia treatment. CONTINENCE (AMSTERDAM, NETHERLANDS) 2022; 2:100032. [PMID: 35789681 PMCID: PMC9250757 DOI: 10.1016/j.cont.2022.100032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The main goal of this study was to determine the effects of arginine vasopressin (AVP) and desmopressin on bladder contractility and to examine whether the effects of these vasopressin receptor (VR) agonists differ in young versus aged animals. These aims were addressed using urinary bladders from young (3 months) and aged (24 month) female Fischer 344 rats that were isolated and dissected into strips for isometric tension recordings. Bladder strips were exposed to AVP and desmopressin through the perfusate, and tension changes recorded. RESULTS In young rat bladders, AVP, an agonist at both vasopressin-1 receptors (V1Rs) and vasopressin-2 receptor (V2Rs), concentration-dependently caused contraction of bladder strips with a sensitivity that was greater in young versus aged bladder strips. Removal of the mucosa did not alter the sensitivity of young bladder strips to AVP yet enhanced the AVP sensitivity of aged bladder strips. The differential sensitivity to AVP between young denuded and aged denuded bladder strips was similar. In contrast to AVP, desmopressin (V2R selective agonist) relaxed bladder strips. This response was reduced by removal of the mucosa in young, but not aged, bladder strips. CONCLUSION These findings support a direct role for VRs in regulating detrusor tone with V1Rs causing contraction and V2Rs relaxation. In aged bladders, the contractile response to V1R activation is attenuated due to release of a mucosal factor that attenuates V1R-induced contractions. Also in aged bladders, the relaxation response to V2R activation is attenuated by lack of release of a mucosal factor that contributes to V2R-induced relaxation. Thus age-associated changes in the bladder mucosa impair the effects of VRs on bladder tone. Because the V2R signaling system is impaired in the older bladder, administering an exogenous V2R agonist (e.g., desmopressin) could counteract this defect. Thus, desmopressin could potentially increase nighttime bladder capacity through detrusor relaxation in concert with decreased urine production, reducing nocturnal voiding frequency.
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Affiliation(s)
- Youko Ikeda
- University of Pittsburgh, School of Medicine, Renal-Electrolyte division, United States of America
- University of Pittsburgh, School of Medicine, Department of Pharmacology and Chemical Biology, United States of America
| | - Irina Zabbarova
- University of Pittsburgh, School of Medicine, Renal-Electrolyte division, United States of America
| | - Mathijs de Rijk
- Maastricht University, Faculty of Health, Medicine, and Life Sciences, School for Mental Health and Neurosciences, Department of Urology, the Netherlands
| | - Anthony Kanai
- University of Pittsburgh, School of Medicine, Renal-Electrolyte division, United States of America
- University of Pittsburgh, School of Medicine, Department of Pharmacology and Chemical Biology, United States of America
| | - Amanda Wolf-Johnston
- University of Pittsburgh, School of Medicine, Renal-Electrolyte division, United States of America
| | - Jeffrey P. Weiss
- SUNY Downstate Health Sciences University, Department of Urology, United States of America
| | - Edwin Jackson
- University of Pittsburgh, School of Medicine, Department of Pharmacology and Chemical Biology, United States of America
| | - Lori Birder
- University of Pittsburgh, School of Medicine, Renal-Electrolyte division, United States of America
- University of Pittsburgh, School of Medicine, Department of Pharmacology and Chemical Biology, United States of America
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Michel MC, Madersbacher S. [Medical treatment of male lower urinary tract symptoms: what's new?]. Aktuelle Urol 2022; 53:240-245. [PMID: 35193150 DOI: 10.1055/a-1749-4556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Decades after the introduction of 5α-reductase inhibitors and α1-adrenoceptor antagonists, new data of practical relevance related to their desired and adverse effects continues to emerge. Some of these novel findings are to be taken seriously but are insufficiently established, for instance associations between drug use and depression or dementia. Multiple combination treatments have been tested. While combination treatment was often statistically superior to monotherapy, the difference was mostly in the range of 1 IPSS point, which raises doubts on the clinical relevance of the findings at the group level. The new evidence enables further personalisation of the treatment of male lower urinary tract dysfunction, but also makes individual risk-benefit considerations more complex.
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Affiliation(s)
- Martin C. Michel
- Pharmacology, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Stephan Madersbacher
- Urologie, Kaiser Franz Josef Krankenhaus, Sigmund Freud Privatuniversität, Wien, Austria
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Harris WN, Everaert K. Overactive Bladder as a Key Driver of Nocturia: The Argument Against. Eur Urol Focus 2022; 8:6-7. [PMID: 35027328 DOI: 10.1016/j.euf.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/17/2021] [Accepted: 12/28/2021] [Indexed: 11/26/2022]
Abstract
Studies have shown that therapies for overactive bladder reduce urgency symptoms. However, these studies fail to demonstrate clinically significant increases in bladder capacity or changes in mean voided volumes at night.
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Affiliation(s)
- William N Harris
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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Hwang EC, Jung HJ, Han MA, Kim MH, Yu SH, Jeong HC, Kim JS, Paick SH, Yeo JK, Jung JH. Korean guideline of desmopressin for the treatment of nocturia in men. Investig Clin Urol 2022; 63:499-513. [PMID: 36067995 PMCID: PMC9448671 DOI: 10.4111/icu.20220165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/01/2022] [Accepted: 07/21/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Eu Chang Hwang
- Department of Urology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hyun Jin Jung
- Department of Urology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Mi Ah Han
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Korea
| | - Myung Ha Kim
- Yonsei Wonju Medical Library, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seong Hyeon Yu
- Department of Urology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hyun Cheol Jeong
- Department of Urology, College of Medicine, Hallym University, Seoul, Korea
| | - Jun Seok Kim
- Department of Urology, Kwangju Christian Hospital, Gwangju, Korea
| | - Sung Hyun Paick
- Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jeong Kyun Yeo
- Department of Urology, Inje University College of Medicine, Seoul, Korea
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea
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Wu PC, Hsiao SM, Lin HH. Prevalence and predictors of nocturnal polyuria in females with overactive bladder syndrome. World J Urol 2021; 40:519-527. [PMID: 34762173 DOI: 10.1007/s00345-021-03865-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/12/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To describe the prevalence and predictors of nocturnal polyuria (NP) in women with overactive bladder syndrome (OAB). METHODS Between July 2009 and January 2018, women with OAB were enrolled. NP was defined when the nocturnal polyuria index (NPI) (nighttime voided volume over 24-h voided volume) was > 33% (NPI33) in women ≥ 65 years-old and > 20% (NPI20) in women < 65 years old. Repeated analysis was also performed for NP defined by the NPI33 definition at all ages. RESULTS A total of 1071 women with OAB were analyzed. The overall prevalence of NP was 30% (319/1071), with the highest prevalence in women in the perimenopausal period (46-50 years old), while NP was diagnosed by age-dependent NPI. The overall prevalence of NP was 12% (128/1071), with an increasing trend with increasing age, while NP was diagnosed by the NPI33 definition only. Daytime frequency and nocturia episodes were both predictors for NP in both definitions. Receiver operating characteristic curve analysis revealed that more than 5 nocturia episodes noted in the 3-day bladder diary were an optimal cutoff value to predict nocturnal polyuria [(sensitivity = 85.6%, specificity = 61.0%; area = 0.80, 95% CI 0.77-0.82) and (sensitivity = 88.3%, specificity = 65.9%; area = 0.83, 95% CI 0.80-0.85), respectively, in the two definitions]. CONCLUSIONS NP is common in women with OAB, especially in women with more than 5 nocturia episodes in their 3-day bladder diaries, and adjuvant therapy for better treatment efficacy is needed.
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Affiliation(s)
- Pei-Chi Wu
- Department of Obstetrics and Gynecology, National Taiwan University College of Medicine and Hospital, No. 8, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Sheng-Mou Hsiao
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan.,Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan
| | - Ho-Hsiung Lin
- Department of Obstetrics and Gynecology, National Taiwan University College of Medicine and Hospital, No. 8, Chung-Shan South Road, Taipei, 100, Taiwan. .,Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan.
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Zachariou A, Filiponi M, Kaltsas A, Dimitriadis F, Sapouna V, Giannakis I, Mamoulakis C, Karagiannis A, Zikopoulos A, Paschopoulos M, Takenaka A, Sofikitis N. Translation and Validation of the TANGO Nocturia Screening Tool into Greek. J Multidiscip Healthc 2021; 14:1883-1891. [PMID: 34321885 PMCID: PMC8309650 DOI: 10.2147/jmdh.s312393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The present study aimed to translate the Targeting the individual's Aetiology of Nocturia to Guide Outcomes Questionnaire (TANGO) into the Greek language to create TANGO-Gr. A relative reliability study in prospective samples of community dwellers and rehabilitation centre residents was undertaken in order to validate the translation. In terms of nocturia severity, these groups were considered to be representative of patients at both ends of the scale, and therefore suitable validation purposes. Patients and Methods The prospective descriptive study took place between 07 and 09/2020. Fifty residents in a rehabilitation centre and thirty-seven community dwellers were included in the study. All participants had more than one episode of nocturia per night. They were asked to complete the newly translated TANGO-Gr Questionnaire twice (test-retest procedure). TANGO-Gr includes three possible answers ("yes", "no", and "DK/NA") to facilitate increased validity. The study group evaluated the socio and demographic characteristics, the level of independence and the comprehensive frailty of all participants. Results Both groups satisfactorily completed questionnaire responses. The overall Cronbach's alpha coefficient was 0.753 (community-dwelling people: 0.776; rehabilitation centre residents: 0.531). A test-retest statistical analysis to determine reliability found an overall median Kappa of 0.88 (IQR: 0.79-0.94) in community dwellers and 0.91 (IQR: 0.84-1.00) in rehabilitation centre residents, thereby confirming an almost perfect respective agreement. Conclusion The validity of the newly translated TANGO-Gr Questionnaire was proven. It should be considered to be a reliable, self-administered screening tool suitable for clinical practice, and therefore invaluable for Greek-speaking people. The study also determined that certain environment-related variables may contribute to nocturia in rehabilitation centre populations, which is a finding which invites further study.
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Affiliation(s)
- Athanasios Zachariou
- Urology Department, Ioannina University, Ioannina, Greece.,Physical Medicine and Rehabilitation Centre EU PRATTEIN, Volos, Greece
| | - Maria Filiponi
- Physical Medicine and Rehabilitation Centre EU PRATTEIN, Volos, Greece
| | - Aris Kaltsas
- Urology Department, Ioannina University, Ioannina, Greece
| | - Fotios Dimitriadis
- 1st Urology Department, School of Medicine, Aristotle University, Thessaloniki, Greece
| | - Vagia Sapouna
- Physical Medicine and Rehabilitation Centre EU PRATTEIN, Volos, Greece
| | | | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Crete, Greece
| | | | | | - Minas Paschopoulos
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, Ioannina, Greece
| | - Atsushi Takenaka
- Urology Department, School of Medicine, Tottori University, Yonago, Japan
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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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