Epidemiology of nocturia

The incidence of nocturia episodes increases with age and is associated with interrupted sleep and distress. There are no large differences in the incidence of nocturia between men and women, but young women tend to have it more frequently than young men, and very old men have it more often than very old women. The International Continence Society has defined nocturia as 'the number of voids recorded during a night's sleep: each void is preceded and followed by sleep.' This simple and useful definition should facilitate further epidemiological study of nocturia. Although there are many direct prevalence studies of nocturia, there is a great need for more advanced analytical epidemiological data on risk factors and comorbidity. Clinicians should question patients about nocturia and should consider this symptom in a broader sense than in its traditional association with benign prostatic obstruction in men and incontinence in women. There are several classic studies of nocturia. The nature of future epidemiological research will depend on the resolution of several methodological issues. Further evaluation of nocturia is warranted because of its high incidence among the general adult population.     

Female nocturia

Many elderly experience nocturia to such adegree that it influences their quality oflife. Different studies use equivocaldefinitions when trying to analyze data onnocturia. The literature on etiology of femalenocturia is sparse, whereas male nocturia hasbeen studied rather extensively because of theassociation with lower urinary tract symptoms(LUTS). At present the few studies on femalenocturia questions the fact that male andfemale nocturia have identical etiologies. Thisreview will go through the present reports onprevalence and etiology of nocturia among womenwith reference to the male situation.     

Evaluation of the etiology of nocturia in men: the nocturia and nocturnal bladder capacity indices.

To determine and quantify the cause of nocturia in men, we describe and evaluate the relative contribution of two complementary indices of nocturia: the nocturia index (Ni), a measure of nocturnal urine overproduction, and the nocturnal bladder capacity index (NBCi), reflective of nocturnal bladder capacity. The records of 100 consecutive men with lower urinary tract symptoms (LUTS), having undergone video-urodynamic studies (VUDS), were prospectively studied. Evaluation included American Urological Association symptom score (AUASS), micturition diary (day, night, and 24-hr voided volume), and VUDS. Voiding diary analysis was carried out as previously described by us, determining the Ni, NBCi, and nocturnal polyuria index (NPi) (nocturnal urine volume/24-hr urine volume). In the case of AUASS question #7 (degree of nocturia), the odds of having a severe AUA question #7 response was found to be 4.09 times higher for patients with NBCi > 2.0 compared with patients whose NBCi was 2 as highly significant in defining diminished NBC as a factor in the etiology of nocturia. In addition, we propose Ni of 1.5 as a threshold greater than which nocturia may be attributed to nocturnal urine overproduction in excess of maximum bladder capacity. Together, these indices describe in quantitative fashion the relative contributions of nocturnal urine overproduction and diminished NBC in identifying the etiology of nocturia in male patients. Neurourol. Urodynam. 18:559-565, 1999.     

New aspects of the classification of nocturia

Nocturia, one of the most bothersome urologic symptoms, has been poorly classified and understood. Multiple factors may cause nocturia, such as behavioral or environmental factors and pathologic conditions, including cardiovascular disease, diabetes mellitus, lower urinary tract obstruction, anxiety or primary sleep disorders, and sleep apnea. Nocturia caused by any combination of these and other conditions may be attributed to nocturnal polyuria, diminished nocturnal or global bladder capacity, global 24-hour polyuria, or a combination of these factors. Distinction among these classes of nocturia is made by a simple arithmetic analysis of the 24-hour voiding diary. Nocturia has been poorly studied and only recently classified according to its etiology and pathogenesis. After reviewing the current state of knowledge, we present a scheme for rational diagnosis of patients suffering from loss of sleep due to nocturnal micturition. This article reviews the current state of knowledge and presents algorithms for the diagnosis and classification of nocturia.     

Clinical guidelines for nocturia

Nocturia is a bothersome condition, defined as a complaint whereby the individual has to wake one or more times per night in order to void. Nocturia that occurs twice or more per night can have a substantial adverse effect on the patient's quality of life (QOL), and in many cases treatment may be required. These guidelines provide a treatment algorithm for use by primary care physicians. The initial assessment is conducted through a history taking interview. With a clear understanding of symptoms, patients can be classified into three broad categories: (1) nocturia only, (2) nocturia and diurnal pollakisuria without other lower urinary tract symptoms, and (3) nocturia and diurnal pollakisuria accompanying other lower urinary tract symptoms. For treatment, the literature supporting each form of drug therapy was ranked and a recommendation grade was determined for each form of therapy. A grade of ‘F (pending)’ was applied to any drug not currently approved for use in Japan or for which the efficacy and safety in Japanese patients was unconfirmed at the time of evaluation. We recommend instruction and guidance on water intake that will generally result in 24‐h urine volume of 20 to 25 mL/kg. This corresponds to a daily water intake of 2.0% to 2.5% of body weight. In Japan, desmopressin is indicated for central diabetes insipidus and nocturnal enuresis, but not indicated for nocturia. The therapeutic mechanism of the anticholinergic drugs for nocturia may depend on the action of the sensory nerve mediated by the muscarinic receptors.     

Etiology of nocturia and clinical efficacy of naftopidil on nocturia in patients with benign prostatic hyperplasia--analysis of frequency volume charts

The etiology of nocturia in 70 patients with benign prostatic hyperplasia (BPH) who had nocturia of two or more times were examined based on frequency volume charts (FVC). Nocturia was classified into four groups: nocturnal polyuria, low capacity, combined nocturia, and no evidence of abnormality. Nearly half of the cases had nocturnal polyuria only. A little under 70% of patients had associated nocturnal polyuria (nocturnal polyuria+combined nocturia). Naftopidil was administered for three months to the patients with BPH who had nocturia with a urinary frequency of two or more times. Clinical efficacy was evaluated in 32 patients based on FVC and naftopidil was shown to improve nocturia. The improvement in nocturia was determined by the increment in voided volume.     

夜尿症的诊治简

夜间1次起床排尿即可称为夜尿症,但是临床发现只有1次夜尿对患者生活质量影响较小,2次以上的夜尿更具备治疗的意义。中国成人（40岁以上人群）1次以上的夜尿症患病率为55％,2次以上的夜尿达22．8％。53．4％的夜尿症患者承认夜尿症导致的睡眠障碍干扰了他们正常的工作和社交。根据成因及临床表现差异,夜尿症可分为4大类：多尿症、夜间多尿、夜间膀胱容量下降、混合型。排尿日记是夜尿症最重要的诊断手段。改变生活方式和行为方式一直是治疗夜尿的一线治疗。去氨加压素能显著减少夜间尿量,提高患者生活质量。药物相关的唯一严重并发症一低钠血症的风险随着年龄的增加而增大,多数发生在65岁以上老年人。目前尚没有确切证据证明抗毒蕈碱剂能减少膀胱过度活动症患者的夜尿次数。国内一项多中心前瞻性随机实验证明,多沙唑嗪4mg与坦索罗辛0．2mg均能够缓解男性下尿路症状患者的夜尿症。