Loxoprofen sodium treatment for elderly men with refractory nocturia: Effect on night-time urine production

Abstract:   We evaluated the efficacy of loxoprofen sodium for refractory nocturia. Twelve men (mean age, 75.1 ± 5.7) with nocturia were enrolled in this study. All patients received 60 mg loxoprofen sodium prior to sleeping at night for 14 days. Nine of 12 patients (75%) felt more satisfaction than previous treatments. Patients were grouped into a loxoprofen sodium-effective ( n  = 7) and ineffective groups ( n  = 5) based on the results of the frequency-volume chart. In the effective group, interestingly, night-time urine volume showed significant reduction ( P  < 0.05). On the other hand, the average single voided volume at night and 24-h urine volume showed no significant change. There was a statistically significant difference in the night-time urine volume after treatment between groups ( P  < 0.01). Loxoprofen sodium is an effective treatment for some patients with refractory nocturia. The main effect mechanism of loxoprofen sodium may involve the reduction of night-time urine production.     

Prevalence of and risk factors for nocturia: Analysis of a health screening program

BACKGROUND: We examined the prevalence of and risk factors for nocturia in Kurashiki city and the surrounding area, a rural area in Japan. MATERIALS AND METHODS: We collected data on 6517 individuals (4568 men and 1949 women) who participated in a multiphasic health screening. We analyzed the relationships between nocturia assessed by a questionnaire (voiding twice or more during night) and other variables including age, hypertension, cardiovascular disease, cerebrovascular disease, chronic obstructive pulmonary disease, diabetes mellitus (DM), chronic renal failure, benign prostatic hyperplasia (BPH), smoking habit and alcohol intake. RESULTS: Overall, 1856 individuals (28.5%) answered that they arose to urinate at least twice during the night. This rate increased with age from 16.5% in individuals younger than 50 to 60.0% in those older than 69. Logistic regression analysis revealed that cohorts of subjects 50-59, 60-69, and 70 years old or over had, respectively, 1.75, 3.35, and 6.21 times the prevalence of nocturia of the 49 years or younger cohort. Hypertension (odds ratio [OR] 1.64) and DM (OR 1.70) were other independent positive risk factors for nocturia. On the other hand, current smokers who smoked 20 or more cigarettes per day were less likely to have nocturia than non-smokers (OR 0.72). In male individuals, BPH was another independent positive risk factor (OR 1.35). Gender was not associated with nocturia. CONCLUSIONS: Although population bias is an important limitation to this study, nocturia is associated with various factors suggesting that multiple approaches are needed to the treatment of patients with nocturia.     

Prevalence and bother of nocturia, and causes of sleep interruption in a Danish population of men and women aged 60-80 years

OBJECTIVE

To study the prevalence and bother of nocturia, and sleep interruptions in an unselected population of Danish men and women aged 60–80 years.

SUBJECTS AND METHODS

A postal 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, in which every person living in Denmark is identified. The Nocturia, Nocturnal Enuresis and Sleep‐interruption Questionnaire (NNES‐Q) was used to evaluate nocturia and bother, and sleep interruptions. Nocturia was defined as waking at night to void, according to the International Continence Society definition.

RESULTS

In all, 92% (3664) subjects returned the questionnaire; 71% completed the questionnaire satisfactorily and were included in the study. The prevalence of nocturia increased with age. The overall prevalence of nocturia was 77% and there was no difference between men and women (P = 0.11), but men had slightly more severe nocturia than women. The bother caused by nocturia in men and women increased with the severity of nocturia, and women were slightly more bothered than men when the degree of nocturia was >2 voids/night. Nocturia was the most frequent self‐reported reason for waking at night, followed by thirst.

CONCLUSION

The prevalence of nocturia increased with age. There was no difference between the genders in the overall prevalence of nocturia, but nocturia of ≥ 2 voids/night was more frequent in men. The degree of bother increased with the severity of nocturia, even after correcting for generic quality of life, and the younger groups were the most bothered. Nocturia was the major reason for waking at night, followed by thirst.

     

中国老年男性骨质疏松症影响因素的Meta分析

目的 通过Meta分析明确中国老年男性罹患骨质疏松(osteoporosis,OP)的主要影响因素.方法 使用计算机检索中国知网、万方数据库、维普网、PubMed、Web of Science、Embase数据库(自建库以来至2020年1月),并使用NOS进行文献质量评价,使用RevMan 5.3进行Meta分析.结果...     

A population study of nocturia in Singapore

OBJECTIVE: To estimate the prevalence of nocturia in the multiracial Asian population of Singapore, using the new International Continence Society standardized definition of one or more voids per night, and to assess its associations, bothersomeness and impact on sleep. SUBJECTS AND METHODS: A door-to-door interview questionnaire survey was conducted amongst a randomly selected sample of 3000 individuals (response rate 78.2%). Nocturia and its associated problems were evaluated using questions from the International Prostate Symptom Score (IPSS), and concurrently, sociodemographic and health variables were recorded. RESULTS: Data from 1134 women (aged 20-95 years) and 1139 men (aged 20-92 years) were analysed; the overall prevalence of nocturia (one or more voids/night) was 55.5%, with an increasing proportion in older groups (P < 0.01). Women had nocturia significantly (P = 0.015) more often than men (58% vs 53%), and it was positively associated with poor health, with the highest odds ratios (95% confidence interval) for diabetes mellitus of 2.0 (1.3-3.1), for renal disease of 6.4 (2.3-18.2), and for strokes of 3.1 (1.1-9.2). In both men and women, the median IPSS in patients with nocturia was significantly higher than that in patients without nocturia (P < 0.001). For individuals waking once a night, only 9.5% considered nocturia a problem and 13.5% complained of sleep disturbances; these values increased to 36% and 40% for individuals waking up twice or more /night. CONCLUSION: Nocturia is a common condition amongst Singaporean adults, especially in the elderly; it has strong associations with poor health and other lower urinary tract symptoms. The degree of nocturia determines whether patients are likely to be bothered by it or have sleep disturbance, which will influence their help-seeking behaviour.     

Antidiuretic hormone in elderly male patients with severe nocturia: a circadian study

OBJECTIVE: To investigate the circadian variation of plasma antidiuretic hormone (ADH) and urine output in patients with severe nocturia (> three times per night) and to assess the effect of oral desmopressin on nocturnal urine output in these patients. PATIENTS AND METHODS: Twelve patients with severe nocturia and five age-matched controls without were assessed over 24 h (circadian sampling) during a 72-h hospital admission. Blood levels of ADH and changes of urine output were measured in the patients before and after the oral administration of desmopressin (0.2 mg, at 22.00 hours in the second day), and in the controls not treated with desmopressin. RESULTS: Compared with the normal control, the patients had no diurnal variation in urine output and greater nocturnal urine production, associated with a lack of nocturnal increase in ADH level. Compared with the baseline urine output, desmopressin significantly decreased night-time (23.00-08.00 hour) urine output in the patients (P < 0.05). Desmopressin significantly increased the osmolality of night-time urine (P < 0.05), and there was no systemic adverse reaction. CONCLUSIONS: Severe nocturia in a large proportion of elderly men with lower urinary tract symptoms is caused by nocturnal polyuria and natriuresis, because they have no nocturnal increase in ADH. These results suggest that desmopressin may be effective in decreasing nocturnal urine production in patients with severe nocturia who do not respond to conventional treatment.     

A multicomponent behavioural and drug intervention for nocturia in elderly men: rationale and pilot results

OBJECTIVES

To evaluate the number of medical and urological conditions associated with nocturia in a cohort of older men who were primary‐care enrolees, and to assess the feasibility and efficacy of using a multicomponent intervention to reduce nocturia and its bother.

SUBJECTS AND METHODS

Men aged ≥50 years and with two or more episodes of nocturia were recruited from the primary‐care clinics at one Veterans Affairs Medical Center to participate in a 4‐week, open‐label, prospective pilot study. A multicomponent intervention composed of behavioural therapy and targeted drug therapy was administered according to a specified protocol based upon identified risk factors for nocturia. Outcome measures included self‐reported nocturia and bother on the American Urological Association (AUA)‐7 Symptom Index, 3‐day bladder diaries and self‐reported sleep‐related measures recorded using 7‐day sleep diaries.

RESULTS

Fifty‐five men completed the protocol (mean age 67 years, sd 8.3); they had a mean of 4.5 of nine defined conditions potentially related to nocturia. Highly prevalent conditions included moderate‐to‐severe benign prostatic hyperplasia (87%), hypertension (86%) and urinary frequency (71%). The mean diary‐recorded nocturia decreased from 2.6 to 1.9 (P < 0.001), and bother score reduced from 3.1 to 1.1, representing a change from a ‘medium’ to a ‘very small’ problem (on a 5‐point scale). Sleep diary‐derived measures also improved significantly (time to initiate sleep, time to return to sleep after awakening, quality of sleep).

CONCLUSIONS

Given that individual older patients often have multiple coexistent risk factors for nocturia, identifying a principal cause of nocturia, a concept emphasized in treatment guidelines, proved to be difficult. Implementing a multicomponent behavioural intervention combined with drug(s) was feasible in older men and reduced nocturia frequency, bother from nocturia, and time to initiate sleep, within 4 weeks. These promising results merit repeating using a randomized, controlled trial.     

Desmopressin in elderly patients with nocturia: short-term safety and effects on urine output,sleep and voiding patterns

OBJECTIVE: To investigate the short-term safety of desmopressin in elderly patients with nocturia, with special focus on the risk of hyponatraemia, and to assess the short-term effects on urine output, sleep and voiding patterns. PATIENTS AND METHODS: Patients (72) were recruited from a study using frequency-volume charts, which in turn was preceded by a questionnaire study. Each patient took one 0.2 mg desmopressin tablet at bedtime for three consecutive nights and kept a frequency-volume chart. Serum sodium was assessed in the morning after the first and the third dose. Patients with a mean serum sodium level during treatment deviating more than five units from baseline were considered sensitive to change in serum sodium. Potential predictors for sodium sensitivity and response were investigated with logistic and multiple regression. RESULTS: All 72 enrolled patients completed the trial; no serious adverse events occurred and no adverse events of severe intensity were recorded. Six patients were sensitive to change in serum sodium. The risk (odds ratio, 95% confidence interval) increased with increasing age (1.3, 1.1-1.6), concomitant cardiac disease (10.0, 0.9-105.8) and increasing baseline 24-h urine output (1.2, 1.0-1.5). Patients sensitive to change in serum sodium were pharmacological responders and desmopressin had a greater effect on their 24-h diuresis, indicating that the drug effect was not limited to the night only. CONCLUSION: Desmopressin was well tolerated in elderly patients with nocturia, but the results suggest that serum sodium should be measured before and after a few days of treatment.     

郑州市社区老年人认知衰弱患病现状及影响因素

目的调查郑州市社区老年人认知衰弱的患病现状,并探讨其影响因素。方法 2018年3～9月,选取郑州市管城区南关与航海两个社区的老年人为研究对象,采用一般情况调查表、临床痴呆评定量表、蒙特利尔认知评估量表、衰弱表型进行调查。结果共调查1 190名老年人,其中认知衰弱114名(9.6%);不同年龄、性别、居住方式、锻炼身体频次、宗教信仰、失眠状况、吸烟、饮酒和饮食状况的老年人,认知衰弱患病率差异有统计学意义(P0.05,P0.01)。多因素Logistic回归分析显示,高龄及女性是认知衰弱的危险因素,经常锻炼身体是认知衰弱的保护因素(P0.05,P0.01)。结论郑州市社区老年人认知衰弱患病率较高,应尽早实施社区认知衰弱预防干预措施。     

The pharmacokinetics of 400 microg of oral desmopressin in elderly patients with nocturia, and the correlation between the absorption of desmopressin and clinical effect

OBJECTIVE: To investigate the pharmacokinetic profile of oral desmopressin in elderly patients with nocturia, and to analyse any possible correlation between the absorption and clinical effect. PATIENTS AND METHODS: In all, 32 patients were screened to determine the baseline number of nocturnal voids and the nocturia index; of these, 24 fulfilled the inclusion criteria and were enrolled for a pharmacokinetic evaluation of oral desmopressin 400 microg. A double-blind, randomized, placebo-controlled, crossover-effect evaluation period was then used to test the association between the absorption of desmopressin and pharmacodynamic effect. Serial plasma samples were collected for 8 h for a pharmacokinetic analysis of desmopressin. The pharmacodynamics after an equivalent oral dose before bedtime were assessed by measuring changes in the number of nocturnal voids, time to first nocturnal void and nocturnal diuresis, from placebo to active treatment. RESULTS: There was a linear relationship between plasma desmopressin at 2 h after dosing and the area under the plasma concentration curve from 0 to infinity (Pearson's rho 0.923, P < 0.001). Women had a significantly higher plasma desmopressin concentration than men (P = 0.0012) and more adverse events. There was no correlation between plasma desmopressin at 2 h after dosing and the within-patient response in any of the effect variables. Generally, the number of nocturnal voids and nocturnal diuresis were half that with placebo. The time to the first nocturnal void was almost doubled compared with placebo. CONCLUSIONS: There seems to be a relationship between gender, plasma level of desmopressin and the incidence of adverse events. Plasma desmopressin at 2 h after dosing cannot be used to predict the pharmacodynamic response, although desmopressin lowers the nocturnal diuresis and the number of nocturnal voids.     

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.     

Low DHEAS levels are associated with depressive symptoms in elderly Chinese men: results from a large study

This study investigated the association between depressive symptoms in elderly Chinese men and the total testosterone, dehydroepiandrosterone (DHEA), DHEA sulphate (DHEAS), oestradiol and sex hormone-binding globulin (SHBG) levels, and the free androgen index. Cross-sectional data from 1147 community-dwelling elderly men, aged 65 and older, were used. Depressive symptoms were measured using the Chinese Geriatric Depression Scale (GDS). Total testosterone, free testosterone, DHEA, DHEAS, total oestradiol, the free androgen index and SHBG levels were assessed. DHEA was significantly associated with GDS score, and there was a trend towards DHEAS association, but this was not significant (β=-0.110, P=0.015; β=-0.074, P=0.055). However, no association was seen between depressive symptoms and total testosterone levels, free testosterone levels, oestradiol levels or SHBG levels. In terms of the presence of clinically relevant depressive symptoms, there were no statistically significant differences between patients in the lowest quartile of sex steroid hormone levels and those in other quartiles of sex steroid hormone levels. Similarly to Western studies, our study shows that DHEA and DHEAS levels are associated with depressive symptoms.     

Correlates for nocturia: a review of epidemiological studies

Traditionally, nocturia was considered to be one of the symptoms of prostatism. However, this symptom has unusual characteristics compared with other lower urinary tract symptoms; for example, there is only a mild benefit for nocturia from treatment for benign prostatic hyperplasia. In the past decade, nocturia has been investigated as a separate symptom in epidemiological studies. These types of studies have shown various correlates for nocturia other than benign prostatic hyperplasia, as well as the prevalence of this symptom. These correlates include age, race/ethnicity, medical problems (such as hypertension, diabetes and stroke) psychological aspects, tasting habits, quality of life and even mortality. The cause-and-effect associations are not always obvious between nocturia and its correlates. In the present article, the author attempts to comprehensively review the correlates for nocturia shown by epidemiological studies.     

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 ≥1 voids was significantly associated with body mass index (BMI), hypertension, and smoking; and nocturia of ≥2 voids with gender, BMI, diabetes and recurrent cystitis, as well as between nocturia of ≥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.     

Classification of nocturia in the adult and elderly patient: a review of clinical criteria and selected literature

Nocturia increases with age and significantly affects quality of life in both men and women. Attempts to determine the pathogenesis of nocturia have been based on frequency-volume charts, and three types of nocturia have been identified: low voided volume (previously termed low bladder capacity), nocturnal polyuria, and mixed origin. Validated clinical criteria based on frequency-volume data allow the type of nocturia to be specified using two threshold values, i.e. largest voided volume/body weight ratio <4 mL/kg for low voided volume; and nocturnal urinary output/body weight ratio >10 mL/kg for nocturnal polyuria. The utility of these thresholds was validated in a study of elderly patients with two or more nocturia episodes/night. Two other studies have improved the understanding of the epidemiology of nocturia. The first showed that in men and women, increased incidence with age was greater for nocturia than for the six other common lower urinary tract symptoms. The second study suggested that prostate changes in men (particularly bladder outlet obstruction caused by benign prostatic hyperplasia, which has been considered to be a major cause of nocturia) appear to play a relatively small role in the development of nocturia; the correlation was based on overall symptom score for seven common urological symptoms. Nocturia should thus be treated independently of other lower urinary tract symptoms, especially in men. The application of valid diagnostic criteria to differentiate the underlying cause of nocturia should help lead to more appropriate and effective management of this pervasive problem.